
 
 < 
 
 Ex Libris 
 C. K. OGDEN
 
 PREVENTION OF 
 VENEREAL DISEASE 
 
 1G9C880
 
 The Practitioner's Manual of 
 
 Venereal Diseases 
 
 With Modern Methods of Diagnosis 
 
 BY A. C. MAGIAN, M.D. 
 
 Demy Svo, 224 pages. Illustrated. 
 IOJ. 6< net 
 
 THIS manual has been written for the pur- 
 pose of giving a concise outline of the 
 diagnosis, symptoms, and treatment of vene- 
 real diseases as we are acquainted with them 
 to-day. It is intended for the use of the 
 general practitioner only. 
 
 Practitioner. "This is the best small 
 book on venereal diseases we have had the 
 pleasure of reviewing." 
 
 British Journal of Inebrity. "This con- 
 cise, detailed, up-to-date exposition . . . has 
 been well planned and admirably carried 
 out. . . . The work should do much to 
 further rational measures for the prevention 
 and arrest of syphilis and gonorrhoea." 
 
 WILLIAM HEINEMANN 
 (MEDICAL BOOKS) LTD. 

 
 PREVENTION OF 
 VENEREAL DISEASE 
 
 BY 
 
 SIR G. ARCHDALL REID 
 
 K.B.E., M.B., C.M., F.R.S.E. 
 AUTHOR OF "THE PRESENT EVOLUTION OF MAN" 
 
 'ALCOHOLISM: A STUDY IN HEREDITY" "THE PRINCIPLES OF HEREDITY' 
 "THE LAWS OF HEREDITY" ETC. 
 
 WITH AN INTRODUCTORY CHAPTER BY 
 
 SIR H. BRYAN DONKIN 
 
 M.D.(OxoN-), F.R.C.P. 
 
 LONDON 
 
 WILLIAM HEINEMANN 
 (MEDICAL BOOKS) LTD.
 
 LONDON : WILLIAM HEINEMANN (MEDICAL BOOKS) LTD., IQ2O
 
 THIS book is addressed, on the one hand, 
 to those who would prevent venereal disease 
 in themselves, and, on the other, to those 
 who would prevent it in the commur 
 
 This Book is endorsed by the Society for the 
 
 Prevention of Venereal Disease and contains 
 
 the evidence and arguments on which the 
 
 Society bases its policy.
 
 LONDON I WILLIAM HEINEMANN (MEDICAL BOOKS) LTD., IQ2O
 
 THIS book is addressed, on the one hand, 
 to those who would prevent venereal disease 
 in themselves, and, on the other, to those 
 who would prevent it in the community.
 
 PREFACE 
 
 IF the evidence in this book be true, the 
 public should know. If untrue, my errors 
 can be exposed very easily from official records. 
 I believe, however, that there will be little denial 
 or debate. All the relevant facts and arguments 
 have long been known to the people most con- 
 cerned, who, as yet, have made only such replies 
 as are contained in the two White Papers on 
 venereal disease which the Ministry of Health 
 has issued, and which are discussed in the present 
 volume. Had more conclusive replies been 
 possible they would have been published already, 
 and I think there is a growing realisation that such 
 matter as is contained in the White Papers is now 
 dangerous. However, it will still be necessary 
 to watch very carefully the publications of the 
 Ministry, especially the statistics and the accounts 
 of the personal experiences of the gentlemen who 
 compile them. 
 
 I have to trace the causes of sexual immorality 
 and to describe the prevention of venereal disease ; 
 but, apart from that, the story I have to tell is 
 unpleasant. There are meaner forms of im- 
 morality than even sexual immorality, and worse 
 diseases of the mind than of the body. With
 
 viii PREFACE 
 
 them also I am forced to deal. I am human 
 enough to hope that the servants of the State 
 shall be rewarded according to their deserts 
 not only those who risked their lives in battle, 
 but also those who, on the home front, risked 
 their honour, and indeed their very souls. 
 
 Venereal diseases are enormously prevalent 
 by far the most prevalent of all the more serious 
 maladies. About every other person in the 
 United Kingdom has suffered from them. They 
 rank among the principal causes of death, and 
 probably are the greatest of all causes of waste in 
 health, happiness, efficiency, and treasure. Our 
 hospitals, asylums, and workhouses are crowded 
 with their victims. They bore heavily on all 
 Armies during the late war, and their easily pre- 
 ventable prevalence was a principal cause of the 
 allied disasters in 1918. They have been exported 
 from our islands to hundreds of hitherto immune 
 communities, some of which are now extinct. 
 Their wide diffusion dates from beyond the dawn 
 of history, and they show no signs of decrease. 
 Hitherto they have been combated only by ex- 
 hortations to chastity delivered by people who, 
 however unconsciously, had antecedently ensured 
 the failure of their own sermons. Unless other 
 and more potent means are adopted, they are 
 likely to prevail undiminished. No other means 
 save suitable sanitation administered by men 
 desirous of making it a success, and perhaps in 
 the remote future reasonable moral teaching, are 
 conceivable. 
 
 Effective sanitation is quite possible. It has
 
 PREFACE ix 
 
 already been practised on a large scale in various 
 parts of the world, and always with success. The 
 prevention of venereal disease is therefore a 
 certainty in the near future. With official help 
 it will come quickly ; without such help more 
 slowly ; but come it will. It depends on the 
 diffusion of a little simple knowledge of a kind 
 that spreads very rapidly and which, once diffused, 
 is diffused for ever. Even this little book should 
 give it a sufficient start with the public ; but the 
 activities of the Society for the Prevention of 
 Venereal Disease, and the fact that a dozen English 
 boroughs are now about to teach it to their citizens 
 places the matter on a securer basis. " Master 
 Ridley . . . we shall this day light such a candle 
 ... in England as shall never be put out." 
 If the reader glances at the list of names in 
 Appendix V. (pp. 411-2) he will gather some idea 
 of the strength which the movement in favour of 
 sanitation has already reached. 
 
 It is likely that venereal disease will presently 
 be the subject of a new Government Commission 
 or Committee, the principal, if unexpressed, object 
 of which will be to ascertain to what extent its 
 predecessors suppressed the truth that they were 
 appointed to reveal. Such a Commission is sure 
 to be resisted ; but I think public opinion will 
 ultimately insist on it. It will then be necessary 
 to take great care that it is not composed wholly, 
 or even partly, of officials whose careers are apt 
 to suffer or benefit accordingly as they are known 
 to hold, or not to hold, or, at any rate to express, 
 or not to express, opinions which " influential
 
 x PREFACE 
 
 people " consider wicked. As one official who 
 has played no inconsiderable part in the past, 
 but who has been most prudent, declared, " I 
 should be blown off my perch at the moment 
 anybody associated me with prophylaxis." 
 Officials ought not to be exposed to unnecessary 
 strain. 
 
 The scandal of the Inter-Departmental Com- 
 mittee which lately presented a Report on Venereal 
 Disease to the Ministry of Health is very great. 
 Certain doctors, indeed many doctors, had placed 
 simple disinfectants within the reach of their 
 publics, and had carefully explained the use of 
 these disinfectants, and that they were mere 
 disinfectants, and must only be used as dis- 
 infectants. The special feature of their teaching 
 was that disinfectants are effective in proportion 
 to the speed with which they are used after the 
 need for them has arisen. Without exception 
 all these doctors had reduced the venereal disease, 
 previously rife among their charges, almost to the 
 vanishing point. In no single instance had their 
 disinfectants been used otherwise than as dis- 
 infectants, and in no single instance had they 
 caused injury to the people using them. The 
 records can be checked from independent official 
 sources, and have never yet been impugned. 
 Other doctors had also placed disinfectants within 
 the reach of their publics ; but acting on official 
 instructions, given in spite of vehement and 
 repeated protests from the successful practitioners, 
 had told their charges so far as they told them 
 anything that which was not true, or which, at
 
 PREFACE xi 
 
 any rate, was nonsensical viz. that the dis- 
 infectants were for " Early Treatment." Early 
 Treatment implies not prevention, but cure. It 
 implies delay. Speed in action was not insisted 
 on, and, therefore, in varying degrees, all the 
 doctors who followed official instructions failed 
 to bring about a diminution of disease. One or 
 more of them complained that their publics had 
 tended to use the disinfectants not for preventing 
 disease, but for curing it i.e. for Early Treat- 
 ment. If this statement be correct it denotes 
 almost incredibly bad teaching on the part of the 
 doctors. As I say, however, these doctors acted 
 on official instructions which were given in spite 
 of repeated protests, and which achieved results 
 that were expected, I suppose, by every one con- 
 cerned influential people, obliging officials, in- 
 structed doctors, revolted doctors, indeed every 
 one except the unfortunate men who acquired 
 disease and their comrades in the firing line. 
 The medical failure in Mesopotamia aroused vast 
 indignation ; but it occurred in an outlying 
 theatre, under circumstances of great and un- 
 expected difficulty, and the sufferers were limited 
 to thousands. On the other hand, the failure to 
 prevent venereal disease occurred in the main 
 theatre, at the most critical period of the war, 
 involved hundreds of thousands of trained soldiers, 
 had long been foreseen and proclaimed, and was 
 
 so easily avoidable that . But the reader will 
 
 soon be in a position to judge for himself. 
 
 Next, the Inter-Departmental Committee met. 
 Averaging all results, but laying special stress on
 
 xii PREFACE 
 
 statistics gathered from the unfortunate majority 
 which had followed official instructions, it pro- 
 nounced disinfection a danger to body and mind, 
 and advised the Ministry of Health to rely on 
 exhortation and on a form of Early Treatment 
 which, very glaringly, is mere window-dressing. 
 The Ministry not only adopted this counsel but 
 arranged that hi future it should be advised by 
 the most conspicuously unsuccessful doctor of all. 
 Suppose a country were ravaged by sleeping sick- 
 ness ; suppose that not many doctors but only 
 one doctor, by using a certain method of sanita- 
 tion, had almost banished the plague from his 
 area ; suppose a thousand doctors in surrounding 
 areas, meeting exactly similar difficulties but em- 
 ploying a different method, had failed completely ; 
 suppose a Committee, ostensibly appointed to 
 investigate the subject, but widely believed, 
 from the date of its very inception, to be of un- 
 satisfactory composition, had struck an average 
 between the one success and the many failures, 
 had announced on that ground that sanitation 
 was useless, and had advised prayer and exhorta- 
 tion ; what, then, would the reader think ? Just 
 this very kind of thing happened here in England 
 less than two years ago. It may be thought that 
 I am romancing, but, after all, there is the massive 
 evidence which I have tried to summarise in this 
 book. It must be borne in mind that though the 
 Inter-Departmental Committee has been attacked 
 publicly and many times in much the same terms 
 as I have just employed, and though excuses 
 have many times been attempted as in the House
 
 PREFACE xiii 
 
 of Lords debate, no real defence has yet appeared. 
 None, indeed, is possible. Again, it must be 
 borne in mind that the scandal of this Committee 
 was so patent that the appearance of its Report 
 led immediately to the foundation of the Society 
 for the Prevention of Venereal Disease with its 
 long list of distinguished supporters. Yet again 
 it must be borne in mind that the advice of the 
 Committee and of the Ministry of Health is in 
 process of being repudiated all over the country. 
 Lastly must be borne in mind the undisputed 
 and indisputable fact that many doctors, because 
 they disregarded official instructions, successfully 
 banished venereal disease, even under the worst 
 conditions, from large bodies of men. Obviously, 
 there must be something peculiar in the methods 
 that achieved success in the midst of prevailing 
 failure. That something was rational instruction 
 given to endangered men. 
 
 Venereal disease presents us with two distinct 
 but related problems. Is it right to prevent these 
 maladies ? Is it possible to prevent them ? The 
 first question necessarily takes precedence. If 
 it be not right to prevent, the possibility of pre- 
 vention should have no more than a theoretic 
 interest. We ought not to attempt that which is 
 wrong. But venereal disease is usually consequent 
 to sexual immorality which, in turn, depends on 
 certain frames of mind. How do these frames of 
 mind arise ? Are they products of " natural " 
 wickedness or weakness, or are they the products 
 of mental training ? If they are natural, are they 
 restrainable by training ? If they are restrainable,
 
 xiv PREFACE 
 
 has the right training been given ? Apparently 
 it has not been given, for both immorality and 
 venereal disease are very prevalent. Who, then, 
 is primarily blamable, the immoral person, or his 
 responsible educators ? 
 
 Frames of mind are subject - matter for the 
 science of psychology. Unfortunately this science 
 has not yet reached that stage of interpretation 
 which is the goal of all advanced sciences and 
 which, when it is reached by psychology, will 
 make some knowledge of it a necessary part of 
 the equipment of every efficient parent, teacher, 
 and statesman. Up to the present psychology 
 has attempted little more than description within 
 a more or less limited field description of per- 
 ception, conception, apperception, association, 
 desire, aversion, instinct, reason, habit, intelli- 
 gence, and so on. It tells us what these 
 mental processes are like. But as yet it has not 
 seriously attempted the vastly important task 
 of accounting for the development of those habitual 
 frames of mind which in their sum constitute the 
 characters of men and nations frames of mind 
 which result in such qualities as modesty, courage, 
 chivalry, resolution, religious devotion, patriotism, 
 honesty, sexual morality, intelligence, reason, and 
 the like, on which depend behaviour of individuals 
 and the status of the Society in which they exist. 
 Every one thinks he knows how these incentives 
 and guides to conduct arise. But there are great 
 differences of opinion, and nearly every one 
 psychologist, parent, teacher, statesman, and the 
 rest is convinced that he alone is entirely right
 
 PREFACE xv 
 
 and that nearly every one else is more or less 
 wrong. There is much dogmatism and passion, 
 but no established truth. Here, in fact, is a field 
 overgrown with prejudices from which, as always 
 in similar cases, science has long shrunk mainly 
 because the vision of its own workers has been 
 obscured by familiar preconceptions masquerading 
 as accepted truths. 
 
 We cannot then decide whether it is right to 
 prevent venereal disease until we have reached a 
 conclusion as to why some people tend to be sexu- 
 ally moral and others immoral. To that problem 
 the earlier part of this book is devoted. I need 
 only add that I do not think that even a reader 
 unlearned in psychology will find the discussion 
 difficult. It is founded on facts with which every 
 one is necessarily familiar, and I have tried to 
 escape from the tyranny of my own prejudices. 
 
 It is possible that some readers may wish to 
 help in the campaign for sanitation. If any such 
 there be, they should communicate with the 
 Secretary of the Society for the Prevention of 
 Venereal Disease. 
 
 I have to thank many friends among them 
 Lady Askwith, Sir Bryan Donkin, Mr. Hugh 
 Elliot, Dr. Mearns Fraser, Mr. H. H. Payne, and 
 Professor H. H. Turner for advice and criticism. 
 Whatever small merits the book may have belongs 
 to them. Its faults are entirely my own. 
 
 G. ARCHDALL REID. 
 
 SOUTHSEA, 
 
 September 1920. 
 
 i
 
 CONTENTS 
 
 CHAP. PAGE 
 
 I. INTRODUCTORY ..... i 
 II. THE URGENCY OF THE PROBLEM . .17 
 
 III. INSTINCT AND REASON . . . .27 
 
 IV. THE DEVELOPMENT OF MIND AND CHARACTER 41 
 V. INCLINATION AND MORALITY . . -59 
 
 VI. MICROBIC DISEASES . . . -75 
 
 VII. METCHNIKOFF . . . . .91 
 
 VIII. THE REPORT OF THE ROYAL COMMISSION . 101 
 
 IX. VENEREAL DISEASE IN THE ARMY . .118 
 
 X. QUICK DISINFECTION . . . .134 
 
 XI. COMPARATIVE STATISTICS . . . .150 
 
 XII. THE VENEREAL DISEASE ACT, 1917 . . 166 
 
 XIII. CIVILIAN EARLY TREATMENT CENTRES . . 175 
 
 XIV. THE INTER-DEPARTMENTAL COMMITTEE . 186 
 
 XV. THE INTER - DEPARTMENTAL COMMITTEE 
 
 (continued) . . . . .212 
 
 XVI. THE SOCIETY FOR THE PREVENTION OF 
 
 VENEREAL DISEASE .... 224
 
 xviii CONTENTS 
 
 CHAP. PAGE 
 
 XVII. LORD SANDHURST'S APOLOGETICS . . 307 
 XVIII. SUMMARY . . . . . .322 
 
 APPENDIX 
 
 I. THE PREVENTION OF VENEREAL DISEASE . 343 
 II. PROPHYLAXIS IN VENEREAL DISEASE . . 344 
 
 III. SPECIMEN LECTURE TO TROOPS ON THE PRE- 
 
 VENTION OF DISEASE .... 346 
 
 IV. REPORT OF THE INTER-DEPARTMENTAL COM- 
 
 MITTEE ON INFECTIOUS DISEASES IN CON- 
 NECTION WITH DEMOBILISATION . . 352 
 
 V. SOCIETY FOR THE PREVENTION OF VENEREAL 
 
 DISEASE . . . . . .411 
 
 VI. STATEMENT MADE BY THE MINISTRY OF 
 HEALTH, WITH CONCURRENCE OF THE WAR 
 OFFICE, RELATIVE TO INCIDENCE OF VENE- 
 REAL DISEASE AMONGST SOLDIERS IN THE 
 PORTSMOUTH MILITARY AREA AND IN THE 
 REST OF THE COUNTRY . . . 413 
 
 VII. THE PREVENTION OF VENEREAL DISEASE IN 
 
 THE ROYAL NAVY .... 437 
 
 INDEX ...... 443
 
 PREVENTION 
 OF VENEREAL DISEASE 
 
 CHAPTER I 
 
 INTRODUCTORY 
 
 / T~" V HE primary aim of this book is to impress 
 upon the public at large, and such members 
 of the medical profession as have not specially 
 directed attention to the subject of it, the urgent 
 necessity for preventing the spread of venereal 
 diseases by the prompt employment of simple 
 antiseptic measures which will effectually destroy 
 the infective agents of syphilis and gonorrhoea 
 before they enter the body tissues, and thus de- 
 finitely prevent the occurrence of disease. 
 
 That immediate and thorough cleansing with 
 soap and water of any part of the body likely to 
 be thus infected, whether in sexual intercourse or 
 otherwise by accident, may be often successful in 
 removing the microbic organisms of venereal as 
 well as of other diseases, has doubtless been more 
 or less known for some time by medical men and 
 others. Yet no active effort has been made until 
 the last few years, at least in this country, to utilise
 
 2 PREVENTION OF VENEREAL DISEASE 
 
 the scientific knowledge concerning immediate 
 medical disinfection which has been gained since 
 the early years of the present century, or to bring 
 before the public the serious importance of attack- 
 ing these terrible and ubiquitous diseases on the 
 same lines as those on which other preventable 
 and infectious maladies are now fought, accord- 
 ing to the best of their knowledge, by responsible 
 Public Health Authorities and medical practitioners 
 generally. 
 
 Venereal diseases are known to stand in the 
 first rank both of diseases which maim and kill, 
 and also of such as can be most readily prevented 
 by prompt personal disinfection at the time of 
 exposure to risk. 
 
 Although the microbe of gonorrhoea was dis- 
 covered by Neisser in 1879, it was not until 
 recently that any widespread knowledge existed, 
 even among medical practitioners, of preventing 
 its infective poison from entering the body after 
 the risk of exposure to it had taken place. In 
 1905 the organism of syphilis was discovered by 
 Schaudinn. Hard upon this discovery came the 
 experiments of Metchnikoff and Roux, which 
 showed conclusively that syphilis could be success- 
 fully prevented by the prompt use of mercurial 
 inunction after the subjects of the experiments, 
 both human and simian, had been carefully in- 
 oculated with the poison of this disease. 
 
 The knowledge thus gained was soon extended 
 and applied practically in several countries, with 
 a view to the prevention of infection in their 
 military and naval services. But, whatever
 
 INTRODUCTORY 3 
 
 sporadic and concealed attempts to utilise it were 
 made by medical officers in the British services, 
 no public nor combined professional effort in this 
 direction arose in this country, until after the out- 
 break of the Great War, to promote or even to 
 ventilate the question of the necessity of preventing 
 the alarming spread of venereal diseases by the 
 employment of immediate medical measures of 
 disinfection. It is, however, to be noted here, to 
 the lasting credit of Mr. H. N. Robson, of Bourne- 
 mouth a British medical practitioner of much 
 experience in the matter of venereal disease in 
 many lands that in the year 1909 he succeeded, 
 after meeting with astonishing difficulties, in pub- 
 lishing a small book in which he gave a suc- 
 cinct and scientific account of venereal diseases and 
 their dire results in all their aspects, and strongly 
 advocated the use of the preventive means set 
 forth in the Reports of the important researches, 
 still too little known in England, of the French 
 authorities mentioned above. Mr. Robson's book, 
 now in its third edition, entitled Sexual Disease 
 and its Medical Prevention, is but little known 
 here, having been systematically ignored on its 
 first appearance by the medical and lay press 
 alike. In common with many others interested in 
 this subject, I had never heard of it until I had 
 already begun to urge publicly by a letter to the 
 Times in January 1917, the actual necessity of 
 making widely known the value of immediate 
 personal disinfection if the fight against venereal 
 disease was to be carried on with any hope of a 
 practically successful issue. I gladly take this
 
 4 PREVENTION OF VENEREAL DISEASE 
 
 opportunity of recording Mr. Robson's right to be 
 known as the first public advocate in England of 
 the medical prevention of venereal disease. 
 
 In 1913, owing to pressure by many public- 
 spirited persons, including members of the medical 
 profession, a Royal Commission was appointed to 
 inquire into the matter of the disastrous and far- 
 reaching evils of venereal diseases, and of the best 
 means of reducing them. In the same year the 
 " National Council for Combating Venereal Dis- 
 eases " was created. As a result of their joint work 
 an Act of Parliament was ultimately passed which 
 made provision for the better and earlier treatment 
 of already infected persons. The Report of the Com- 
 mission was published in 1916, about one and a half 
 years after the outbreak of war ; but in spite of 
 the knowledge possessed by a few scientific mem- 
 bers of the Commission concerning the value of 
 immediate disinfection, no recommendation was 
 made on this important matter, nor was there any 
 mention in the Report of the question having 
 been discussed. Yet Dr. (now Sir Frederick) 
 Mott, F.R.S., an eminent scientific member of the 
 Commission, had written, several years previously, 
 in an authoritative medical treatise, with reference 
 to the action of a calomel ointment which had been 
 demonstrated by Professor Metchnikoff to be pro- 
 tective, if promptly applied, against the microbe 
 of syphilis, that " it would be well if this were 
 widely known and practised in the civil population 
 as a means of prophylaxis." 
 
 As a matter of fact the Royal Commission had, 
 from the first, decided to omit the question of
 
 INTRODUCTORY 5 
 
 immediate self -disinfection from their Report ; and 
 a similar attitude was shown by the " National 
 Council," whose action on other lines, and espe- 
 cially in the direction of bringing the disastrous 
 results of venereal disease before the community 
 at large, is now so widely known as to render further 
 details of this kind unnecessary in this place. 
 Owing, however, to the considerable influence 
 which the Council has exerted, and still exerts, in 
 counteracting all efforts to spread the important 
 knowledge of immediate personal prevention by 
 medical means, it is needful to dwell shortly on 
 the course of action or inaction which it has taken 
 in regard to this essential point. 
 
 The National Council, or, to speak strictly, a 
 majority of it, advocated at first " early treat- 
 ment " of persons already infected or supposed to 
 be infected, and recommended that facilities should 
 be provided in hospitals and other places where 
 appropriate medical treatment could be obtained. 
 As time and more or less open discussion went on, 
 the term " early preventive treatment " was intro- 
 duced, and further facilities for curative treatment 
 were recommended in the form of an increase of 
 " centres " where medical aid might be sought. 
 It seems from this later importation of the word 
 preventive, that it was intended that persons who 
 had run the risk of infection should go as soon as 
 possible to the nearest available place for the pur- 
 pose of " preventive " treatment. But the majority 
 of the Council still opposes vigorously all facilities 
 for persons who may run the risk of infection to 
 provide themselves with disinfectants which can be
 
 6 PREVENTION OF VENEREAL DISEASE 
 
 used immediately after running this risk. Thus, 
 if it be admitted that the success of medical 
 preventive treatment depends essentially on the 
 shortness of time that intervenes between the risk taken 
 and the employment of the disinfectant, it needs 
 no argument to show that, unless provision of an 
 easily portable disinfectant be made before the 
 risk is run, the earliest possible moment for success- 
 ful disinfection would be lost in an immense 
 majority of cases, and that countless failures 
 would be thereby entailed. 
 
 All that the Council's scheme would provide 
 for what is called " early preventive treatment," 
 is the establishment of centres where a person may 
 obtain antiseptic treatment as soon as he or she 
 may apply for it. It may be granted that some 
 persons may thus apply, and that among these some 
 few may possibly apply within even an hour or less 
 after running the risk. This scheme, therefore, be 
 it noted, does not actually disallow, but indeed 
 admits, the principle of preventing venereal in- 
 fection from entailing the otherwise consequent 
 disease ; and it thus deprives its promoters of the 
 argument adduced by many of them that any 
 preparation for disinfection, made before the risk 
 is run, in order for immediate use at the earliest 
 possible moment, is to be decried as both danger- 
 ous and morally wrong. Surely there is no moral 
 difference between being in possession of a disin- 
 fectant before exposure to infection and seeking 
 disinfection immediately afterwards at a recognised 
 centre or by a visit to a doctor. 
 
 It is needless to argue at any length that the
 
 INTRODUCTORY 7 
 
 scheme of the National Council, in respect to 
 medical prevention, is futile. The treatment 
 centres cannot compass any material degree of 
 success unless they are widely advertised ; and wide 
 advertisement will make people ashamed to go to 
 them. Everybody would necessarily soon know 
 the object of those who were seen1;o attend there. 
 But, above and beyond the practical force of this 
 great probability as an argument against the utility 
 of the scheme, a brief reflection on the circum- 
 stances in which an immense majority of cases of 
 irregular sexual intercourse take place in all classes 
 of the community will convince most people that 
 the only medical advice given by some members 
 of the National Council, e.g. " in case of a lapse, 
 immediate recourse to a doctor," must be deemed 
 of negligible value in any serious fight against the 
 countless evils that result from impulsive desire to 
 satisfy a natural instinct. Whatever degree of 
 further control than generally obtains at present 
 over the urgency of this instinct may possibly be 
 achieved, as some imagine, in a future civilisation, 
 the instant danger to the community of its result- 
 ant evils calls very clearly for more than constant 
 reiteration of moral advice alone. 
 
 The advocacy of immediate self-disinfection as 
 the prime necessity for the successful prevention 
 of venereal disease has lately been persistently 
 opposed from various points of view, based mainly 
 either on the belief that such action is wicked or 
 immoral, or on an assumption made by those who 
 are disinclined to express a more definite view, that 
 " public opinion " would not tolerate it. These
 
 8 PREVENTION OF VENEREAL DISEASE 
 
 lines of objection are fully considered in this book. 
 There is no warrant for belief that public opinion is 
 or would be hostile to the measures now proposed : 
 there is, indeed, much evidence to the contrary : 
 but it is not to be doubted that influential opposition 
 from privileged quarters has been largely effectual 
 in hindering the establishment of an adequate test 
 of public opinion on the subject. 
 
 In an official instruction issued by the Army 
 Council in March 1916, it was directed that sol- 
 diers who had exposed themselves to the risk of 
 venereal disease should be required to attend for 
 treatment within twenty-four hours of " infection " 
 a period far too long to secure immunity. It was 
 not even stated whether " infection " meant ex- 
 posure to the risk, or to the first noted symptoms 
 of the disease. But this instruction was prefaced 
 by the following somewhat obscurely worded 
 and wholly unpunctuated sentence : " Suggestions 
 with regard to prevention which might imply the 
 adoption of any system of prophylaxis which 
 might be said to afford opportunities for unre- 
 strained vice could not be accepted by the Army 
 Council." 
 
 Not until early in 1918, after a deputation had 
 been received at the War Office from a number of 
 medical men (including the writer of this book and 
 myself) who were strongly advocating the with- 
 drawal of this Instruction, and the urgent necessity 
 of establishing at once effective preventive measures 
 in the Army, was any attempt made to remove or 
 modify the necessary and actual effect of the 
 Instruction, which was virtually directed against
 
 INTRODUCTORY 9 
 
 any effort to facilitate the practice of immediate 
 self-disinfection against venereal infection among 
 soldiers. Nor even now are there any official 
 orders which can ensure the establishment or en- 
 couragement of such medical measures as could 
 lead to any important reduction of the venereal 
 plague still so prevalent in the Army and the com- 
 munity generally. It was my great doubt, late 
 in 1916, of any efficient steps in this direction being 
 taken promptly by either military or civilian 
 authority, that determined me to do all I could 
 to bring this question to public notice in the hope 
 that wide and free discussion might lead to a satis- 
 factory practical issue. But the powers that are 
 have persistently, and in spite of ascertained fact, 
 decried all efforts to promote this object. 
 
 Since the beginning of 1917 many medical 
 authorities and others, who fully recognised the 
 importance and necessity of forwarding such 
 measures as are advocated in this book, have 
 given material help in various ways towards in- 
 creasing public knowledge on this subject. But 
 in spite of discussions in newspapers, medical 
 and other journals and reviews, and lectures and 
 discussions at several societies dealing with matters 
 of Public Health, it is still apparent that a more 
 general understanding of the pressing necessity of 
 some effectual action in the direction of the medical 
 prevention of venereal disease must be established. 
 The advocates of such action are, as has been 
 shown above, vigorously opposed from variable 
 standpoints by the National Council for Combating 
 Venereal Disease ; and in many instances their
 
 10 PREVENTION OF VENEREAL DISEASE 
 
 objects and aims have been seriously misrepre- 
 sented. 
 
 The most recent form of opposition to the method 
 of facilitating the successful prevention of venereal 
 diseases by immediately destroying the infective 
 agents before the disease comes into existence is 
 apparently based, at least partly, on medical 
 grounds. It has been urged, even by some Army 
 medical officials, that expert medical knowledge is 
 required for the successful application of any 
 disinfectants to the male genitals, and the deduc- 
 tion is made that self-disinfection, being untrust- 
 worthy, would establish a false confidence of 
 security and lead to increase, instead of decrease, 
 of the spread of disease. This argument is fully 
 dealt with in this book. It is mentioned here 
 prominently as an illustration of the culpability 
 and danger of drawing a conclusion in this in- 
 stance a most important one from an entirely 
 unsubstantiated allegation. The import of this 
 conclusion is patent. For if its premisses could 
 be definitely established, the opponents of self-dis- 
 infection could readily dispense with all the con- 
 testable arguments they still urge against it, and 
 might rest assured that the practice they denounce 
 would at once come to an end through its own 
 futility. It is, however, pertinent to remark that 
 soldiers under the medical care of those who make 
 the objection in question were permitted to dis- 
 infect themselves, and, indeed, were taught to do 
 so in the " ablution rooms " established under 
 Army authorities. Moreover, the advocates of im- 
 mediate self -disinfection hold, and strongly urge,
 
 INTRODUCTORY 11 
 
 that definite instructions on the mode of using 
 disinfectants should always be given orally or be 
 made available in printed form to all who desire 
 to employ them ; that they do not recommend, 
 as has been repeatedly stated by their opponents 
 in the face of repeated denials, the " wholesale 
 distribution of prophylactic packets " ; and that 
 the object of this book, to put it briefly, is to spread 
 the knowledge of a nationally important and 
 practical item of scientifically accredited medical 
 knowledge to the community at large. 
 
 Yet we find in a letter to the Times of 31st 
 December 1918, written by three prominent 
 members of the Executive of the National Council, 
 in reply to a letter published in that journal on 
 28th December and signed by the late Professor 
 Sir William Osier and a number of well-known 
 medical authorities, the erroneous and grossly 
 misleading statement that " the panacea of these 
 signatories is a wholesale distribution of prophy- 
 lactic packets " ; and this is followed by another 
 erroneous statement that " the policy of the 
 National Council has, since 1916, been early 
 preventive treatment." Both of these statements 
 are misrepresentations. The signatories of the 
 letter of the 28th December neither made, nor 
 would support, the first ; nor did the National 
 Council introduce the word " preventive " into 
 their recommendation of " early treatment " until 
 after 1916, and after the practice of immediate 
 disinfection had been advocated in the Times, and 
 discussed at length in the Nineteenth Century Review 
 and elsewhere in the course of the year 1917.
 
 12 PREVENTION OF VENEREAL DISEASE 
 
 The writing of this book was undertaken by Sir 
 Archdall Reid in the summer of 1919, and I was 
 glad to accede to the publisher's request to supply 
 an Introductory Chapter. From early in 1917 
 onwards, Sir Archdall and I had been, at first 
 without any communication, striving each in our 
 own way to further the aims which are now set 
 forth in the book, and are also advocated by the 
 Society for the Prevention of Venereal Disease 
 which was founded independently in the autumn 
 of 1919, and of which we were subsequently invited 
 to become members. 
 
 Before I had published my first public appeal 
 in January 1917, on the pressing importance of 
 spreading the knowledge of the medical prevention 
 of venereal disease which had resulted from the 
 work of Metchnikoff, Dr. Archdall Reid had been 
 making his own practical efforts to diminish ven- 
 ereal disease among the numerous troops under his 
 medical charge ; and when he became aware that 
 I was similarly interested, he gave me full in- 
 formation both of his methods and his success. 
 Since 1917, the results of his work have been 
 reported in medical and other journals as far as 
 outside authority has not stood in the way, and 
 they are recounted in detail in the present book. 
 But since the book was projected, the publication 
 took place in August 1919 of an official " Note " 
 on *' Prophylaxis against Venereal Diseases," ad- 
 dressed to the Minister of Health by the Chairman 
 of the Inter-departmental Committee on Infectious 
 Diseases in connection with Demobilisation ; and 
 although this White Paper is also fully considered
 
 INTRODUCTORY 13 
 
 by Sir Archdall Reid, I am induced, in view of its 
 official prominence, to comment shortly on it here. 
 
 In this " Note " it is stated that it was considered 
 desirable to present it forthwith " in view of the 
 public interest on the subject," although the Com- 
 mittee was appointed to inquire into the general 
 question of the medical prevention of infectious 
 diseases. The Committee consisted of the Hon. 
 Waldorf Astor, M.P. (now Lord Astor), Chairman, 
 and of " some representative medical officers from 
 the Local Government Board, the National Health 
 Insurance Joint Committee, the Navy, Army, and 
 Air Forces, and such other representatives as 
 might be specially suitable either in place of or in 
 addition to the above, at particular meetings, for 
 particular purposes." The names of these gentle- 
 men were not mentioned, but, in remarkable 
 contrast to the composition of most inquiries pur- 
 porting to get at the truth of the matter inquired 
 into, there was, apparently, not a single supporter 
 on the Committee of the advocates for the medical 
 prophylaxis of venereal disease, or a single member 
 who had had personal knowledge or experience of 
 the method of prophylaxis as actually practised 
 by those who had employed it with success. 
 
 The Committee state in the 6th paragraph of 
 this Note, which is signed only by the Chairman, 
 that the issue which they desire to lay before the 
 Minister of Health is restricted to a consideration- 
 of the advisability or otherwise of special encour^- 
 agement being given officially by the Government 
 to the sale of " packets." After thus conveniently 
 defining, or rather creating, their Reference, they
 
 14 PREVENTION OF VENEREAL DISEASE 
 
 arrive, in paragraph 13, at the conclusion that " the 
 official application of a packet system to the civil 
 community is neither desirable nor practicable." 
 
 The reasons given by the Committee for arriving 
 even at this conclusion are wholly inadequate. 
 There were no members of it who had specially 
 thought and worked on the chief points under 
 discussion. Such men might well have helped 
 their colleagues in some degree to formulate 
 accurately the real issue which ought to have been 
 placed before them, and differs very widely from 
 that which the Committee elected to set forth for 
 the express purpose of their conclusion. The only 
 witnesses who were called to give evidence on 
 medical prevention had never advocated, or said 
 a word in favour of " official application of a packet 
 system to the civil community." As one con- 
 sequence of this procedure, the only arguments in 
 support of the efficacy of prompt personal disin- 
 fection that were submitted, were dealt with by 
 cross-examination, and this was chiefly concerned 
 with the subject of statistics. Such a method of 
 inquiry, in view of the well-known insufficiency of 
 statistics on all hands in this matter, would have 
 been far more destructive to the contentions of 
 the opponents of self-disinfection, had it been 
 possible for them to be cross-examined on the nature 
 and quantity of the statistics they relied upon them- 
 selves to support their own case. 
 
 It may be noted further, that although it is stated 
 in the Committee's Note that two other well- 
 known supporters of prompt self-disinfection were 
 invited to give evidence before the Committee,
 
 INTRODUCTORY 15 
 
 viz. Sir William Osier and Sir Bertrand (now Lord) 
 Dawson, there is no mention made in the Note 
 of the opinions of either of these gentlemen, both 
 of whom had elsewhere publicly and strongly 
 stated their views in favour of self -disinfection. 
 
 The general trend of this Note plainly indicates a 
 very insufficient inquiry and a foregone conclusion. 
 
 To such readers as may question why the matter 
 of the self-disinfection of women is not treated in 
 this book, I would point out that 
 
 (1) Effectual disinfection of women, even by 
 medical experts, is a matter of much greater 
 difficulty than is the case with men, though it is 
 apparently carried out, often with considerable 
 success, by some women of the prostitute class. 
 
 (2) It is plain that the disinfection of one sex 
 must necessarily lead to the non-infection of the 
 other, and it is desirable that the easier and more 
 trustworthy process should be securely estab- 
 lished in the first instance. 
 
 (3) No implication whatever is made against 
 any efforts directed towards instructing both men 
 and women how to protect themselves against 
 all possible sources of venereal infection, whether 
 such infection be conveyed by sexual intercourse 
 or accidentally. 
 
 It must be remembered that this book makes no 
 pretence of being a handbook on venereal disease 
 generally. / have endeavoured only to make clear 
 in this Introduction its primary aim, and to give 
 a short account of the recent history of the preventive 
 movement, and the opposition it has met with on the 
 part of both army and civil authorities and of the
 
 16 PREVENTION OF VENEREAL DISEASE 
 
 National Council for Combating Venereal Diseases 
 which receives Government support ; all of which 
 bodies appear, from the arguments they employ, to 
 be similarly inspired. The urgency of the point at 
 issue is surely of sufficient national importance to 
 call for a public and unbiased inquiry on the whole 
 matter, including, of course, the official Note to the 
 Minister of Health referred to above, as well as any 
 subsequent documents on the question which have 
 issued or may issue from the office of that Ministry. 
 Since the principles of the action of the Society 
 for the Prevention of Venereal Disease are prac- 
 tically the same as those set forth in this book, a 
 list of the Grand Committee and Officers of that 
 Society is printed as an Appendix, and it is hoped 
 that the knowledge of the common aim of the 
 Society and the book will be instrumental in in- 
 forming the public more widely than has hitherto 
 been practicable of the urgent necessity and positive 
 duty of striving to stay the venereal plague in this 
 country by the use of means which are scientific- 
 ally accredited as successful in destroying the 
 infective agents of these maladies before their 
 disastrous and deadly effects can become actual. 
 
 (By BRYAN DONKIN, M.D. Oxon., F.R.C.P.)
 
 CHAPTER II 
 
 THE URGENCY OF THE PROBLEM 
 
 T N England, at the present time, if one person 
 1 deliberately poisons and kills another with 
 arsenic, the law hangs him by the neck till he is 
 dead. If he merely tries, but fails, the law gives 
 a long term of penal servitude. But it is open 
 to any diseased drab to tempt and poison with 
 venereal disease any inexperienced boy, or to any 
 diseased scoundrel to poison, perhaps his own 
 wife and children, perhaps even to death, and the 
 law lifts not a finger in protest, provided the 
 poisoning is done for private profit or pleasure, and 
 in the most cruel and treacherous way conceivable. 
 If a law were passed placing venereal poisoning on 
 the same criminal basis as other forms of poisoning, 
 it would be a dead letter ; for it is a peculiarity of 
 this particular form of crime that publicity greatly 
 enhances the sufferings of its victims. Appeals to 
 the law, therefore, would be correspondingly rare. 
 If the onus of furnishing information to the police 
 were placed on medical men, victims would tend 
 either to suffer without treatment or to appeal to 
 a disreputable class of practitioners, such as those 
 who practise abortion. Moreover, a wide field 
 for the exercise of blackmail would be opened.
 
 18 PREVENTION OF VENEREAL DISEASE 
 
 For example, if two people have sexual relations 
 and both suffer from venereal disease, it soon be- 
 comes hard to decide which has infected the other. 
 The culprit might easily accuse the real victim. 
 Any number of similar situations may be imagined. 
 
 Much the same objections apply to the proposal 
 for the notification of venereal diseases to the Health 
 Authorities in order that sufferers may be forced 
 to submit to treatment and to abstinence from 
 sexual intercourse until cured. Notification would 
 be useless unless accompanied by adequate action 
 by the public authorities, which, in turn, would 
 have to rest on a very intimate knowledge of the 
 lives of millions of sufferers. People infected 
 would be unwilling to complain of the crime. A 
 fertile field would be opened to blackmailers. 
 Doctors would be chosen rather because they failed 
 to comply with the law than because they were 
 otherwise suitable. 
 
 After every great war a considerable increase of 
 venereal disease has been recorded. Thus, towards 
 the end of the fifteenth century a real pestilence 
 swept over Europe. At that time there were two 
 outstanding plagues. One, which claimed its 
 millions of victims, was smallpox. The other, a 
 vaster evil which invaded palace and presbytery, 
 castle and cottage, was known as the Great Pox. It 
 is still with us under the name of syphilis. The 
 greatest of all wars is unlikely to furnish an ex- 
 ception. 
 
 The full extent to which British troops suffered 
 during the war has not been made public. It is 
 known, of course, to the authorities, but the in-
 
 THE URGENCY OF THE PROBLEM 19 
 
 formation, as far as I am aware, has been withheld. 
 Presumably soldiers suffered as much during the 
 war as before, and as much abroad as in England 
 at any rate, in many portions of the far-flung line. 
 An element of confusion is created by the fact that 
 men, home for short leave from the front, often 
 acquired disease and went sick on returning to 
 the trenches. Of course troops actually in the 
 firing-line suffered relatively little. Within the 
 United Kingdom before the war the lowest rate 
 for many years was 50-9 per annum per thousand. 
 In the American Army serving in the States it 
 was 113-82 per thousand per annum in 1917. 
 During the six months ending on 27th December 
 1918 it was 150-62. During the war the rate for 
 Canadian troops in the United Kingdom varied be- 
 tween 222-0 and 81'6, while among the Australians 
 it was from 132 to 176. During and since the war, 
 the rate for British troops serving at home has 
 varied from 36 to 64. I fear I am only guessing, 
 but I do not think I exaggerate if I suppose that 
 the British rate for all troops at home and abroad 
 during the war was at least 50 per thousand per 
 annum. If that is correct, something like a quarter 
 of our troops, some 2,000,000 men, suffered during 
 the five years of the war. 
 
 Towards the end of 1917 it became known at 
 the War Office that a method of protecting troops 
 from venereal disease, so effective that the rate of 
 infection was reduced to 1-5 per thousand per 
 annum, had been discovered. Arrangements were 
 made to apply this method to the whole Army. 
 Quick action was essential. Thousands of men were
 
 20 PREVENTION OF VENEREAL DISEASE 
 
 pouring into hospital ; the German offensive was 
 known to be impending ; the British Army in 
 France had sunk through lack of drafts to far below 
 the limits of safety. All that was necessary to 
 secure almost complete immunity was an order to 
 medical officers to give their men certain very 
 simple sanitary instruction, and thereafter to 
 institute vigorous inquiry if any M.O. failed to 
 achieve success. The men could themselves pro- 
 vide the proper chemicals, or the medical officers 
 could supply them. The requisite materials were 
 present hi abundance in every military inspection 
 room throughout the world. I myself had used 
 Government stores for this purpose for a year, and 
 I suppose the total cost to the State was something 
 under a shilling. Before me, other officers in India 
 and Africa, using only the materials at hand, had 
 been equally successful, and at a cost to the State 
 as trivial. What some men could do quite easily 
 others could do also. However, the authorities 
 in their wisdom decided to scrap the apparatus 
 for preventing venereal disease already in use, 
 and to transfer identically the same chemicals to 
 new apparatus which was to be manufactured at 
 a cost of thousands of pounds in money and months 
 in time. Protests were again raised that nothing 
 was necessary beyond the simple order to medical 
 officers, but again in vain. At last orders came to 
 remove the old apparatus, as the new was now on 
 the way. There was a good deal more delay, 
 however, and some units removed the old apparatus 
 before the new was received, leaving the men 
 without protection. At last the new material was
 
 THE URGENCY OF THE PROBLEM 21 
 
 received ; and with it came directions which meant, 
 if they meant anything, that it was to be used in the 
 old, inefficient way. Nothing, therefore, was done 
 except to transfer chemicals from one set of re- 
 ceptacles to another. In the interval between the 
 resolve of the authorities to introduce the new 
 method and the provision of the new apparatus an 
 incredible thing had happened. A few " influential 
 people," at a time of national stress, had per- 
 suaded or frightened the authorities into a reversal 
 of their policy, under threat of public agitation. 
 
 The money and time spent on the new apparatus 
 was entirely wasted. The soldiers continued to 
 pour into hospitals. The German offensive broke. 
 The British line was smashed. Nearly 100,000 
 British soldiers went into captivity. Some 
 hundreds of thousands suffered death or wounds. 
 The war was prolonged. The cost in money 
 alone ran into thousands of millions. Immature 
 boys and fathers of families training in England 
 were sent to fill the depleted ranks. At that time 
 there were, but need not have been, in the venereal 
 hospitals or in depots as convalescents, British, 
 French, and American soldiers, mature and trained 
 men, otherwise fit for active service, sufficient not for 
 an army corps only, but for a great army. All these 
 men had become diseased after the authorities had 
 learned how to prevent disease. They were put 
 out of action, and the allied cause brought to the 
 verge of ruin, by the fanaticism of a few " in- 
 fluential people," and the complaisance or timidity 
 of a few obliging officials. 
 
 I am sure I have not exaggerated as to the effect
 
 22 PREVENTION OF VENEREAL DISEASE 
 
 the failure to deal resolutely with venereal disease 
 had on the fortunes of the British Army at the time 
 of its direst need. Since it was important not 
 to discourage recruiting, all allusion to venereal 
 disease among soldiers and sailors was excluded 
 from the English newspapers during the war. But 
 it is significant that in Ireland, Canada, Australia, 
 and later in the United States, conscription was 
 vehemently opposed on the ground that the armies 
 in England and at the seat of war were " rotten " 
 with venereal disease. Governments and people 
 were urged not to send their young men into that 
 cesspool. Australian soldiers believe again I have 
 no documentary evidence, but I am assured of 
 the fact on very good authority that their govern- 
 ments at one time sent an ultimatum to the British 
 authorities threatening to withdraw their forces 
 unless measures were taken to protect them from 
 venereal disease. 
 
 That I do not exaggerate as regards the efficacy 
 of the new methods of prevention may be judged 
 not only from the difference in the incidence of 
 disease between units under the charge of different 
 medical officers, but also from the records of military 
 venereal hospitals. For example, not long ago I 
 learned at one such hospital which drew its patients 
 from a district in which both the new and the old 
 methods were employed in different localities, that 
 not one infected man had used the new method ; 
 a few had taken no precautions ; all the rest, 
 hundreds in number, had employed the old method. 
 
 It is difficult to estimate the extent to which 
 venereal disease is prevalent among the civil
 
 THE URGENCY OF THE PROBLEM 23 
 
 population. Sufferers conceal their troubles, and 
 sometimes do not even consult medical men. 
 Women, particularly when innocent, are often 
 unaware of the real nature of the illnesses from 
 which they and their children suffer. Their hus- 
 bands do not tell them. Medical men themselves 
 are very apt to be mistaken, for venereal disease, 
 especially in children and in women, and in its 
 later stages in men, is often hard to diagnose. 
 Even when it is recognised, the doctor, for obvious 
 reasons, may describe the illness by one of its 
 results as heart disease, aneurism, paralysis, in- 
 sanity, epilepsy, skin disease, ophthalmia, pelvic 
 cellulitis, or what not. In proportion to the 
 number of cases the mortality is small ; but it 
 has been asserted that " of the killing diseases 
 syphilis comes third or fourth." If this estimate 
 is correct, at least 40,000 people die annually in 
 Great Britain of syphilis alone. The Final Report 
 of the Royal Commission on Venereal Disease 
 issued in 1916 states, " While we have been unable 
 to arrive at any positive figures, the evidence we 
 have received leads us to the conclusion that the 
 number of persons who have been infected with 
 syphilis, acquired or congenital, cannot fall below 
 10 per cent, of the whole population in the large 
 cities, and the percentage affected with gonorrhoea 
 must greatly exceed this proportion." Gonorrhcea 
 is six or seven times as common as syphilis. If, 
 then, the estimate of the Royal Commission 
 approaches the truth, 70 or 80 per cent, of 
 the population of large towns has suffered from 
 venereal j disease. Doubtless country folk suffer
 
 24 PREVENTION OF VENEREAL DISEASE 
 
 less ; but so large a part of the total population is 
 now urban, and the whole country is so studded 
 with large towns to which country folk resort, 
 especially for pleasure, that the difference cannot 
 be very great. At any rate, if we say that some 
 30, 40, or even 50 per cent, of the inhabitants of 
 Great Britain have suffered from venereal disease, 
 we are probably within the mark. Men suffer 
 more in proportion than women ; for on the average 
 young men are less chaste than young women. 
 It follows, if the estimate of the Royal Commission 
 is at all near the truth, that more than half of the 
 male population has suffered from venereal disease. 
 I have drawn this estimate from the opinion of 
 the Royal Commission. But I am anxious that 
 the reader should judge from facts within his own 
 knowledge. After all, the opinion of the Royal 
 Commission is a mere opinion. It has no preten- 
 sions to verifiable accuracy. It is founded on 
 the opinions of the doctors who appeared before 
 it, of whom none were in a position to do more 
 than guess. On some subjects doctors can speak 
 with fair accuracy. For example, since statistics 
 have been compiled by competent persons, and 
 since there are no motives for concealment, they 
 are able to indicate approximately the number of 
 deaths caused by pneumonia. But of the number 
 of illnesses formerly caused by pneumonia, or of the 
 number of deaths or illnesses caused by venereal 
 disease or drink, they are little better able to speak 
 than ordinary observant laymen. In my own case, 
 if I judged purely from recollections of my medical 
 experiences, I think I should come to very wrong
 
 THE URGENCY OF THE PROBLEM 25 
 
 conclusions. It would seem to me that almost 
 every kind of illness was rather uncommon. Thus, 
 it is only now and then that I see a case of measles. 
 Yet I know that almost every one suffers from 
 it at one time or another. I have gathered this 
 belief from the fact that nearly all the people 
 whom I have known well have suffered from it. 
 I think, therefore, that the reader, if he be an 
 average member of the community, is almost as 
 well qualified as a doctor or a Royal Commission 
 to form his own opinion. When he was young he 
 was on confidential terms with a certain number 
 of young men. How many of these confessed to 
 having suffered from venereal disease ? I believe 
 that he will conclude that the estimate that more 
 than half the male population suffers at one time 
 or another is not excessive. Venereal diseases are, 
 in fact, by far the most prevalent of all the more 
 serious diseases. 
 
 They are prevalent to an appalling extent. 
 There are few, if any, families of which some 
 members have not been infected. Together they 
 constitute a principal, if not quite the principal, 
 cause of poverty, insanity, paralysis, blindness, 
 heart disease, disfigurement, sterility, disablement, 
 and the life of pain to which many women are con- 
 demned. Our hospitals, asylums, and homes for 
 the broken are crowded with their victims. The 
 cost in loss of efficiency and, therefore, in money, 
 is incalculable. More than anything else they are 
 responsible for the blunting of the moral sense, 
 not only in the people who poison for private 
 profit or pleasure, but also in those who, careless
 
 26 PREVENTION OF VENEREAL DISEASE 
 
 of this vast flood of misery, seek to obstruct the 
 path of the reformer. 
 
 However, we shall have much to say on all this 
 later. At present I seek only to make clear that 
 we are dealing with a problem of vast national 
 importance.
 
 CHAPTER III 
 
 INSTINCT AND REASON 
 
 VENEREAL diseases are distinguished from 
 other maladies by their close connection 
 with sexual immorality. They would die out 
 within a very few years if all men and women were 
 chaste. No sanitary measures would be necessary. 
 Innocent people suffer from them ; but in the line 
 of transmission there are always acts of unchastity. 
 A man may acquire venereal disease in a lavatory 
 and transmit it to his wife, who may transmit it 
 to her children, who may infect a nurse, who may 
 infect her own husband, and children, or a doctor, 
 or another nurse, who may infect their own families. 
 But such a chain is ideal rather than real. The 
 rule is that when the innocent are infected the 
 disease ends with them or with their children. 
 The only considerable exception is furnished by 
 gonorrhoea, which sometimes spreads mysteriously 
 among very young girls, mere babies, inhabiting 
 a house or street. Probably it is then communi- 
 cated by the hands or clothes. 
 
 Venereal disease persists, then, only because men 
 and women are unchaste. The question as to why 
 they are unchaste is of the utmost importance, for 
 on it hangs the question not only as to whether 
 
 27
 
 28 PREVENTION OF VENEREAL DISEASE 
 
 it is possible to prevent sexual immorality, but 
 also as to whether it is right to prevent venereal 
 disease. 
 
 Some people are ardently chaste. They scarcely 
 feel temptation ; or, if they feel it, the emotion is 
 overpowered by a passionate hatred of the thing 
 to which they are tempted. Others are contemp- 
 tuously unchaste. They are careless as to whether 
 unchastity is right or wrong ; or it may seem to 
 them a mere peccadillo, a case wherein a temptation 
 resisted is a temptation wasted. Whence these 
 differences of temperament or character ? Are 
 they natural mental differences, or are they dif- 
 ferences which the individuals have acquired 
 through environment, education, training, home 
 and school influences, good and bad companion- 
 ship, and the like ? If some people are by nature 
 so constituted that it is impossible for them to 
 learn to be chaste, it is, of course, folly to try to 
 teach them to be chaste, either through dread of 
 venereal disease or by any other means. Though 
 it may be necessary to restrain them, it is wrong 
 to expose these helpless unfortunates (mostly idiots, 
 imbeciles, and feeble-minded persons) to poisoning. 
 If it be possible to teach people to be chaste, but 
 if they have not had the opportunity of learning, 
 then again it is wrong to expose them to poisoning, 
 because the fault is primarily with the teachers. 
 On the other hand, if people are capable of learning 
 to be chaste, and, having had adequate oppor- 
 tunities to learn, are yet unchaste, the fault is 
 theirs. They are themselves to blame, and can 
 hardly complain of punishment. But, even then,
 
 INSTINCT AND REASON 29 
 
 should the punishment, or threat of punishment, 
 take the form of poisoning ? And should we per- 
 sist in preserving the danger of it for the unchaste 
 even when the guiltless suffer with the guilty, 
 and even when it is doubtful whether the danger 
 causes an increase or decrease of immorality ? 
 
 Here are problems which must be considered 
 unless we intend to act in mere wantonness and 
 cruelty. They are questions which every one who 
 takes sides in this controversy thinks he has an- 
 swered, but which few have considered seriously. 
 In this case, as almost always, the more vehement 
 the opinions, the more unfounded the assumptions, 
 the more dogmatic the statements, the more pro- 
 found as a rule is the ignorance and the lack of 
 thought. The whole matter involves a knowledge 
 of the development of the human mind. To this 
 study we must now turn. If the reader finds it 
 tedious, he must bear in mind that on it hinges the 
 question of the responsibility for immorality, and 
 the question as to the right and wrong of preventing 
 venereal disease. 
 
 In all human affairs, and conspicuously in all 
 that concerns sex, two forms of mental activity are 
 involved, instinct and reason. In order to achieve 
 a clear view of instinct, consider a caterpillar, an 
 animal which is actuated purely, or almost purely, 
 by it. He emerges from the egg and unhesitatingly 
 sets about the business of life with a perfect com- 
 mand of his limited, but sufficient, faculties. He 
 needs no external guidance. He seeks his proper 
 food and shelters from enemies and weather. In 
 the fulness of time, at the right season of the year,
 
 30 PREVENTION OF VENEREAL DISEASE 
 
 he finds a proper place and spins a cocoon, an 
 elaborate structure, the like of which he has never 
 seen. Thence he emerges as a butterfly, to a 
 new life in the air, where he seeks a different kind 
 of food, and avoids a different set of enemies in a 
 different way. Presently he finds his mate and 
 deals with her in the right way, and later she lays 
 her eggs in the proper place. From first to last 
 he is actuated by instinct. Apparently he learns 
 nothing. Learning would be useless to him ; for 
 he must always be ready from the beginning to take 
 the fitting action. Abandoned before conscious life 
 by his parents, he has no teacher and no time or 
 opportunity for learning. Experience, therefore, 
 Is no guide to him. 
 
 Obviously, an instinct is a mental impulse, an 
 inclination, an emotion, which develops in the 
 individual in the lack of all experience, to do a 
 certain act, the instinctive act, when the proper 
 conditions arise. Hunger is an instinct ; it impels 
 to the act of eating and swallowing. Thirst is an 
 instinct ; it impels to drinking. Tiredness and 
 sleepiness are instincts ; they impel to the proper 
 kinds of rest. Sexual love is an instinct ; it impels 
 to the sexual act. The distinguishing peculiarity 
 of an instinct is that it is not learned. It develops 
 infallibly as the individual matures, and, without 
 antecedent experience, manifests itself at the 
 proper time. 
 
 If the caterpillar cannot learn, if he is impelled 
 solely by instinct, he can have no memory. Mem- 
 ory is that faculty which enables the individual to 
 store his past, and recall, and recollect it for the
 
 INSTINCT AND REASON 31 
 
 guidance of his present and future. It enables him 
 to profit by experience. By means of it he acquires 
 various emotions and impulses, knowledge of 
 facts, and skill in thinking and doing. Memory is 
 the servant of thought. Without memory there 
 can be no thinking, for the mind then contains 
 nothing to think about. There can be only feeling 
 only pleasure, and pain, and instinctive fear and 
 desire, and impulses to do this or that, and feelings 
 of the like kind. The caterpillar feels, but takes no 
 thought. His instincts, which are merely emotions, 
 urge him this way and that, and he blindly obeys. 
 He acts, but he knows not why. His past is a 
 blank, and, therefore, his future also. He lives 
 only in the immediate present. He may be 
 alarmed and startled, but never surprised ; for the 
 latter emotion is only felt when past experience 
 seems to be contradicted. A baby would not feel 
 surprise if a dragon came into the room. Nor 
 would a caterpillar. 
 
 But while there is no evidence that the caterpillar 
 can learn, there is plenty that he can for a longer 
 or shorter time " bear in mind." Bearing in mind 
 is like the sound from a harp-string ; it lingers for 
 a space, growing fainter, and then is no more. 
 Remembering is like the sound from a gramo- 
 phone ; it recalls, it recollects the vanished past. 
 The caterpillar may feel fear for a time, he may be 
 frightened again and again ; but he cannot in 
 memory recall his terror. This incapacity to profit 
 from experience may be perceived in any housefly. 
 It settles on our hand, alert with instinct ; we 
 strike at it, and instinct unhesitatingly impels its
 
 32 PREVENTION OF VENEREAL DISEASE 
 
 flight. But in a moment it is back again as wary, 
 but no more wary than before. A higher animal 
 would have learned caution. A man with his long 
 memory would shudder for hours and remember 
 for all his life. 
 
 As we pass higher in the animal scale, we find 
 clear evidence of memory. Birds and mammals 
 have a family life. They protect and train their 
 young, which have not a sufficient equipment of 
 instincts to enable them to fend for themselves 
 from the beginning. Time and opportunity is thus 
 afforded for experience and learning to supply the 
 defect. The insect cognises his mate. The mam- 
 mal recognises her and his offspring again and 
 again. The offspring learn to know their pro- 
 tectors. Their play, in which the parents join as 
 exemplars and instructors, is always educative. 
 It develops body and mind in exactly the right way. 
 The cat lies in wait, and pounces. The dog chases 
 and fights. The kid climbs. The little girl dandles 
 her doll. The boy engages in contests of strength, 
 dexterity, and wit, which foreshadow the grimmer 
 contest of maturity. 
 
 Roughly speaking, in proportion as the animal is 
 capable of learning, he has a defective equipment 
 of instinct, is helpless at birth, requires prolonged 
 training, and ultimately becomes intelligent and 
 capable. Intelligence is the power of profiting by 
 experience ; stupidity is incapacity to profit by 
 it. A dog is very intelligent ; a cat is less intelli- 
 gent, more stupid. A caterpillar is absolutely 
 unintelligent, entirely stupid. It is because the 
 higher animals are very capable of learning that
 
 INSTINCT AND REASON 33 
 
 we are able to domesticate them. Learning, then, 
 not only supplements their defective instincts, but 
 even restrains them. They learn to tolerate, obey, 
 and, in the case of the most intelligent, even to 
 love us. The dog, for instance, is so very intelligent, 
 so very educable, that we award blame and praise 
 to him. He cannot learn enough to be moral 
 sexually ; but he may be taught to be honest, 
 clean, and faithful. 
 
 As it is with mind, so it is with body. The lower 
 animal develops his body, like his mind, without 
 the aid of use ; the higher animal develops his 
 body, like his mind, mainly because he uses it. 
 Thus, there is no evidence that a caterpillar's 
 body increases in size, strength, and efficiency 
 because of use. A butterfly dwells motionless in 
 the chrysalis, and yet develops perfectly. Even 
 a frog, that develops in a cavity, grows, apparently, 
 as well as one that leads an active life. So also, 
 like human instincts, some human structures, for 
 example, eyes, ears, hair, teeth, are not influenced 
 in their development by functional activity. 
 But most of the human body, like most of the 
 human mind, grows because it is used. Thus, 
 human muscles and limbs, paralysed in infancy, 
 develop little, if at all. Increased use brings 
 increased size and efficiency. Thus, if one kidney, 
 or one-half of the brain, be injured, the other takes 
 up the work and grows larger and more efficient. 
 It is this exceptional power of developing both in 
 mind and body to fit the conditions in which the 
 lot is cast that makes the human being capable 
 and adaptable beyond all other animals. To it 
 3
 
 34 PREVENTION OF VENEREAL DISEASE 
 
 he owes his ability to become a clerk, a blacksmith, 
 or an acrobat ; and to it he owes all his intelli- 
 gence, reason, and morality. 
 
 At the basis of all learning is instinct. The 
 higher animals in proportion as they are high in 
 the scale of life, lose many instincts. But to their 
 stock they add four which lower types totally lack : 
 (1) the parental instinct to protect and educate 
 offspring ; (2) curiosity, which impels the young 
 to store their minds ; (3) imitativeness, which 
 impels them to copy their teachers, and so profit 
 by parental and racial experience ; and (4) play- 
 fulness, which impels them to develop body and 
 mind, especially with respect to strength, skill, 
 and activity. These four instincts are the servants 
 of memory. They awaken interest, without which 
 the individual would have no incentive to train 
 his offspring or himself. The love dance of gnats 
 and other insects is quite distinct from the play- 
 fulness of the young of the higher animals. Its 
 function is not education, but sexual attraction. 
 
 The higher animal, then, is distinguished from 
 the lower (a) because his instincts by themselves 
 are insufficient to equip him for the battle of life ; 
 (b) because he lacks some instincts which the lower 
 possesses, and possesses some which the lower 
 lacks ; and (c) because he is, in proportion to his 
 position in the scale of life, a trained and educated 
 being, in whom learning and habits supply, and 
 more than supply, defect of instinct. 
 
 Nature has caused some animals to specialise 
 to develop a particular feature immensely. Thus 
 the bat has developed the fingers of his hand and the
 
 INSTINCT AND REASON 35 
 
 skin between them so greatly that they constitute 
 wings. The elephant has developed his nose. The 
 narwhale has an enormous tooth. Man has developed 
 his brain, and with it his memory, and therefore 
 his power of learning and thinking. He is born so 
 poorly equipped with instinct that he cannot even 
 seek the breast. Contrast the helplessness of the 
 baby with the swift efficiency of the young insect. 
 At birth the human mind is a blank, or rather a 
 chaos of sense-impressions. Light, sound, touch, 
 and smell tell the new-born baby nothing intel- 
 ligible. He feels pleasure and pain, but they have 
 no meaning. Taste impels him to suck, but he 
 knows not why. Pain and discomfort cause him 
 to utter instinctive cries, unmeaning to him, which 
 are, in effect, appeals for aid. He has not a notion 
 whether the pain is in his toe or his toe in the pain, 
 the taste in his mouth or his mouth in the taste. 
 But he learns with astonishing swiftness and ampli- 
 tude. Soon order begins to replace the chaos. His 
 feelings commence to send intelligible messages. 
 He learns to control and co-ordinate his thousand 
 muscles, and the vague movements of his limbs 
 and tongue become purposeful. He recognises his 
 mother, and presently his home, and his whole little 
 world. Day by day, month by month, year by 
 year, he adds to the wealth of experiences stored in 
 his memory. Not only does he increase in body and 
 grow in knowledge, but he becomes continually 
 more and more dexterous physically and mentally. 
 He forms habits. Since his mind directs his body, 
 his physical dexterities are really mental, they are 
 habitual ways of doing things, ways along which
 
 36 PREVENTION OF VENEREAL DISEASE 
 
 through constant repetition and practice his mind 
 works swiftly and easily. Within two years he 
 has learned to walk, and speak, and use his hands, 
 and distinguish between right and wrong, and a 
 vast deal more. What grown man starting from 
 absolute ignorance and incapacity, from pure 
 mental chaos, could achieve results so tremendous. 
 Babies are the real intellectual giants of the world ; 
 adults are dwarfs that stand on the shoulders of 
 their former selves. Instinct, working with more 
 than machine-like precision, impels the child to 
 educate himself in exactly the right way in a 
 way infinitely superior to the blundering tactics of 
 the teachers he will encounter later in school and 
 college. Curiosity fixes his interest on new things 
 till he knows and understands. When he has 
 learned, no time is wasted, for his interest wanes. 
 Play leads him with delicate skill to acquire wonder- 
 ful skill ; and then again his interest wanes, and 
 he passes to new fields of endeavour. Imitation 
 helps most potently, so that at last he grows up 
 like his parents, closely fitted to the state of society 
 in which he finds himself savage, civilised, 
 Mahomedan, Pagan, Christian, tinker, tailor, 
 soldier, sailor, gentleman, ploughboy, thief. Above 
 all, he has been biased in all sorts of ways in 
 favour of particular persons, or of a country, or a 
 religion, or a system of morals. These attitudes, 
 these outlooks on life, are mental habits. Habits 
 are not instincts ; they are learned ; but they 
 differ from instincts only in their mode of origin. 
 They are imitation instincts. They fulfil the same 
 function.
 
 INSTINCT AND REASON 87 
 
 No grown man can learn anything so perfectly 
 as a child. Compare a foreign language as acquired 
 by a child with the same language as acquired by 
 an adult. If an English adult and a little English 
 child spent five or six years alone with Germans 
 or savages, the adult would come back an English- 
 man. But the child would return a German or a 
 savage, so perfectly would he learn and imitate. 
 He would copy his associates not only in such 
 obvious things as language, knowledge, and re- 
 ligion, but also in more subtle ways so that his 
 whole habitual outlook on life, his whole character, 
 would resemble that of his educators, not that of 
 his progenitors. Because man is so helpless at 
 birth, he has much to learn, and vast capacity for 
 learning it. Because he has so much to learn, he 
 takes long in learning it. For twenty years or so 
 he must be guided. Thereafter he is equipped for 
 the battle of life. Once equipped, he can add to 
 his mental harness, but he can only to a small 
 extent exchange the old for the new. His mental 
 habits, which in their sum constitute his charac- 
 ter, become fixed. From maturity onwards, as he 
 begins, so, very nearly, he will end malicious or 
 kindly, mean or chivalrous, honest or knavish, 
 selfish or unselfish, modest or forward, reticent or 
 open, courteous or rude, genial or morose, boorish 
 or gentle, arrogant or humble, energetic or slothful, 
 brave or timid, confident or nervous, patriotic or 
 unpatriotic, devout or sceptical, moral or immoral, 
 and so on. As the insect is a creature of instinct, 
 so the grown man is a creature of habit. 
 
 As the twig is bent so the tree grows. The mind
 
 38 PREVENTION OF VENEREAL DISEASE 
 
 of man is like a house ; you may lay almost what 
 foundations you please in the space given you ; but 
 afterwards you can only build in accord with your 
 foundations. It is like wet clay which you can 
 mould as you please ; but only while it is fresh 
 and plastic. It is like a fair sheet on which life 
 writes with indelible ink. 
 
 The Moving Finger writes ; and, having writ. 
 Moves on : nor all thy Piety nor Wit 
 
 Shall lure it back to cancel half a line, 
 Nor all thy Tears wash out a Word of it. 
 
 Habits tendencies to a routine, " physical " 
 dexterities, outlooks on life, bents of character 
 are, as I say, imitation instincts. The habit 
 is learned ; the instinct develops " naturally " ; 
 there is only a difference of origin. 
 
 Thus the insect and the man both walk, and did 
 we not know how the skill arose we could not dis- 
 tinguish the instinct from the habit. The fly 
 dodges a blow by instinct, the boy by habit. The 
 bee and the man alike feel patriotic fervour. The 
 mother and the miser both gloat over their treasures. 
 The man and the caterpillar both build. Re- 
 ligious devotion and the migratory instinct are 
 both emotions. The point that concerns us is 
 that habits, like instincts, are acquired mainly by 
 the young ; and the earlier the age at which they 
 are acquired the more instinct-like they are, the 
 more unchangeable. This is especially true of all 
 that goes towards the make-up of " character " 
 honesty, chastity, chivalry, and the like. 
 
 Man is the educable animal. Perhaps the mag-
 
 INSTINCT AND REASON 89 
 
 nitude of the part played by learning in creating 
 the normal human mind is best seen when we 
 compare together the idiot, the newly-born infant, 
 and the normal adult. The idiot has the ordinary 
 human instincts. He feels, for instance, hunger 
 and thirst, the sexual impulse, curiosity, and 
 imitativeness. But he has no memory, no power 
 of learning, no ability to store experience, no 
 capacity to profit by it. The absolute idiot cannot 
 even learn to walk and speak. He cannot think. 
 He is said to be of filthy habits ; but as a fact he 
 has no habits. He has not learned, and cannot 
 learn. The infant has not learned, but can learn. 
 The normal man can learn, and has learned. 
 There, in a nutshell, is the whole mental difference 
 between them. The infant, for all his vast capacity, 
 is in effect an idiot. Judged by the human stan- 
 dard, every insect is an idiot, every cat an imbecile, 
 every dog a feeble-minded person. We always judge 
 the intelligence of a lower animal by his capacity 
 to learn, by his ability to profit by experience. It 
 is the same with a man. The stupid man cannot 
 put two and two together. He is not skilled in 
 linking the past with the present and the future. 
 He cannot anticipate correctly, and so prepare for 
 contingencies. We accept the stupidity of lower 
 animals as natural with no thought of its origin, 
 but at its basis is always a mean capacity to learn, 
 and therefore to think. Think of the aquarium 
 pike which broke its nose for six months trying to 
 get at minnows beyond a glass partition, and then 
 for six months after the partition was removed 
 left them unharmed. Think of the cow whose
 
 40 PREVENTION OF VENEREAL DISEASE 
 
 dead calf stuffed with straw was placed beside her 
 at milking to induce contentment, and who licked 
 the calf till she came on the straw which she 
 pulled and eat with satisfaction. 
 
 Intelligence may be denned as a power or capacity 
 to use past experience as a guide to future conduct. 
 Necessarily it is possessed only by a being which 
 has a memory ; that is, one which can learn. 
 When the knowledge on which this being draws is 
 vast, varied, and complex, when the thinking by 
 which it is utilised is very skilful, when the aims 
 that are sought are perhaps remote, then that 
 individual is a rational being, exercising reason. 
 Reason differs in degree, not in kind, from intelli- 
 gence. It is merely exalted intelligence. The dog 
 is very intelligent as compared with other lower 
 animals, but he draws on only a few simple facts, 
 combines them in only a simple way, and seeks 
 only an immediate end. Therefore he is not 
 rational, but merely intelligent.
 
 CHAPTER IV 
 
 THE DEVELOPMENT OF MIND AND CHARACTER 
 
 THOUGH the imitative faculty never quite 
 disappears in human beings, it fades quickly 
 and early. The boy is less imitative than the child, 
 the youth than the boy, and the man than the youth. 
 In the aged the instinct is very feeble. Its function 
 is to equip the individual with family and racial 
 modes of thought and motives for acting, or, in 
 other words, with traditions so that he may play 
 his part in the community. By the time he is 
 grown this task is largely accomplished. To some 
 extent, however, he remains imitative as is shown 
 by fashion, religious revivals, the infectious fury 
 of mobs, and the growing enthusiasm or despond- 
 ency of armies. Curiosity and playfulness fade 
 more slowly and less completely. In the complex, 
 changeful, human world, even the adult must 
 continue to learn to become skilful in thinking and 
 acting in new ways. Therefore, driven by their 
 instincts, even old men play games, and are curious 
 and interested. But the mental growths of the 
 adult, like the growths of a tree, are mainly addi- 
 tions, not substitutions. He may learn a new 
 language, or a new business, or become skilful in 
 a new handicraft ; but he tends to retain in man- 
 
 41
 
 42 PREVENTION OF VENEREAL DISEASE 
 
 hood the knowledge and traits of character he 
 acquired in youth. 
 
 Great ability to learn and change under the 
 influence of experience is the mark of youth. 
 Small capacity to learn and change is the mark of 
 age. The child is capable, especially in extreme 
 youth, not only of rapid mental growth, but, unlike 
 the adult, of substitution also. Thus it is possible 
 to create in him an intense preference, or bias, or 
 prejudice, and then substitute for it a contrary 
 bias. For example, a little Mahomedan child may 
 be taught to love Christianity and hate his first re- 
 ligion. The adult can seldom be so altered. A very 
 large part of a child's training all the world over 
 consists in creating, consciously or unconsciously, 
 these bents of mind, these mental attitudes, these 
 preferences towards religion, family, class, nation, 
 honour, courage, probity, generosity, and the like. 
 They arise in the child, become fixed in the adult, 
 are taught to the next generation, and the next, 
 and the next, and so become traditional, racial, 
 or national characters. The most frantic and 
 obvious wickedness may be perpetuated by these 
 means folly and wickedness which seem to the 
 unfortunates that are blinded by prejudice as the 
 height of wisdom and rectitude, and from which 
 they can by no manner of means be persuaded. 
 We perceive all this clearly when we consider 
 religious beliefs, moral opinions, and prejudices 
 other than our own. If, however, we are like the 
 rest of humanity, we are probably just as prejudiced 
 as other people. All the greatest crimes of history 
 have been committed by prejudiced men who
 
 THE DEVELOPMENT OF MIND 43 
 
 believed they were doing right. The Spanish 
 Inquisitors and the Mahomedan zealots are cases 
 in point. They had formed mental habits which 
 rendered them incapable of seeing right and wrong 
 as we see it. 
 
 There are two ways in which an individual may 
 learn to hold an opinion, belief, or conviction. 
 (1) He may be convinced by such facts relating 
 to the matter as come within his knowledge. In 
 that case his belief is usually cool, dispassionate, 
 and changeable on the production of fresh evidence. 
 Adults are able to acquire fresh facts almost as well 
 as children, and, therefore, are able to change 
 those opinions which originally they founded on 
 facts almost as quickly as children. A belief 
 acquired in this way leaves the individual with an 
 open mind. (2) Or the belief may be founded on 
 bias. The individual has, then, probably in child- 
 hood, imitated a bias held by his associates ; or 
 some antecedent bias, also probably acquired in 
 childhood, has impelled him to accept this addi- 
 tional bias. It is in this way that people usually 
 learn all or much that goes towards the formation of 
 character honesty, patriotism, religion, modesty, 
 and the like. All such beliefs tend to be held 
 passionately and unchangeably. They tend to 
 close the mind. They may close it to evil ; never- 
 theless they do close it ; and the closure, as such, 
 is an evil. It would be better, were it possible, 
 if the conviction were founded on evidence. It is 
 these convictions, based on bias, on feeling into 
 which an element of passion enters, that the child 
 learns readily, and, if young enough, even changes
 
 44 PREVENTION OF VENEREAL DISEASE 
 
 readily, but which the adult can rarely learn, and 
 can still more rarely change. He may have any 
 number of passionate convictions ; but as a rule 
 they were acquired in early youth, or are based on 
 preferences then acquired preferences which were 
 woven into the texture of his character as it de- 
 veloped, and themselves constitute the main part 
 of his character. Consider, as I say, a Mahomedan. 
 Hehas all sorts of passionate convictions which seem 
 to us mere prejudices, which he was taught as a 
 child, and which he cannot now discard no matter 
 what facts are brought to his notice. His mind is 
 closed not only as regards them, but as regards 
 much else. It has acquired a general habit of 
 inertia which fatally handicaps him which handi- 
 caps all Mahomedans, and has led to the stagnation 
 and downfall of Mahomedan nations. The moral 
 of all this is that if we wish to cause an individual 
 to hold a given opinion or conviction, it is best for 
 his own sake to base it on evidence if possible. 
 But if that cannot be done (as is usually the case 
 in matters of right and wrong), and if he must be 
 given a bias, then we must teach him as a child. 
 Later the task will be enormously more difficult, 
 and probably impossible. 
 
 We see, then, that the failure, increasing with 
 age, of the capacity to learn and change mentally, 
 is not entirely a matter of senile decay. In all 
 men to some extent, and in most men to a great 
 extent, it is also a matter of habit a thing artifici- 
 ally created by education. Every prejudice, every 
 bias, every item of unreasoning faith, good or evil, 
 true or untrue, tends to close the mind and to in-
 
 THE DEVELOPMENT OF MIND 45 
 
 duce a habit of mental inertia. On that account 
 a conviction founded on evidence is intellectually 
 superior to one founded on bias. The former, if 
 wrong, may be altered in all except the most stupid 
 minds by the production of better evidence ; the 
 latter, even if glaringly wrong, is irremovable from 
 most minds. It is, then, an imitation instinct. 
 
 When the child's mental training consists mainly 
 in the creation of a mass of prejudices, a habit of 
 mental inertness is developed which covers and 
 colours all that is emotional and intellectual in him. 
 There are types of training, for instance that given 
 to our ancestors during the Dark Ages, which pro- 
 duce an inability to assimilate new truths and 
 ideas, and, therefore, an incapacity to think 
 rationally, that is almost senile or imbecile in its 
 completeness. Hence the stagnation of Europe 
 during the Dark Ages, hence also the present 
 stagnation of Turkey. Hence, in such cases, the 
 inefficiency of the government in peace and war, 
 and the brutality and lawlessness of the governed. 
 Compare the achievements of the nations that fought 
 in the late war. Every nation was formidable and 
 efficient, or ineffective and inefficient, in proportion 
 as its education caused its people to base their 
 thinking on evidence or on bias. There are types of 
 training, for instance, those given to the youth of 
 ancient Greece and Rome, which produce a minimum 
 of prejudices, and, therefore, preserve an almost 
 boyish openness of mind. People are, then, taught 
 not so much what to think as how to think. They 
 get the habit of being open-minded and receptive. 
 They do not hate new facts and ideas, but will
 
 46 PREVENTION OF VENEREAL DISEASE 
 
 accept them readily like a child. Hence the 
 extraordinary brilliancy and changefulness of the 
 Greek and Roman civilisations in the midst of 
 surrounding barbarism and stagnation. Utter 
 savages are always governed by a mass of pre- 
 judices against which the plainest facts count as 
 nothing. In modern Europe we are gradually 
 beginning to reproduce the open, thoughtful type 
 of mind that Socrates so plainly tried to produce 
 in his pupils. But, owing to the state of transition, 
 there are great inequalities among us. Children 
 acquire very unlike mental tones in different homes 
 and sections of the community. Some men, espe- 
 cially men of science, grow up as mentally youth- 
 ful, as free from bias, as efficient, as the ancient 
 Greeks. Others are like a clergyman of my 
 acquaintance, who, before he read a book, caused 
 his wife to examine it, in case it might contain 
 anything calculated to upset his convictions. An 
 exceedingly kind, sincere, and upright man he 
 was, though he knew it not, of the sort that created 
 the Dark Ages and converted heretics with red-hot 
 irons. No ruffian, not Bill Sykes himself, is so 
 utterly unscrupulous and wicked as your convinced 
 fanatic as we shall presently see in this matter of 
 venereal disease. 
 
 An illustration will make my meaning clear. I 
 could teach my child that the earth is flat in two 
 ways. I could say to him : " The earth is flat. 
 This is a blessed truth, believed by all the elect of 
 Heaven, which you must never question. It is 
 damnable to doubt it. Only wicked, contemptible, 
 and hateful people doubt it. Never listen to them."
 
 THE DEVELOPMENT OF MIND 47 
 
 Just this very thing has been taught in just this 
 very way. Or I could say to him : " The earth is 
 flat. Obviously it is flat. You can see for yourself 
 how flat it is. You can prove its flatness in all 
 sorts of ways. There are, however, silly people 
 who say it is round. If they talk to you, ask for 
 their proofs, and you'll soon see what nonsense the 
 idea is." The first kind of teaching, which is the 
 kind very prevalent among barbarians, would, if 
 successful, close the mind by introducing bias, 
 prejudice, passion, fanaticism. The second kind 
 would leave the mind open, accessible to truth, 
 capable of growth and change. In the world, as 
 it is at present, prejudice and bias are inevitable ; 
 for we who are exemplars and teachers to our 
 children have ourselves been deeply prejudiced by 
 our predecessors. But for the sake of the children 
 we should try to delay, as far as possible, the advent 
 of senility by teaching them to think in an open- 
 minded way. To this end we should never found 
 belief on faith when it is possible to found it on 
 knowledge, or morals on prejudice when it is possible 
 to base them on reason. 
 
 We have only to examine the past of human 
 society to perceive that, however important it may 
 be to teach the right thing, it is yet more important 
 to teach in the right way. Human society could 
 not exist without some teaching of bias ; but in 
 most communities this teaching is carried to excess, 
 and even to enormous excess. Bias, whether it be 
 towards right, or towards wrong, has always an 
 evil side for beings capable of becoming rational. 
 In every case it closes the mind. When there is
 
 48 PREVENTION OF VENEREAL DISEASE 
 
 much of it, the mental horizon is so limited that an 
 extreme incapacity to learn, and change, and grow 
 mentally, results not merely because each item 
 of bias obscures a portion of the horizon, but also, 
 and chiefly, because of the general tone given to 
 the mind. With their defective knowledge of 
 nature and their fabulous religion, the Ancients 
 cut their teeth, so to speak, on falsehood ; yet 
 they achieved intellectual greatness. With a much 
 wider knowledge of the truth, many modern nations 
 are plunged in intellectual darkness. What we call 
 " enlightenment " is nothing other than a relative 
 freedom from bias or prejudice and superstition 
 as we call it in other people. Openness of mind 
 enables us to use available knowledge, and discover 
 more. Compare Norway with Turkey, Japan with 
 Czarist Russia, the United States with the South 
 American Republics, ancient Rome and Greece 
 with mediaeval Europe, and the last with modern 
 Western Europe. If you would explain savages, 
 hearken to their witch doctors ; if ancient Greece, 
 read Herodotus, Thucydides, or a dialogue of 
 Socrates ; if mediaeval Europe, read the Athanasian 
 Creed ; if modern Europe, read Bacon, Gibbon, o.' 
 Lecky. The things St. Athanasius taught made 
 his people Christian and Catholic ; the way he 
 taught them made them barbarians. The things 
 Socrates taught were of no moment ; the way he 
 taught made Greece glorious. Among enlightened 
 peoples the great worker, thinker, or man of action 
 is honoured. Among more darkened nations the 
 great emotionalist for example, Peter the Hermit 
 and the Mahdi achieves influence. A country
 
 THE DEVELOPMENT OF MIND 49 
 
 which honoured St. Simeon Stylites could not 
 possibly have given birth to Homer, or Aristotle, 
 or Alexander, or Newton, or Darwin, or have 
 created the North American and Australasian 
 nations. 
 
 But more results from the teaching of bias than 
 a mere limitation of the mental horizon. Savages, 
 for example, are savage not only because they are 
 hedged about by a multitude of prejudices, but 
 also because of their short views and wild passions. 
 A bias is an imitation instinct, and as such is 
 founded on emotion. To the extent you bias a 
 child you foster passion. To the extent you train 
 him to weigh evidence you foster reason. It may 
 be difficult to judge from him alone ; you will be 
 apt to attribute his faults to " nature," and his 
 merits to your training. Consider, therefore, whole 
 communities, or sections of communities. Con- 
 sider, for example, the ecclesiastics of all religions 
 men usually learned, by profession mild, and, 
 according to their lights, conscientious and well- 
 meaning ; but always deeply biassed, and always 
 teaching bias. Among them we often meet lov- 
 able individuals sincere, broad-minded, unselfish, 
 altogether noble. But consider not only how little 
 they, as a class, are able to learn from fresh evidence 
 (hence their unending controversies and their 
 irradicable conservatism), but also the ferocity and 
 wickedness of their conflicts with thumbscrew and 
 rack as aids to argument, even in the case of the 
 mildest of religions. Was ever an ecclesiastic State 
 progressive and prosperous ? Was ever a priest- 
 ridden government other than corrupt and ineffi- 
 4
 
 50 PREVENTION OF VENEREAL DISEASE 
 
 cient, or a priest-ridden people other than poor, 
 turbulent, and exceedingly difficult to govern ? 
 If you doubt, examine the history and the prison 
 statistics, even the most modern statistics, of all 
 organised States. The criminal statistics especially 
 are interesting. The more authoritative a sect, 
 the more it founds its teaching on bias, the higher 
 is the crime-rate among its members as compared 
 to the rate among members of less authoritative 
 sects living in the same community. The fact is 
 you may inculcate an endless number of virtues 
 and convictions by means of authority ; but if you 
 carry your attempt to create bias far enough you 
 end by shaping a type of mind to which the practice 
 of many of those very virtues is impossible. Your 
 teaching of virtue becomes mere preaching. Philip 
 of Spain and Torquemada were, doubtless, much 
 instructed in favour of chastity and mercy ; but 
 Philip was not chaste, and Torquemada was not 
 merciful. 
 
 Revolutions, again, illustrate very vividly the 
 effect of different methods of training the mind. 
 There are two sorts of revolution. In the one kind 
 nothing happens except a change of rulers, and 
 perhaps some bloodshed. York succeeds to Lan- 
 caster. Even the expulsion of foreign conquerors 
 makes little difference. This sort of revolution, 
 in preparation if not in execution, is usually a 
 quick affair engineered by a few influential people, 
 and was common in mediaeval Europe, and is to-day 
 common in South America. All heavily biased 
 peoples (e.g. Hindoos and Mahomedans), if free to 
 conduct their own affairs, are liable to it. The
 
 second kind is a more tremendous thing. It is 
 accompanied, or rather caused, by a dissolution of 
 ancient bias, and, therefore, is always long in 
 preparation ; for the change of thought must first 
 permeate the masses. If the rulers have moved 
 with the people, it may be slow and bloodless in 
 action evolution rather than revolution. Pre- 
 cedent then broadens down from precedent. Thus 
 England altered during the Reformation and 
 subsequently. The new men were governed to a 
 much less extent than their predecessors by tradi- 
 tion. It was not so much that they acquired new 
 beliefs as that they learned and thought about 
 them in a new way. Hence the change of temper. 
 To York and Lancaster succeeded Shakespeare and 
 Drake, Burleigh and Bacon, the Puritans and 
 Presbyterians, and, when intellectual authority 
 returned for a little space, Hampden and Cromwell. 
 So the British started on their enormous career 
 a people, relatively speaking, Greek-like in their 
 common-sense reliance on evidence, and armed 
 therefore with a growing knowledge of nature. 
 
 But when the rulers have not moved with the 
 people this kind of revolution may be most terrible 
 and bloody as in France a century ago and in 
 Russia to-day. The ancient foundations of society 
 are then broken for ever. The old order passes 
 never to return. In the welter that follows, while 
 the populace is swayed this way and that by the 
 infectious fury of mobs, men are nothing, a man is 
 everything. Men of supreme ability, utterly with- 
 out bias and scruple, judging all things by the light 
 of a cold and selfish intelligence, tend to force
 
 52 PREVENTION OF VENEREAL DISEASE 
 
 their way to the front. To-day we, changed by 
 evolution, are shocked at the course of the Russian 
 Revolution. We perceive its horrors ; but I think 
 few suspect the dire Talleyrands and Napoleons 
 that even now may be quickening in its 
 womb. They will come surely, unless by happy 
 chance better men first appear, and are per- 
 mitted to guide into peaceful channels the 
 energies of the awakened giant. Judging by 
 the history of past revolutions, with peace we 
 may see a great people in Russia ; with war we 
 shall see great generals. War is the more probable. 
 Some form of autocracy is certain. Such a people 
 a people so trained in youth to bias cannot at 
 once achieve a democracy. It may, under the 
 influence of mob-infection, shed every bias im- 
 planted by the Orthodox Church, but the effects 
 of the training received during youth will endure 
 the emotionalism, the savage passions, the gul- 
 libility, the stupidity. The Chinese also have 
 their revolution. But they have changed not 
 their bias, but only their government. Among 
 them we shall see mediaeval Europe and modern 
 South America reproduced. The world is in 
 torment because it has eaten too much of bias. 
 It suffers the pangs of indigestion. As during the 
 decline of old Rome, there is not enough intelli- 
 gence to provide good government and policy. 
 Consider all the conflicts now raging. Invariably 
 the chaos is greatest among the peoples most 
 trained to bias. 
 
 There is this peculiarity about very biassed 
 people they are exceptionally ready to do evil
 
 THE DEVELOPMENT OF MIND 53 
 
 that good may come of it Hence the rack, and the 
 stake, and the Index Expurgatorius. In modern 
 times the evil very commonly takes the form of 
 a suppression of the truth. The biased man, 
 himself impervious to facts, dreads their influence 
 on the wisdom and constancy of his weaker brother. 
 This is the point that we must bear in mind in our 
 discussion of the venereal problem, for here there 
 has been much suppression of the truth. 
 
 We see, then, that it is in youth principally that 
 knowledge, skill, and character are acquired. 
 Knowledge is founded mainly on the instinct of 
 curiosity, and grows through experience. Skill in 
 thinking and acting are founded mainly on play- 
 fulness, and are developed through practice. 
 Character is founded mainly on imitation, and, of 
 course, is copied chiefly from the closest associates 
 of the child. If we bear these facts in mind, they 
 furnish us not only with valuable guides for the 
 training of children, and with explanations of much 
 in the characters of grown men and women, but, 
 as we shall see, they also provide the basis for our 
 judgment of the right and wrong of preventing 
 venereal disease. In this connection the following 
 is significant. Some parents and guardians are 
 austere, ruling their charges with a rod of iron. 
 Intimacy between a child and an austere person 
 is not impossible, for austerity is sometimes 
 tempered with geniality and kindness. When 
 intimacy with such people occurs, the child tends 
 to reproduce the guardian's character. When, as 
 more commonly happens, it does not occur, it is 
 rema.rka.ble how often the pupil tends to " go
 
 54 PREVENTION OF VENEREAL DISEASE 
 
 wrong " in later life. Knowledge and skill he may 
 acquire ; but frequently he develops just those 
 qualities which the austere person most dislikes 
 deceitfulness, slyness, lax morality, and the like. 
 In such cases much of the child's character is formed 
 out of the guardian's sight by his real intimates 
 with whom, sooner or later, he foregathers. Parents 
 of a second kind, often wealthy people, delegate 
 the training of their offspring to other hands 
 nurses, tutors, schoolmasters, chance companions. 
 They are never really intimate with their children, 
 and have no direct part in shaping their characters. 
 They, also, are frequently disappointed. The chil- 
 dren of poor people much more often resemble their 
 parents in disposition than do the children of 
 wealthy parents. A third sort of parent estab- 
 lishes from the beginning the closest intimacy with 
 his child. They play together during infancy and 
 childhood, and are companions in boyhood and 
 youth. Such a parent may endow his child with 
 many bad traits ; for he himself may be, for 
 example, dull, ignorant, and prejudiced. But 
 rarely, if ever, does the child of such a one " go to 
 the bad." If the reader reflects, he will find he 
 cannot call to mind a single instance to the con- 
 trary. So potent, because of the child's intense 
 imitativeness and because of the stability of the 
 traits of character acquired in early youth, is the 
 influence of intimacy and example. 
 
 It may be thought that I have assigned to 
 nurture a part too large, and to nature a part too 
 small, in the formation of the human mind. As a 
 fact their parts are equal. Man is the educable
 
 THE DEVELOPMENT OF MIND 55 
 
 animal. That is his nature, and on that basis 
 nurture builds. He is not, like the insect, confined 
 by mere instinct to the narrow groove trodden by 
 his ancestors for ages innumerable. On the 
 contrary, he is teachable, changeable, intelligent, 
 rational, capable of learning to adapt himself to 
 an endless variety of conditions which were quite 
 unknown to his predecessors. These are the 
 qualities which distinguish him intellectually from 
 other living beings, and have given him the mastery 
 over them. The insect has his little equipment of 
 instincts ; but man has his vast and ever-growing 
 armoury of traditional knowledge and skill in 
 thinking and acting knowledge which he has 
 learned to embalm in those immense and rigidly 
 accurate memories his books, skill in thinking, for 
 which he has invented such instruments as mathe- 
 matics, and skill and power in acting, in aid of which 
 he has devised his tools and machines. 
 
 Doubtless men differ by nature in mind as they 
 do in body. But while they may differ by nature 
 from one another in body in a million ways, they 
 can differ from one another in mind in only a 
 limited number of ways. On the one hand they 
 may differ in instincts not in kind, for the real 
 instincts of mankind are everywhere of the same, 
 but in degree. Thus one man may have a 
 stronger instinct of parental or sexual love, or 
 playfulness, or curiosity, or imitativeness, than 
 another, and as a consequence may learn to act 
 differently. Or one man, and this is a very 
 common cause of mental difference, may have 
 vastly the greater capacity for acquiring mathe-
 
 56 PREVENTION OF VENEREAL DISEASE 
 
 matical, musical, artistic, military, mechanical, or 
 any other kind of knowledge and skill. But mere 
 capacity without learning is nothing. As an 
 infant the greatest mathematician or musician had 
 no greater skill than a natural dolt. Two brothers, 
 even twins, may differ greatly in disposition, but 
 who can say what part of their differences was 
 due to nature and what to nurture ? Who can 
 say what subtle diversity of experiences may not 
 have given each his bent ? Both may be exceedingly 
 well endowed mentally by nature ; yet, if one 
 had learned nothing, he would have been an idiot, 
 and the other, if reared by natives in West Africa, 
 would have been a savage. Indifferent parents 
 and guardians are apt to excuse their own errors 
 by attributing the faults of their charges to original 
 sin, and shallow historians commonly ascribe all 
 national characteristics to race. But as John 
 Stuart Mill very truly says : " Of all vulgar methods 
 of escaping from the effects of social and moral 
 influences on the mind, the most vulgar is that of 
 attributing the diversities of conduct and character 
 to inherent natural differences." 
 
 The common sense of mankind, as expressed in 
 universal practice, has recognised the ductibility 
 of youth and the stability of maturity, and, there- 
 fore, the vital importance of early learning, training, 
 education, and example, not only in the sphere of 
 knowledge and skill, but also in that of character. 
 For that reason parents teach their children re- 
 ligion and morals, and seek to provide them with 
 schools and companions possessing a good tone. 
 All of us know that as the twig is bent so the tree
 
 THE DEVELOPMENT OF MIND 57 
 
 will grow. All of us know of the extreme diffi- 
 culty of changing a man's character once it has 
 matured and set. The moral of all this is that if 
 you wish your child to hold a particular attitude 
 of mind as a matter of bias, you must teach it to 
 him when he is very young. If you fail to do so and 
 he acquires a contrary bias, then, as a rule, you will 
 find it impossible to change him. Even if he has 
 grown up indifferent, even if he has acquired no 
 contrary bias, your task will be difficult. His 
 imitative instinct will have become feeble, and 
 before he changes he will require the production 
 of evidence and reason. 
 
 If sexual morality is to be taught at all, it must 
 be taught, like honesty, or chivalry, or religion, as 
 a matter of bias. It cannot be founded on evidence. 
 It follows that, if you wish to train your child to 
 habits of sexual morality, you must begin when he 
 is very young, when he is a mere child. If you do 
 not, or cannot, teach him as a child, if you leave 
 him to pick up his bias from chance companions, 
 then you must not blame him if, when grown, he 
 is immoral. The fault is primarily yours. You 
 had the twig to bend, and you did not bend it. 
 You had an awful responsibility, and you ignored it. 
 Or, if you yourself were bound by convention or 
 antecedent bias, the fault lies primarily with the 
 social system under which you were reared. In 
 any case, the child was helpless. If, having failed, 
 from whatever cause, to do your duty, you now try 
 to secure his poisoning, by preventing sanitation, 
 you are guilty of a crime greater than almost any 
 I can think of,
 
 58 PREVENTION OF VENEREAL DISEASE 
 
 The points I have tried to emphasise in the 
 foregoing pages are as follows : (1) The human 
 being is very educable. That is his especial 
 peculiarity, and the source of all his superiority 
 and power. But he is not in youth and maturity 
 educable in the same degree or in the same way. 
 (2) His mind reaches its convictions as to truth 
 and light in two ways, through bias, and through 
 evidence. (3) Bias is especially acquired during 
 childhood, through the imitative instinct. Adults, 
 except in so far as their minds are closed by ante- 
 cedent bias, tend to acquire their new convictions 
 through facts. (4) A conviction, reached through 
 evidence, is superior intellectually to one reached 
 through bias. The latter tends to close the mind. 
 Over-much training in bias is a principal cause of 
 the stupidity and savagery of individuals and the 
 stagnation and misgovernment of peoples. A very 
 biased man may be cunning. He can never be 
 really intelligent. (5) But there are many desirable 
 traits, for example, honesty and sexual morality, 
 indeed all that goes towards the formation of 
 character, which cannot be taught otherwise than 
 through bias. If, then, they are to be taught at 
 all, they must be taught to the very young.
 
 CHAPTER V 
 
 THERE is such a thing as a sexual instinct. 
 It is that which impels to the sexual act. 
 But there is no such thing as a moral instinct. 
 Morality is that which restrains the instinct. 
 No one could, or would, be moral unless he had 
 learned to be moral. The instinct, always the same 
 in kind if not in degree, is passed from generation 
 to generation by nature, and has endured, as a 
 necessary condition of racial existence, from 
 remote geological times. On the other hand, 
 morals, criteria of right and wrong, sexual and 
 other, are affairs of time and place, and are handed 
 on by tradition, and never last unchanged even for 
 historic time. They undergo alterations which, 
 especially under altering conditions of religion and 
 civilisation, may be very rapid. Thus at one time 
 or another, and at one place or another, everything 
 from promiscuous sexual intercourse to the most 
 rigid abstention from all sexual intercourse has 
 been held holy, or desirable, or permissible, or 
 damnable. In association with religions, many 
 fantastic systems of sexual morality have prevailed 
 and been held with fanatical devotion. To their 
 adherents all other ideas of right and wrong, 
 
 50
 
 60 PREVENTION OF VENEREAL DISEASE 
 
 ancestral or foreign, have seemed obviously absurd 
 or abominable as absurd and abominable as their 
 ideas seem to us. Even to think or speak of the 
 local and contemporary code in other than reverent 
 and acquiescent terms has everywhere and every - 
 when been considered wicked ; and thus ortho- 
 doxies, always changing but especially stable under 
 savage or barbarous conditions, have been main- 
 tained for thousands of years. The most terrible 
 sacrifices have been endured with triumph, and 
 the most hideous crimes committed with callous- 
 ness, in defence of moral codes. 
 
 All moral codes are systems of taboos, of con- 
 ventions, which restrain within recognised limits 
 actions of men living in association. As mental 
 habits they imitate the social instincts of lower 
 animals, but unlike the social instincts they are 
 not always exactly adjusted to secure the common 
 good. Without them, however, human society 
 could not exist ; for lacking ideas of right and 
 wrong, men would merely prey on one another. 
 There could be no society. Every moral system 
 has its peculiar features. Thus among Polynesians 
 various places and material things are taboo. 
 Hindoos particularly forbid certain articles of diet. 
 Among Christians, Jews, and Mahomedans, the 
 sexual instinct is particularly restrained. Formerly 
 in England only those sexual relations which had 
 obtained the sanction and blessing of the Church 
 were regarded as permissible. Lately there has 
 arisen a tendency to accept the sanction of the 
 State as sufficient. 
 
 The development of sexual moral ideas in the
 
 INCLINATION AND MORALITY 61 
 
 mind of the individual is governed by the same laws 
 as govern all other mental habits. They grow 
 most readily in, and are most easily eradicated 
 from, the minds of the very young. Given the 
 right conditions, that is, given uniform ideas in a 
 community, it is possible, as I say, to make children 
 believe that anything sexual is right or wrong. 
 Given a timely change to another orthodox com- 
 munity, it is possible to substitute in their minds 
 quite a divergent set of morals. But once the twig 
 is bent, change is usually impossible, and always 
 very difficult. Thus any very young Mahomedan 
 or Papuan child may be trained to the Christian 
 set of morals ; older children may also be trained, 
 though with more difficulty. But adult Mahome- 
 dans and Papuans tend to hold their beliefs and 
 ideas with a conviction as unalterable as our own. 
 To them our ideas seem wicked or foolish. The 
 reader should test these truths by examining his 
 own mind. Probably he was reared in England, 
 and acquired the local and contemporary bias. 
 Now that he is adult, would any amount of 
 argument, admonition, or even example, cause him 
 to change cause him to regard that as right 
 which he now regards as wrong, or that as very 
 wrong which now appears as a mere peccadillo ? 
 As he is, so are other men. Moral admonitions, 
 given to unconverted adults, are among the most 
 futile things in the world. They are heard with 
 dislike or contempt. Their proper r61e is to 
 accentuate the bias of the faithful. 
 
 The Christian moral code limits sexual intercourse 
 to legal husband with legal wife. But in addition
 
 62 PREVENTION OF VENEREAL DISEASE 
 
 to the code there is a convention, or taboo, more 
 or less prevalent in all Christian countries, but 
 especially prevalent in modern times, and more 
 especially among English-speaking peoples, which 
 prohibits familiar discussion of sexual matters 
 between people of different ages and different 
 sexes (except husband and wife). Grown men 
 discuss sexual matters freely among themselves, 
 and often are not chary of exchanging opinions 
 and experiences. Presumably the same is true of 
 women. But, in this particular, adults are most 
 careful to exclude children from their intimacies. 
 Parents are especially careful. They discuss many 
 things with their offspring, and set examples in 
 many ways in language, deportment, honour, 
 honesty, modesty, religion, patriotism, and the 
 like, but neither by word nor deed do they teach 
 their children anything about sex except extreme 
 reticence. The convention, which, as a fact, no 
 one is tempted to break, is far more rigidly and 
 universally honoured than the code, which many are 
 tempted to break, and which many do break. 
 
 In countries other than Christian the same 
 reticence, or the same degree of reticence, is not 
 observed. Conversation about sexual matters is 
 open and unabashed. Burton's Arabian Nights 
 conveys only the faintest notion of discussions, 
 ordinary conversations between men and women 
 in ordinary social gatherings with children present, 
 that I myself have heard in various parts of the 
 world. 
 
 In England very few people reach maturity 
 without learning about sex and its functions.
 
 INCLINATION AND MORALITY 63 
 
 Almost invariably they acquire the knowledge as 
 children from other children but little older than 
 themselves. A knowledge of sex is traditional 
 among boys, and I presume among girls. Most 
 men, no matter what their station in life, can recall 
 the freedom, even the obscenity of schoolboy 
 discussion, and the curiosity and interest the topic 
 excited. Parents commonly assume that their 
 children are ignorant. They forget their own 
 youth, and the reticence they themselves were 
 taught and have taught. The world has not 
 altered in a generation. An indication of boyish 
 knowledge, and a very common boyish outlook, 
 is afforded by the stuff which errand boys scribble 
 on doorways. Doubtless some parents succeed in 
 keeping their children, especially girls, ignorant of 
 the function of sex. But ignorance is not quite the 
 same thing as innocence, by which name it is usually 
 called. Nor is it the same thing as a right moral 
 tone an active abhorrence of irregular sexual 
 intercourse. Nor is it always desirable. I have 
 known girls infected with venereal disease who 
 first learned of the function of sex from the seducer, 
 and who were hardly conscious of wrong beyond 
 the breach of reticence with him. Some few 
 parents indeed try in a very distant and guarded 
 way to instruct and warn their children ; but 
 lectures, even when given to children, are immeasur- 
 ably less potent in shaping character than intimate 
 companionship. It follows that the real teachers 
 of sexual morality in Christendom generally, but 
 especially among English-speaking peoples, are 
 children. They alone reach impressionable youth
 
 64 PREVENTION OF VENEREAL DISEASE 
 
 in the most impressive way by familiar intercourse. 
 Later, when grown, the children may find adults 
 prolific in exhortation and admonition ; but by 
 then the plaster has set. Moreover, moral ad- 
 monitions are not usually heard by those who need 
 them most. The children teach ; the adults 
 preach. There is all the difference in the world 
 between real teaching and mere preaching. After 
 all, the admonitions of an ardently moral man are 
 no more likely to affect a contemptuously immoral 
 man than vice versa. 
 
 Again, most men, recalling the past, will realise 
 that since youth their outlook on sex has altered 
 little except in so far as marriage caused the change. 
 Marriage introduces new elements of which the 
 obligation to keep the plighted word, another 
 tradition taught by English boys, is not the least. 
 Most married men, whatever their antecedents, 
 " play the game." Women, as a class, are more 
 continent, and more convinced of the wickedness 
 of incontinence than men, in accord, I suppose, 
 with the general tradition handed on by girls to 
 one another. Doubtless the moral tone taught 
 by the very young varies vastly in different sections 
 of the community, but the general result is that a 
 great many people are incontinent after reaching 
 maturity. 
 
 We have, then, this extraordinary position of 
 affairs Christian peoples, who are also the most 
 civilised and enlightened of mankind, are, on the 
 whole, especially zealous in training their children. 
 Hence their schools and colleges. They recognise 
 more clearly than non-Christians that as the twig
 
 INCLINATION AND MORALITY 65 
 
 is bent so the tree grows. They are particularly 
 zealous in the cause of sexual morality. But, 
 governed by a convention, they leave the sexual 
 training of their children altogether to other chil- 
 dren ; that is to chance. It is remarkable that 
 precisely the people (e.g. the clergy) who are most 
 zealous in the cause of morality, are also those 
 who are most zealous in maintaining the convention 
 which renders the teaching of morality by them- 
 selves impossible. The result is that immorality is 
 very prevalent among Christians more prevalent, 
 as I think all residents abroad will agree, than 
 among the adherents of other religions. The sexual 
 codes of the latter differ from the Christian, and 
 in this or that particular are more, or less, re- 
 strictive ; but, such as they are, they are more 
 closely observed. Infractions of them are not 
 regarded by any section of the populace as mere 
 peccadilloes, but always as offences of great magni- 
 tude, greatly to be punished socially and legally. 
 In practice as well as in theory, in private as well 
 as in public, they are condemned by the whole 
 community. Since sexual matters are openly 
 discussed, the teaching is not mere preaching. 
 
 The evidence of sexual immorality among 
 Christians is voluminous. The birth-rate of highly 
 civilised peoples, who are all Christians, has been 
 falling owing to checks on conception, which are 
 regarded as even worse ecclesiastical crimes than 
 immorality. Beyond doubt these checks are used 
 even more by the unmarried than by the married. 
 Yet, even before the war, the illegitimate birth-rate 
 in some Christian communities approached and 
 5
 
 66 PREVENTION OF VENEREAL DISEASE 
 
 even passed the legitimate birth-rate. In Vienna 
 it was 51 per cent, of the total rate. Nothing 
 like this proportion can be found, for instance, in 
 Turkey, West Africa, or China. The fact that 
 about half the male population of England has been 
 infected with venereal disease gives some indication 
 of the prevalence of immorality among us. Pros- 
 titution has been termed the oldest of professions ; 
 but it has never more than touched the fringe of 
 a much wider female immorality. Necessarily 
 prostitutes, as a class, are much more diseased 
 than other women ; yet three out of four infected 
 soldiers acquire their disorders from " amateurs." 
 Doubtless sailors, since the shortness of their 
 sojourns on shore is a bar to the formation of 
 associations, acquire more of their diseases from 
 professionals ; but doubtless civilians acquire even 
 less. 
 
 Much the same amount of immorality appears 
 always to have prevailed in Christian Europe. 
 Now and then this or that community has reached 
 a good or bad pre-eminence. But the general 
 average appears to have been much the same during 
 all the ages. Every page of history during the last 
 two thousand years tells of widespread and lightly 
 tolerated unchastity. Revivals there have been, 
 but usually they have ended in debauchery. 
 Austerities there have been, but usually they have 
 ended in licence. Consider the history of the 
 kings of Europe, even of the devoutest kings of the 
 devoutest kingdoms during their devoutest epochs. 
 Consider the origin of many noble families. Con- 
 sider such institutions as the Droit de Seigneur.
 
 INCLINATION AND MORALITY 67 
 
 The fashion of immorality has changed somewhat 
 during the centuries ; it has become more open or 
 less open ; but the amount of immorality has 
 changed little, if at all. 
 
 With the experience of the ages before us, we 
 have no grounds for supposing that immorality 
 will be less in the future than in the past and the 
 present. The law is even more impotent to check 
 unchastity than to check venereal disease. When 
 the latter is acquired one person is injured, feels 
 resentment, and has cause for complaint. When 
 immorality occurs both parties are guilty, and 
 neither feels resentment. The act is private, and, 
 except in the case of married people, it is no one's 
 business to expose the offenders. Indeed the 
 scandal-monger is regarded not as a public bene- 
 factor, or as a policeman, but as a pest. Besides, as 
 already noted, civilised states, in proportion as they 
 are civilised, and as a condition of their civilisa- 
 tion, have ceased to punish by legal process moral 
 offences as such. They reserve the terrors of the 
 law for offences against the community for 
 offences, that is, in which one person by force or 
 fraud, and against the will of a second person, 
 infringes the legal rights of the latter. To God 
 has been left the punishment of offences against 
 God ; to man the punishment of offences against 
 man. Since morals are linked with religion, moral 
 offences are usually religious, and religious intolera- 
 tion is out of date. 
 
 Good teaching universally applied to the whole 
 community would certainly check immorality ; 
 for, as we have seen, except in the case of the
 
 68 PREVENTION OF VENEREAL DISEASE 
 
 mentally feeble, man is so educable that he may be 
 trained to accept anything as true or right provided 
 the surroundings be favourable that is, provided 
 his associates be all of the same opinion. If we 
 begin with the child, it is quite possible to create 
 such a bias for sexual morality of any sort (e.g. 
 English or Papuan) as to ensure a concordant 
 restraint of the instinct. The fact that many 
 people are moral through bias is proof in itself that 
 the requisite bias can be given to all ordinary 
 people. But this teaching, to be efficient, must 
 obviously be given by adults to children ; and good 
 teaching by adults in matters sexual is hopelessly 
 out of reach in England, where convention permits 
 only preaching. This convention, perhaps now 
 our strongest racial tradition, could not be modified 
 for ages. The community is all of one opinion as 
 regards it, but not as regards morals. It is popu- 
 larly esteemed as more sacred than morals. Every 
 preacher and almost every schoolmaster and parent 
 would oppose its abrogation. If these people, in 
 whose hands the future of the children lies, decline 
 to be familiar on any given topic with them, it is 
 hard to say how they can be forced to be familiar. 
 Besides, since the country is not of one mind as 
 regards morals, the abrogation of the taboo would 
 open the way for the immoral as well as the moral. 
 Venereal disease, therefore, is not likely to be 
 banished or even checked by an improvement in 
 public morality. The only conceivable alternative 
 is sanitation, which, as we shall see, can easily be 
 applied, and quite certainly be made successful. 
 Here, as always, sanitation means prevention,
 
 INCLINATION AND MORALITY 69 
 
 not cure. The question now arises whether it 
 is right to prevent venereal disease. If the 
 guilty suffer, the innocent must suffer also ; if 
 the innocent are saved, the guilty must escape 
 also. Here is the alternative that every man must 
 face. Shall the guilty be saved with the innocent, 
 or shall the innocent suffer with the guilty ? That 
 is the alternative. We cannot separate the sheep 
 from the goats. When considering familiar prob- 
 lems the judgment is liable to be obscured by 
 prejudice. Consider, therefore, a curiously similar 
 case. Suppose a great city stood in a plain, and 
 that in it were many who were wicked, but also 
 many who were just, what would the reader do if 
 he had power to inflict indiscriminate punishment, 
 or power to prevent it ? " And Abraham drew 
 near and said : ' Wilt thou also destroy the righteous 
 with the wicked. . . . Shall not the judge of all the 
 earth do right ? And the Lord said : ' If I find in 
 Sodom fifty righteous within the city, then will I 
 spare all the place for their sakes.' . . . I will not 
 destroy it for the ten's sake" It is a matter of 
 opinion as to whether wholesale and indiscriminate 
 poisoning should be employed as an aid to morality ; 
 but at any rate the Christian has very clear leading. 
 Formerly all diseases, especially when occurring 
 on a very large or unusual scale, were regarded as 
 punishments for sin, manifestations of the wrath 
 of the Deity, and best combated by prayer and 
 offerings, and a stricter adherence to the local and 
 contemporary system of taboos. Attention was 
 thereby diverted from sanitation, which, in any 
 case, was thought to be of doubtful piety and
 
 70 PREVENTION OF VENEREAL DISEASE 
 
 morality. " Where three doctors are gathered 
 together, there are always two atheists " is an 
 ancient saying. These ideas, though still current 
 in such places as New Guinea and Darkest Africa, 
 have been almost wholly abandoned in all civilised 
 states ; for microbes which spare neither the just 
 nor the unjust have been discovered, and modern 
 conceptions of justice do not accord with the 
 notion of indiscriminate punishment. They linger, 
 however, in certain classes in England with respect 
 to the venereal diseases which are so often plainly 
 and immediately consequent on immorality. But 
 even in the case of venereal diseases, they are 
 seldom very openly or confidently expressed. We 
 meet them in conversation and moral lectures 
 more often than in print. 1 
 
 The reasons usually assigned for opposition to 
 sanitary measures against venereal disease are : (a) 
 that such measures would be ineffective ; and (b) 
 that they would make vice safe and so encourage 
 immorality. These contentions are contradictory, 
 but are reconciled by the assertion (c) that, though 
 effective sanitary measures are impossible, the 
 public would believe in and practise them, with the 
 
 1 1 remember one such lecture given to military units in my 
 charge. I did not attend it, but I inquired subsequently of my 
 orderly. 
 
 What sort of a lecture was it ? " 
 
 Very good lecture, sir. The usual sort." 
 
 What did he say ? " 
 
 He said venereal disease was God's punishment for sin." 
 
 Well, what of it ? " 
 
 The men are saying, sir, that it can't be sinful to go with 
 virgins and respectable married women."
 
 INCLINATION AND MORALITY 71 
 
 result that both immorality and venereal disease 
 would receive an impetus. We shall have to deal 
 at length with the first assertion, and, therefore, 
 with the third. The second may be considered at 
 once. In passing, it may be noted that the ex- 
 treme importance attached to dread of venereal 
 poisoning constitutes in itself an admission of the 
 failure both of preaching and of such teaching as 
 is given to the public. 
 
 It is, of course, a matter of opinion as to whether 
 elimination of the fear of contracting disease would, 
 on the whole, cause an increase of immorality. 
 From the nature of the case no direct evidence is 
 available. Any man who knows the ordinary life 
 of the community is, on the average, in as good a 
 position as any other to reach a right conclusion. 
 A lawyer or a doctor is perhaps well placed. A 
 "man of the world " is exceptionally well placed. 
 A clergyman or an old maid is exceptionally badly 
 placed. Judgments will necessarily depend a good 
 deal on mental habits on whether opinions are 
 habitually founded on probabilities or on bias. 
 The reader must form his own opinion. I can only 
 give the reasons which have led me to mine. 
 
 Doubtless some men are chaste for no higher 
 reason than because they dread infection, and have 
 no opportunities of gratifying their desires without 
 danger ; but I think not many. This kind of man 
 is apt to dally with temptation and eventually 
 succumb to it. The consistently moral man hates 
 immorality and, therefore, is never even exposed 
 to temptation. One would not expect to see 
 an Archbishop or a member of the N.C.C.V.D.
 
 72 PREVENTION OF VENEREAL DISEASE 
 
 exchanging glances, or opinions concerning the 
 weather, with a lady of the pavement. Men who 
 know much about venereal diseases are less moral 
 than women who know relatively little. Of all 
 young men medical students know most, and are 
 perhaps the least famed for austerity. As we have 
 seen, prostitutes are necessarily more infected with 
 disease than other women ; yet soldiers acquire 
 three-fourths of their infections from amateurs 
 a fact which indicates on the one hand the extent 
 of private female immorality, and, therefore, the 
 futility of attempting to control only prostitutes by 
 licence or otherwise, and on the other hand the 
 fact that drunkenness is not often an antecedent 
 to infection ; for the amateur, who usually sins 
 after dark in the open air, seldom chooses drunken 
 partners, and is seldom drunken herself. There is 
 a terrible superstition very current among the 
 ignorant that venereal disease may be cured by 
 " passing it on." Above all, fear of infection 
 causes many men to seek satisfaction of their 
 desires from " decent " women, as many an un- 
 happy girl has found to her ruin. If is from the 
 ranks of these unfortunates that the whole army of 
 prostitutes is recruited ; for no woman voluntarily 
 begins a career of immorality as a prostitute. On 
 the whole, then, as far as I am able to judge, 
 venereal disease does not check immorality, but 
 tends vastly to increase it. 
 
 A desire to prevent sin is one thing. A desire to 
 secure the poisoning of the sinner is quite another 
 thing. Unless it can be demonstrated that 
 venereal disease tends on the balance to keep the
 
 INCLINATION AND MORALITY 73 
 
 sinner moral, any attempt to obstruct the appli- 
 cation of sanitary measures to these disorders is 
 merely an act of vengeance. Poisoning, even if 
 limited to the guilty, and even if it were a real 
 deterrent, is not a moral means of promoting 
 morality. It matters not who hands out the 
 poison. If we, directly or indirectly, secure its 
 administration, we are as guilty as the actual 
 poisoner. In fact, while the poisoner has some 
 excuse, we have none. He or she is tempted, 
 or in want. We are actuated by what is indis- 
 tinguishable from unrelieved cruelty. It is folly 
 to argue that sinners suffer through their own 
 fault. As we have seen, the fault is not entirely, 
 or even primarily, theirs. It lies mainly with 
 the system which renders moral teaching, as 
 distinguished from mere preaching, impossible, 
 and therefore renders immorality inevitable. At 
 the present day the strenuous opponents of sanita- 
 tion are, as already indicated, just the people who 
 most uphold the system of reticence. But you 
 cannot have your cake and eat it too. If you 
 neglect your duty to teach, you must not reserve 
 a right to poison. 
 
 Doubtless there have been campaigns of purity 
 in the past. But the children were always neg- 
 lected, the campaigns were quite ineffective, and 
 now are forgotten. During the last two generations, 
 the zeal of the virtuous has slumbered profoundly 
 unless some one has tried to prevent disease. Then, 
 and then only, has zeal flamed into passion, and 
 passion been translated into action. Then only 
 have campaigns of purity been undertaken. The
 
 74 PREVENTION OF VENEREAL DISEASE 
 
 trees of the wood have been warped by a strong 
 and steady breeze. Let a man try to prevent 
 canker, and virtue awakes and perceives that his 
 breath causes the warping. Shall innocent youth 
 the errand and public school boy, the sailor and 
 the soldier, the factory hand and village lad 
 receive evil suggestions ? Shall the pure mirror of 
 his mind be tarnished ? The sufferings of the 
 innocent ! What are the sufferings of the innocent 
 to the guardians of innocence ? So the reformer 
 is checked, virtue returns to its slumbers, and the 
 land continues to reek with immorality and 
 disease. But the day of this kind of virtue is 
 passing. There are those who regard the innocent 
 as even more important than innocence, and who 
 are determined to teach sanitation and make an 
 end of all this insincerity, and humbug, and oil, 
 and grease. I do not know how, or by whom, 
 they can be prevented from imparting knowledge 
 of a kind that spreads very rapidly.
 
 CHAPTER VI 
 
 MICROBIC DISEASES 
 
 MANKIND is a parasitic species, preying on 
 lower types, plant and animal. But it 
 also has its parasites. Almost every disease from 
 which human beings suffer, indeed almost every 
 disease that affects animals and plants, is caused 
 by microbes, themselves animals or plants, minute 
 living entities which multiply in, or on, the bodies 
 of their " hosts," and so set up the various maladies 
 tuberculosis, malaria, dysentery, epidemic diar- 
 rhoea, cholera, typhus fever, influenza, typhoid 
 fever, smallpox, measles, common cold, whooping- 
 cough, chicken-pox, bronchitis, pneumonia, scar- 
 latina, septicaemia, tetanus, trench fever, hydro- 
 phobia, diphtheria, rheumatic fever, syphilis, gon- 
 orrhoea, soft chancre, yellow fever, sleeping sickness, 
 boils, abscesses, toothache, ringworm, itch, plague, 
 spotted fever, ophthalmia, erysipelas, gangrene, 
 leprosy, mumps, puerperal fever, appendicitis, 
 quinsy, rinderpest, swine fever, foot-and-mouth 
 disease, anthrax, fly sickness, fowl cholera, 
 distemper, silk-worm disease, and a host of 
 others. All decay is caused by microbes. Lack- 
 ing them life would cease, for the earth would 
 become encumbered with imperishable dead 
 
 75
 
 76 PREVENTION OF VENEREAL DISEASE 
 
 bodies. Fairy rings are caused by microbes, 
 which enrich the soil with plant food. If a 
 fire be lighted in a field so that the soil is 
 thoroughly roasted, the grass perishes. But, after 
 a season, it returns and grows with greater vigour 
 than in the surrounding area. In the soil are, 
 among others, two species of microbes, one a kind 
 beneficial to plants, the other a larger type which 
 preys on the first, and secures its victims by means 
 of powerful poisons or toxins. The first returns 
 the more quickly after the fire, and, multiplying un- 
 checked, increases the fertility of the soil, till its 
 enemies increase and thin it out again. In the 
 unseen but indubitable world that lies beyond the 
 ken of human eyes, and even beyond that of the 
 microscope, lies a great and complex universe of 
 eager and sometimes very terrible life. Every drop 
 of sewage water contains its millions of microbes ; 
 every pin-point of our skins teems with its inhabi- 
 tants. 
 
 Each disease is caused by a separate kind of 
 microbe. The diversity of the diseases of animals 
 and plants gives an index of the diversity of disease- 
 producing microbes which are only a fraction of 
 the total number of the different kinds. Most of 
 the disease microbes are purely parasitic, and, 
 therefore, cannot persist away from the animal or 
 plant which is their proper host. Many are so 
 specialised that they are able to persist only on, 
 or in, particular parts of the body. Thus the 
 microbes which cause diphtheria inhabit the throat, 
 those of malaria the blood, those of typhoid fever 
 the bowels, and so on. Man cannot acquire any
 
 MICROBIC DISEASES 77 
 
 of the diseases caused by them except directly or 
 indirectly from other men. They are never con- 
 tracted in solitudes, and, until introduced by 
 travellers, are absent from isolated populations 
 for ages. But the microbes of some few diseases, 
 for example, tetanus or lock-jaw, and septicaemia 
 or blood-poisoning, normally inhabit the outer 
 world and attack man only accidentally. These 
 foreign " pathogenic " microbes are all intensely 
 poisonous, and so are able to set up disease and 
 persist in the host by lowering his powers of 
 resistance. But ordinarily their poisons are used, 
 like those of the big microbes of the soil, against 
 their natural microbic enemies or prey. 
 
 Before the discovery of microbes, doctors 
 treated disease almost entirely by means of medi- 
 cines and the knife. In that era, which was not 
 very long ago, probably no more dangerous animal 
 could be introduced into a house than a doctor 
 with his boluses and his blood-lettings, and his 
 dirty hands and instruments and bandages, and 
 his denial of fresh air and light. Even at the 
 present day most of his medicines are of very 
 trifling use. To be of considerable value they 
 should either kill the microbes or else counteract 
 their poisons. Apart from vaccines, and the like, 
 no medicines are known which counteract the 
 poisons. Plenty of drugs (antiseptics) are known 
 which quicklyand certainly kill all sorts of microbes. 
 The difficulty is to get the antiseptic to them 
 in sufficient strength. When the microbes are 
 situated on the surface, or some easily accessible 
 part of the body, the problem is simple. The whole
 
 78 PREVENTION OF VENEREAL DISEASE 
 
 wonderful advance of modern surgery is due to 
 the fact that surgeons have learned to disinfect 
 their patients' skins and their own hands and 
 appliances. But when once the microbes have 
 found entry into the body and set up disease, the 
 problem is usually insoluble. The microbes and 
 their victim are equally living beings. What is 
 poisonous to the one is poisonous to the other also. 
 If an antiseptic were given as a medicine it would 
 kill the sufferer long before it affected his assailants, 
 for it would reach the former in a concentrated 
 condition, but the latter diluted by the blood 
 fluids of the host. Very few drugs are known which 
 are so much more poisonous to the microbes than 
 to the sufferer that they can be used as medicines. 
 Quinine, in the case of malaria, is one ; mercury, in 
 the case of syphilis, is another. But both are only 
 very slightly more poisonous to the microbes than to 
 their host. They can be given in doses only suffi- 
 cient to reduce very gradually the vitality of the 
 microbes, and so ultimately destroy them. There- 
 fore, recovery under the influence of these drugs 
 is slow and most uncertain. Beyond comparison, 
 prevention is better. 
 
 Most, or all, vegetable medicines are poisons 
 manufactured by plants as means of protection 
 from the animals that consume them. Thus 
 opium, strychnine, and nicotine are nerve poisons 
 which protect the poppy, nux vomica, and tobacco 
 plants. Their abominable nastiness of taste serves 
 the same purpose. Doctors think, and indeed 
 have proved, that by giving a little of these poisons 
 they sometimes produce beneficial results. Thus
 
 MICROBIC DISEASES 79 
 
 opium reduces pain, and quinine poisons the 
 malaria parasite. Many animals also produce 
 poisonous or distasteful substances which they use, 
 consciously or unconsciously, for purposes of offence 
 or defence. 
 
 Man, as we have seen, is the educable animal. 
 His body as well as his mind is educable. If we 
 begin with small doses of some vegetable or 
 animal poisons we become so used to them that 
 ultimately we are able to tolerate much larger 
 doses. Opium and nicotine are examples. A 
 resident in a place where mosquitoes or sandflies 
 are prevalent suffers less from their poisons than 
 newcomers. There are two ways in which a man 
 may be trained to tolerate poisons. He may, as 
 in the case of nicotine, habituate himself by be- 
 ginning with small doses and then gradually in- 
 creasing their volume. A quicker and a better 
 way is to begin with the poison more or less chemi- 
 cally altered and so weakened. Thus one man may 
 swallow without injury a dose of snake venom 
 sufficient to kill a thousand men if it be injected 
 under their skins. Thereafter, for a time at 
 any rate (while he remains educated, while his 
 body remembers), he is immune to the bite of 
 the same kind of snake as produced that poison. 
 The swallowed poison, partially digested in the 
 stomach, has entered his blood, and, instead 
 of destroying him, has trained him to resist the 
 unaltered venom. If we take matter from the 
 pustule of a man who is ill of smallpox and inocu- 
 late a calf, the animal gets not typical smallpox, 
 but cowpox. If matter from the cow be transferred
 
 80 PREVENTION OF VENEREAL DISEASE 
 
 to another man, the latter is vaccinated. He 
 develops a weakened and altered smallpox, and is 
 thereby so trained that he becomes resistant to 
 the virulent disease. So wonderful are man's 
 powers for education, that in some cases it is even 
 possible to train him against a disease when he is 
 actually suffering from it. Thus in rabies and 
 diphtheria, cure is achieved by injecting weakened 
 toxins which serve as stepping-stones towards 
 immunity. When a man is infected by a kind of 
 microbe which produces and sets free much poison, 
 he develops fever. Recovery means that he has 
 been able to get used to the poison ; death that he 
 has found habituation impossible. After recovery, 
 for a period which as a rule is lifelong in the 
 case of some diseases (e.g. chicken-pox), but often 
 of shorter duration in the case of others he 
 retains his immunity ; that is, he remains habi- 
 tuated. By far the greatest advance achieved by 
 the art, or, as it is now becoming, the science of 
 medicine, has been due to the discovery of edu- 
 cating serums and vaccines. 
 
 The greater triumphs, however, have fallen not 
 to the physician, but to the sanitarian. The 
 microbes of disease enter and leave the bodies of 
 their victims by various channels, and by means 
 adapted to the ports of entry and exit. If we 
 would prevent disease, we must learn the life-history 
 of the different kinds and their modes of travel, 
 so as to be able to cut the line of passage at some 
 point. That is the science of sanitation. 
 
 Some microbes, for example, those of common 
 cold, influenza, measles, smallpox, chicken-pox,
 
 MICROBIC DISEASES 81 
 
 whooping - cough, mumps, and diphtheria, are 
 air-borne. They are inhaled by the infected 
 person, multiply in his air-passages, or in some 
 part (e.g. his blood) whence they have access to 
 the air-passages, are exhaled again, and so reach 
 fresh victims. Most air-borne microbes, for in- 
 stance, those of measles and smallpox, are minute 
 beyond the ken of the microscope, and float in 
 the air as the finest dust. They are, therefore, 
 very infective, and occasionally cause great and 
 even world-wide epidemics. Others, for instance, 
 those of diphtheria, are larger and heavier, multiply 
 more slowly, and are less infective. It is claimed 
 that the microbe of influenza has been seen and 
 recognised, but probably this is an error, for the 
 disease is so very infective that, to judge by analogy, 
 its microbes should be excessively minute. Or- 
 dinary sanitary measures have quite failed to 
 prevent air-borne disease. The volume of the air 
 is too vast, and its flow too swift and erratic, for 
 effective disinfection and control. All air-borne 
 diseases, therefore, are as common as ever they 
 were. Even smallpox in its modified form of 
 vaccination has not diminished. The substitution 
 of a milder disease for virulent smallpox is never- 
 theless a triumph of preventive medicine. 
 
 The microbes of earth-borne disease, of which 
 the principal is tuberculosis, are large and heavy. 
 The tubercle bacilli are coughed from infected 
 lungs and fall, enclosed in droplets of fluid, to the 
 floor of dwelling-houses, whence, when dried, they 
 are swept into the air again and inhaled with the 
 dust. Light and air are inimical to the microbes, 
 6
 
 82 PREVENTION OF VENEREAL DISEASE 
 
 which are essentially inhabitants of such dark, 
 ill-ventilated houses as are found in Northern 
 Europe. Sanitation has achieved something against 
 earth-borne diseases, and will achieve more by 
 improving, especially in great cities, the conditions 
 under which human beings dwell. 
 
 The microbes of the water and food-borne dis- 
 eases, of which cholera, dysentery, typhoid fever, 
 and epidemic diarrhoea are the chief, are swallowed, 
 inhabit the alimentary canal, and leave the victim 
 with his excreta. Flies may carry them to fresh 
 articles of food, or they may infect drinking-water. 
 Sanitation has achieved some of its greatest suc- 
 cesses against them. None of the diseases caused 
 by them are now common in England, with the 
 exception of epidemic diarrhoea, which is communi- 
 cated mainly by milk infected by flies, and, there- 
 fore, especially attacks infants and children. All 
 our common sanitary measures, for example, 
 closed drain-pipes, disinfection of drains and other 
 infected areas, and protection of food and water, 
 are directed against these disorders. The mi- 
 crobes are large and heavy. It is possible that 
 they may sometimes be transported in the dust of 
 dried excreta by the wind, but it is not probable 
 that this is often the case. 
 
 Insect-borne diseases form a large and important 
 class, which, however, proper sanitation has re- 
 duced to insignificance in England. The microbes 
 inhabit the blood of the sufferer, whence they are 
 sucked by biting insects, which introduce them 
 into fresh victims. Typhus, or gaol fever, is 
 conveyed by the body louse. It was formerly
 
 MICROBIC DISEASES 83 
 
 common in the filthy prisons of the past, and has 
 been banished from among us by a personal clean- 
 liness which is not so habitual in Eastern Europe. 
 The " Trench Fever," from which the armies of 
 all nations suffered during the late war, is conveyed 
 by the same insect, and came from Eastern Europe, 
 whence it was brought to the Western Front by 
 German soldiers. Malaria and yellow fever are 
 carried by the mosquito. Malaria was formerly 
 present in England, but was banished by the 
 draining and reclamation of swamps, the breed- 
 ing grounds of the mosquitoes. It was absent in 
 Mauritius, though the right kind of mosquitoes 
 was plentiful, till infected coolies from India 
 were introduced. Thereafter it became a pest. 
 Anciently it seems to have been absent from the 
 south of Europe, though here, too, the mosquito 
 appears to have been present. Apparently the 
 microbes were introduced by infected Greek and 
 Roman soldiers from Asia and Africa. Since then, 
 for some 2000 years, it has been a terrible scourge, 
 almost depopulating great areas such as the Cam- 
 pagna, near Rome. Until lately, it was very pre- 
 valent among the rice fields in Northern Italy, on 
 which account the Government of the country 
 closed the fields for five years, allowing them to 
 dry. When they were re-opened, mosquitoes 
 became prevalent ; but malaria was absent till the 
 later years of the war, when it was re-introduced 
 by infected British troops from Greece. Sleeping 
 sickness is carried from victim to victim by the 
 tze-tze fly. Plague is properly a rat disease, which 
 is conveyed by the rat flea. When many rats,
 
 84 PREVENTION OF VENEREAL DISEASE 
 
 dead without apparent cause, are found in India, an 
 epidemic of plague is feared. Deprived of their 
 natural food by the death of the rats, the fleas 
 attack human beings. The most terrible pestilences 
 of the past the vast epidemic in the sixth century, 
 the Black Death in the fourteenth century, and the 
 Great Plague in the seventeenth, for example were 
 due to this disease. But probably it has now been 
 banished for ever from Western Europe by the 
 reduction of the rat population in dwelling-houses. 
 
 The last important group of infectious diseases 
 is that constituted by the contagious maladies, 
 which, as the name implies, reach the victim through 
 his surface by actual contact with an infected 
 person or thing. All the infectious skin diseases, 
 ringworm, scabies, and the rest, belong to this 
 group ; as do also the infectious surgical com- 
 plaints, septicaemia, pyremia, erysipelas, gangrene, 
 tetanus, cellulitis, abscess, boils, ulcers, carbuncles, 
 wound infections, and almost every condition 
 with which pus is associated. Last but not least 
 the venereal diseases are all strictly contagious. 
 
 The organisms which cause skin diseases are, 
 necessarily from their mode of life, of a hardy 
 habit and most difficult to destroy. Like all 
 living beings, they are killed by antiseptics used 
 in sufficient strength ; but since antiseptics also 
 injure the human victims, they can be used only 
 in such strength as to slowly poison the microbes 
 when once the latter have penetrated into the 
 skin. Preventive measures are difficult, because 
 the relative rarity of these diseases lulls vigilance, 
 and because the vehicles of infection are various
 
 MICROBIC DISEASES 85 
 
 a hand shaken in friendship, a cap, a brush, a 
 pillow, a sheet, a towel, and the like. 
 
 Surgical fevers are all caused by species of 
 microbes which normally live outside the human 
 body, and invade it only under conditions exception- 
 ally favourable to themselves. Necessarily, like 
 the microbes of skin diseases, they are hardy and 
 relatively difficult to kill. Normally, we are pro- 
 tected from them by our skins, which are, from the 
 nature of then' function, the hardiest and most 
 resistant of our tissues. The skin is a bottle, 
 much of the contents of which are fluid and for the 
 microbes highly nutritious. A breach of the skin 
 exposes to the microbes a cavity filled with, or a 
 surface coated with material in which they are 
 able to multiply and flourish. At first they are 
 unable to exist in living tissues ; but when once 
 established in the dead fluids in or on a wound, 
 they tend swiftly to gather virulence till at last 
 they are able to invade and destroy even living 
 tissues. When they have become so virulent, or 
 their victim has become so enfeebled, that they 
 are able to spread over the whole body, the death 
 of the sufferer is inevitable. Our means of curing 
 the graver surgical diseases are exceedingly feeble. 
 Medicines are quite useless. A hopeful future 
 awaits serums and vaccines, but as yet they have 
 not achieved great success. Antiseptics cannot 
 reach the microbes once they have drifted far into 
 the lymph spaces or penetrated into the tissues. 
 But preventive measures have revolutionised the 
 whole art and science of surgery. Not here, as 
 in skin diseases, is there any uncertainty as to the
 
 86 PREVENTION OF VENEREAL DISEASE 
 
 time and mode of infection. Unless the injured 
 individual is very resistant, or the conditions very 
 favourable, infection is certain in the case of every 
 wound, accidental or made by the surgeon, no 
 matter how slight, unless it is quickly sealed by 
 drying blood clots (as in a scratch), or unless swift 
 precautions are taken. If the wound is accidental, 
 the surgeon proceeds without a moment's delay 
 to disinfect as far as lies in his power. If he is 
 about to make the wound himself he takes the most 
 minute and elaborate precautions to disinfect the 
 patient's skin, and his own hands, instruments, 
 and dressings. He knows that in some cases 
 possibly, and in others probably, and yet others 
 certainly, death must follow unless his precautions 
 are sufficient. As the result of a perfected 
 technique, he is now able, as a commonplace of 
 surgical practice, to undertake operations of which 
 his immediate predecessors hardly dreamed. His 
 predecessors were not less skilful with the knife, 
 but they knew not how to guard against septic 
 infection. Timely disinfection is to-day so much 
 a recognised and established article of surgical 
 procedure, that if any surgeon knowingly or un- 
 reasonably neglected it, he would be liable to the 
 most serious legal consequences for malpraxis. 
 For instance, if it could be proved that he knew, 
 or had grounds for suspecting, that the microbes 
 of septicaemia were on the surface or in the neigh- 
 bourhood of a wound, of which he had undertaken 
 the care, and that he had not immediately done 
 his best to destroy or remove them, a prosecution for 
 manslaughter would lie against him, I think no
 
 MICROBIC DISEASES 87 
 
 one would more cordially approve of the infliction 
 of a severe punishment than his own professional 
 brethren. Some few surgeons, it is true, fearing 
 the poisonous or corrosive action of antiseptics, 
 do not use them, or use them only to a minimal 
 extent in their practices ; but they invariably 
 substitute for disinfection even more elaborate 
 means of preventing the access of the dreaded 
 microbes. 
 
 Venereal diseases resemble the surgical fevers, 
 in that infection occurs only under very special 
 conditions. The time and manner of infection 
 are exactly known, and in the vast majority of 
 instances may be anticipated. They are, there- 
 fore, much more easily warded off than the surgical 
 poisonings. Their assault is almost always de- 
 livered on the genital organs, which, in the male at 
 least, are extremely accessible, and so shaped as 
 to be susceptible of quick, easy, and thorough dis- 
 infection. Moreover, the microbes, owing to their 
 protected and changeless modes of existence, are 
 extremely delicate and easily destroyed. For a 
 space they lie naked and unprotected on the surface. 
 It is only after an appreciable lapse of time that 
 they penetrate into the pipe and below the skin. 
 But, once they have passed from the surface, the 
 power of the sanitarian ends, and the slow, difficult, 
 and uncertain work of the physician begins. 
 Thereafter, for weeks, or months, or years, it may 
 be for the remainder of life, the sufferer is an 
 animated magazine of microbes, a misery to himself, 
 and a danger to all his fellows, but especially to 
 his wife and children.
 
 88 PREVENTION OF VENEREAL DISEASE 
 
 The reader perceives the importance of knowing 
 exactly how the microbes of disease reach and 
 enter their victims. Human beings are now so 
 crowded together, and the facilities for the passage 
 of microbes from victim to victim so great, that, 
 lacking intelligent sanitation, modern civilisation 
 would be impossible. It is true that even before 
 the discovery of microbes, sanitary science had 
 made some progress ; but it fumbled in the dark. 
 Jenner introduced vaccination, but knew not how 
 it acted. Cities were drained, and drains were 
 sometimes closed ; but still they leaked into the 
 water supply and were accessible to flies. The 
 importance of isolating the microbes was not 
 understood. When plague last devastated Lon- 
 don, the authorities lighted fires in the street and 
 thanked God for the burning of half the town, 
 whereby, as a fact, multitudes of rats were de- 
 stroyed. When cholera invaded military stations 
 in India, the authorities, thinking it was air-borne, 
 marched the troops across the wind, drinking 
 what they liked on the way, and utterly careless 
 of their excreta infected and infecting. Sur- 
 geons washed their hands after, not before, opera- 
 tions, and ascribed the terrible septic diseases 
 which swept through hospitals to " miasma." 
 Even thirty years ago, supposing the microbes 
 which poison wounds were air-borne, they operated 
 in clouds of carbolised steam. 
 
 Modern sanitation has almost swept away the 
 food and water-borne diseases from England. It 
 has almost eliminated the insect-borne diseases. 
 It has greatly reduced the incidence of the earth-
 
 MICROBIC DISEASES 89 
 
 borne diseases. Leprosy, apparently an earth- 
 borne disease, has disappeared. Tuberculosis has 
 diminished ; but since it is difficult to detect in its 
 beginnings, and is a disease of long duration, it 
 will probably long be with us. Speaking generally, 
 the sanitary campaign against air-borne diseases 
 has totally failed. Vaccination appears to be the 
 only remedy in sight ; but as yet the only air- 
 borne disease effectually dealt with by this means 
 has been smallpox. Against contagious diseases 
 as a class, sanitation has proved highly successful, 
 and there is no conceivable reason why the fre- 
 quency of all these maladies should not be as greatly 
 reduced as those of the surgical fevers, provided 
 the public be adequately instructed. 
 
 According to the way in which microbes travel, 
 the prevention of infectious diseases must be mainly 
 the work of public authorities or of private in- 
 dividuals. It is the duty of Departments of Health 
 to watch water and food supplies, and provide 
 sufficiently for drainage, light, ventilation, isolation 
 of the sick, and the cleanliness of people in places 
 of public resort ; or, in other words, to protect 
 the community from air, water, food, earth, and 
 insect-borne diseases. The individual himself must 
 take action against contagious diseases. The 
 public authorities can do no more than tender 
 advice, and, in some cases, prosecute glaring 
 offenders for example, people who neglect their 
 children. The authorities are helpless as regards 
 surgical fevers, for which no one is directly blame- 
 able, except, perhaps, now and then a careless 
 doctor or nurse whose neglect is usually difficult
 
 90 PREVENTION OF VENEREAL DISEASE 
 
 to detect, and still more difficult to prove. Some 
 one is usually blameable for each case of venereal 
 disease, but the victim dares not complain, and in 
 any case has no real remedy. 
 
 The connection with immorality has brought 
 venereal diseases within the range of the taboo 
 which surrounds with reticence, bias, ignorance, 
 and stupidity all that relates to sex. Here, as we 
 have seen, is the last stronghold of the belief that 
 diseases are punishments for ecclesiastical offences. 
 The task of the sanitarian has been complicated by 
 the preacher, who has supposed himself an author- 
 ity, and has conceived his exhortations to adults 
 as having an influence on morality. Free discussion, 
 both of the moral problem and that of prevention, 
 has been made impossible ; and, as a result, the 
 legend that venereal disease prevents sin, and the 
 savage notion that poisoning is a legitimate means 
 of promoting morality, are still current. People 
 accept these notions much as they formerly accepted 
 the notions that witches were damnable, and the 
 church infallible. There is no veil like the veil of 
 familiarity. Even medical men, those atheistical 
 miscreants, have been affected.
 
 CHAPTER VII 
 
 METCHNIKOFF 
 
 THE origins of venereal diseases are lost in the 
 mists of antiquity. There is a popular 
 notion, founded on a great epidemic which occurred 
 in Europe at the end of the fifteenth century, that 
 they were imported from America ; but " (1) un- 
 doubted evidence of diseases of the genitals due to 
 lewd or impure sexual gratification comes to us 
 from every period of the -world's history, even from 
 biblical and mythical times ; l (2) it is more espe- 
 cially the venereal catarrh of the urethra (clap), 
 and its consequences, whose occurrence may be 
 followed with certainty into the remotest periods 
 of antiquity ; (3) minute descriptions of ulcerous 
 conditions of the male or female sexual organs are 
 found not only in the ancient and mediaeval com- 
 pendiums of medicine and in the prescription-books, 
 
 1 For example : " The Scythians became masters of Asia. . . . 
 In their return, however, they came to Ascalon, a city of Syria, 
 and when most of them had marched through without doing 
 any injury, some few, who were left behind, pillaged the temple 
 of Celestial Venus . . . the goddess inflicted on the Scythians 
 who robbed her temple at Ascalon, and on their posterity, a 
 female disease ; so that the Scythians confess that they are 
 afflicted with it on this account, and those who visit Scythia 
 may see in what a state they are whom the Scythians call 
 Enarees." Herodotus, i. 103. 
 
 91
 
 but also in the erotic and satyric poets of Greece 
 and Rome, as well as in many chronicles of the 
 Middle Ages ; and these sores, when we bear in 
 mind the frequency with which they occurred, and 
 the indications sometimes given as to their origin, 
 cannot be regarded as other than venereal affec- 
 tions, that is to say, as chancres, or primary syphil- 
 itic ulcers." l 
 
 During mediaeval times only low-class prac- 
 titioners were supposed to treat venereal diseases ; 
 hence, probably, the scantiness of the historical 
 records. Modern times have produced an enor- 
 mous literature dealing with pathology and treat- 
 ment, but only a very scanty literature of pre- 
 vention. The few doctors who have tried to pro- 
 mote it have been denounced as miscreants, have 
 had their means of subsistence endangered, and 
 have even been threatened by their own colleges. 
 Unfortunately, college authorities, like ecclesiastical 
 dignitaries, are sometimes ancient biased men in- 
 capable of appreciating new ideas. 
 
 As a fact, the ordinary doctor has little induce- 
 ment to think about the prevention of venereal 
 disease, and little opportunity of practising it. 
 Patients consult him after, not before, infection. 
 In a medical experience of more than thirty years 
 I do not remember an occasion when I was asked 
 to advise on the prevention of disease though I 
 have been asked scores of times, alike by the married 
 and unmarried, to advise on the prevention of 
 offspring. Seemingly, few men, and no women, 
 
 1 Hirsch's Handbook of Geographical and Historical Pathology, 
 vol. ii. pp. 59-60.
 
 METCHNIKOFF 93 
 
 realise the danger of infection. Probably most men 
 have intercourse with prostitutes on impulse ; and 
 have no idea how prevalent disease is among 
 amateurs, from whom the mass of infection is 
 derived. 
 
 While military surgeons have had better oppor- 
 tunities for study, their opportunities for discussion 
 have been scanty. Whoever has adopted inde- 
 pendent methods and achieved success has, in 
 view of the " influential persons," found it judicious 
 to " lie low." Where there is little discussion, 
 doctors, like other people,. tend to run in grooves. 
 Until recent years, the method most approved in 
 the Army has been the restriction of soldiers to 
 certain approved women who have been required 
 to reside in certain specified houses. But this plan 
 carries with it the seeds of failure ; for in an 
 immoral community it is impossible to prevent 
 intrigues between soldiers and unauthorised women. 
 Another plan has been to intern or banish diseased 
 women who ply for hire. Here, again, the seeds 
 of failure are apparent. Disease cannot be de- 
 tected unless women be examined ; they will not 
 be examined unless forced ; if they be forced, 
 innocent and virtuous women are liable to the 
 degradation. A wide field is opened for the elo- 
 quent denunciation of " organised vice," and for the 
 bribery of officials, and blackmail by officials. A 
 professional prostitute carries no distinguishing 
 marks. Sometimes she presents a most respect- 
 able appearance. She has been known to wear the 
 uniform of a hospital nurse. On the other hand, 
 virtuous women have incurred suspicion and even
 
 94 PREVENTION OF VENEREAL DISEASE 
 
 arrest. A lady I know nodded and laughed at a 
 young officer across the street, who, smiling but 
 embarrassed, stood hesitating. An old gentleman, 
 also of my acquaintance, rushed at her. " Do you 
 know you are endangering that young man's 
 immortal soul," said he, and left her gasping. 
 The boy was her brother on the way to the photo- 
 grapher, having " first put this uniform on." The 
 mass of disease is not communicated by pro- 
 fessionals. A medical examination is not infallible. 
 A doctor can often say positively that a woman is 
 diseased. He can never say positively that she is 
 not diseased. In one case a woman, repeatedly 
 certified healthy by surgeons, who employed modern 
 bacteriological methods, infected twenty-five men 
 within a week. Experienced prostitutes learn to 
 prepare for examination by disinfection. 
 
 In 1864 the first Contagious Diseases Act in 
 England was passed. It was repealed, and an 
 amending Act substituted in 1866. These Acts 
 aimed at preventing venereal diseases by sub- 
 jecting prostitutes to surveillance and medical 
 examination, and were in force only in certain 
 naval and military centres. In 1869 a further 
 amending Act was passed. In 1886 all these Acts 
 were repealed by a Contagious Diseases Repeal 
 Act. In military stations overseas, commanding 
 officers, in their desperate efforts to stay what was 
 sometimes a real pestilence, adopted the system of 
 placing out of bounds all native houses except a 
 few. This plan also was abandoned in conse- 
 quence of an agitation in England. 
 
 In 1905 Professor Eli Metchnikoff of the Pasteur
 
 METCHNIKOFF 95 
 
 Institute in Paris published the first of a series of 
 papers, in which are described the experiments 
 which furnish the starting-point of all modern 
 preventive measures. The microbes of most human 
 diseases are so perfectly and exclusively adapted 
 to their natural environment, that it is difficult to 
 get them to cause diseases in other animals. The 
 nearer, however, an animal is to man the greater, as 
 a rule, is its capacity to receive infection. Metch- 
 nikoff found that anthropoid apes could be inocu- 
 lated with syphilis. He found, also, that if an 
 ointment, composed of one part of calomel to two 
 parts of anhydrous lanoline were, within a limited 
 time, rubbed into the site of inoculation, no disease 
 developed. I quote from a clear and interesting 
 account of these experiments published by Mr. 
 Hugh Elliot. 
 
 " The first set of experiments on monkeys are 
 to be found on page 683 of the Annales de Vlnstitut 
 Pasteur, 1905. The crucial experiment on man, 
 which I am about to describe, was published in the 
 Bulletin de V Academic de Medicine, 8th May 1906. 
 A more detailed account was issued in book form 
 entitled Experimentation sur la prophylaxie de la 
 Syphilis, by Paul Maisonneuve, Paris (Steinheil), 
 1906. Further discussion may be found in the 
 Annales de Vlnstitut Pasteur, 1906, page 795, and 
 in the Annales for October 1907. . . . All these 
 researches were the joint production of Metchnikoff 
 and of Roux, Director of the Pasteur Institute. 
 They were issued from the Pasteur Institute in the 
 interests of humanity and of public health. They 
 have been adopted in the armies and navies of every
 
 96 PREVENTION OF VENEREAL DISEASE 
 
 civilised country, with astonishing success, and it 
 is indeed curious at this time of the day that their 
 efficiency can remain doubtful to any one, even 
 though blinded by theological furor. 
 
 " The crucial experiment to which I have oc- 
 casionally referred, was as follows : After numerous 
 experiments uniformly successful on chimpanzees, 
 baboons, and macaci, Metchnikoff and Roux 
 selected from various persons who offered them- 
 selves a young man by name Paul Maisonneuve. 
 On the 1st of February 1906, in the presence of 
 three expert doctors, they severely inoculated him 
 with syphilis by means of a scarifier in two places. 
 The syphilitic virus inoculated was taken at the time 
 of the experiment from two syphilitics in the stage 
 of most virulent infectiousness. The inoculation 
 was " incomparablement plus dbondante " than could 
 occur under natural conditions. One hour later 
 they rubbed in the calomel ointment. M. Maison- 
 neuve was kept under observation for several 
 months afterwards, until it was conclusively 
 established that no syphilis supervened. 
 
 " In order to test the virulence of the inoculation, 
 four macaci were inoculated at the same time as 
 M. Maisonneuve, and with the same virus. One 
 of the macaci was treated with the calomel oint- 
 ment one hour later, in the same way as M. Maison- 
 neuve. Another was treated with it twenty hours 
 after inoculation. The last two macaci were not 
 treated at all. The result was as follows : The 
 two untreated macaci developed syphilis after 
 seventeen days the usual incubation period in 
 monkeys. The macacus treated after twenty hours
 
 METCHNIKOFF 97 
 
 developed a mild syphilis in thirty-nine days. 
 The macacus treated after one hour remained per- 
 manently free of syphilis. .The effectiveness of 
 the virus was thus established ; likewise the effect- 
 iveness of the calomel ointment, if applied after 
 one hour, but not if applied after twenty hours. 
 
 " Since that time the prophylactic has been 
 adopted into general use, with uniformly successful 
 results. For a year or two, instances of alleged 
 failure were brought forward, but in every case 
 investigated it was found that, either the ointment 
 contained less than 25 per cent, calomel (the 
 necessary minimum), or that its application was 
 unduly delayed. The precise limits of time have, 
 so far as I know, not been fixed. It is known that 
 one hour is safe, and that twenty hours is not safe. 
 Preponderance of opinion seems to be that six to 
 eight hours' delay would be reasonably safe, as in 
 fact is borne out by military experience." 1 
 
 In 1913 a Royal Commission, under the chair- 
 manship of Lord Sydenham, undertook to " inquire 
 into the prevalence of Venereal Diseases in the 
 United Kingdom, their effects upon the health of 
 the community, and the means by which those 
 effects can be alleviated or prevented, it being 
 understood that no return to the policy or provision 
 of the Contagious Diseases Acts of 1864, 1866, or 
 1869 is to be regarded as falling within the scope 
 of the inquiry." 
 
 The Commission, then, was appointed to seek 
 means of alleviating or preventing the effects of 
 venereal diseases. Some knowledge of the horror 
 
 1 The Nineteenth Century and After, March 
 7
 
 98 PREVENTION OF VENEREAL DISEASE 
 
 and the extent of the plague was beginning to 
 penetrate to the public. Presumably " alleviate " 
 means cure, complete or partial, and " prevent " 
 means well, just " prevent." It issued its Report 
 in 1916. Metchnikoff's results had then been 
 published for several years, and the war had been 
 in progress for two years. Hundreds of thousands 
 of British soldiers had acquired venereal disease 
 and become temporarily or permanently unfit for 
 service. Millions of British civilians were suffering. 
 Metchnikoff's methods had been adopted by nearly 
 all the armies of the world ; it had long been in use 
 in the British Navy. In its three years of arduous 
 labour the Commission asked more than 20,000 
 questions of its many eminent witnesses. In all 
 these questions and answers only once was Metch- 
 nikoff's name mentioned, and then the witness 
 was asked not whether syphilis could be prevented 
 or aborted in man, but whether it could be repro- 
 duced in anthropoid apes. In its Report the 
 Commission appointed to discover means of 
 alleviation and prevention alludes to the same 
 impressive fact that monkeys may be inoculated. 
 In one single obscure sentence, which is not even 
 indexed, it mentions casually that Metchnikoff 
 prevented syphilis in men and monkeys. But the 
 source of this recondite information is not revealed, 
 nor is any recommendation founded on it. One 
 naval witness mentions that prophylaxis has been 
 tried in the Navy. Another witness mentions that 
 he thinks that syphilis has diminished in certain 
 sections of the community owing to the use of 
 prophylactics. As far as I have been able
 
 METCHNIKOFF 99 
 
 to learn there is no other allusion to pre- 
 vention. 
 
 There is good reason to believe that before the 
 war venereal disease was diminishing throughout 
 the community. It is impossible to prove this 
 for the community generally, for no trustworthy 
 figures exist. But a quite reliable index is fur- 
 nished by the statistics of the Navy and Army. 
 Sailors and soldiers acquire venereal disease when 
 off duty, when they are not under control, when 
 they are quite ordinary members of the community. 
 Before the war soldiers were not protected in any 
 way, and sailors had been protected for a very few 
 years only. Yet the rate among sailors fell very 
 steadily from 170*66 per annum per thousand in 
 1889 to 73-11 in 1914. Among soldiers it fell equally 
 steadily from 275-4 in 1885 to 50-9 in 1913. It is 
 impossible to account for this vast fall except on 
 the supposition that the men used prophylactics, 
 or that the women with whom they associated used 
 them. The morals of the community have not 
 improved to an equal extent, if to any extent. 
 Precisely during the period covered by the fall in 
 the venereal rate occurred a fall in the birth-rate 
 which, admittedly, is due to the use, especially 
 among the educated classes, of checks on concep- 
 tion. Reckoning per thousand married men below 
 fifty-five years old, the average number of children 
 born to them in 1911 was as follows : 
 
 Anglican clergy .... 101 
 Other ministers and priests . . 96 
 Teachers, professors, etc. . 95
 
 100 PREVENTION OF VENEREAL DISEASE 
 
 Doctors ..... 103 
 Authors, editors, etc. . . .104 
 Policemen . . . . .153 
 Postmen . . . . .159 
 Carmen ..... 207 
 Dock labourers .... 231 
 Barmen ..... 234 
 
 Miners 258 
 
 General labourers . . . 438 
 
 Clearly the checks on conception were used in 
 proportion to the average amount of education. 
 So also prophylactics, as preventives of venereal 
 disease, have been used by the educated classes. 
 But the use has extended even to the masses. 
 
 "Unkempt about those hedges blows 
 An English unofficial rose." 
 
 Probably so easy is it to prevent venereal disease 
 ordinary soap and water has played a great part. 
 We are a much cleaner people than our fathers. 
 Nevertheless, since before the war nearly half the 
 population had been infected oy venereal disease, 
 and since during the war there has been a con- 
 siderable increase in these disorders, there is still 
 vast room for improvement.
 
 CHAPTER VIII 
 
 THE REPORT OF THE ROYAL COMMISSION 
 
 BUT let us return to the Royal Commission. 
 In its Final Report it gave a history of 
 British attempts to control venereal disease the 
 Contagious Diseases Acts, and the like. Next it 
 gave a description of venereal diseases and their 
 means of transmission, with the pictures of the 
 microbes the sort of thing that medical students 
 study. Next it discussed the prevalence of venereal 
 disease among the public at large and among 
 soldiers, sailors, police, prisoners, lunatics, and the 
 like. Next it described venereal disease again, but 
 more elaborately from the point of view of the 
 medical text-book. Next it discussed diagnosis 
 and treatment the best kind of treatment, whether 
 all doctors are fitted to give treatment, whether 
 the facilities for teaching doctors and for treating 
 disease are sufficient, and so forth. Next it 
 condemned quacks. Next it discussed marriage 
 in relation to venereal disease. Next it discussed 
 the education of medical students and the general 
 public. 
 
 " 218. |We attach great importance to the 
 educational aspect of the question with which we 
 
 are called upon to deal. It is, in our opinion, 
 
 101
 
 102 PREVENTION OF VENEREAL DISEASE 
 
 absolutely necessary that the public should have 
 fuller knowledge of the grave evils which exist 
 among us, and of their effect upon the national 
 life, present and future. At the same time we 
 believe that instructions and warnings should be 
 given to the young of the moral and physical 
 dangers which may imperil them. 
 
 " We have, therefore, taken important evidence 
 from educational authorities. 
 
 "219. The evils which lead to the spread of 
 venereal diseases are, in great part, due to the want 
 of control, ignorance, and inexperience, and the 
 importance of wisely conceived educational meas- 
 ures can hardly be exaggerated. If venereal 
 diseases are to be stamped out, it will be necessary 
 not only to provide the medical means of com- 
 bating them, but to raise the moral standards and 
 practice of the community as a whole. Such an 
 improvement can only be brought about by closer 
 co-operation between religious bodies, the teaching 
 and medical professions, and educational auth- 
 orities. 
 
 " Though we are not unmindful of much excellent 
 work that is being carried on, we are strongly of 
 the opinion that there is an urgent need for more 
 careful instruction in regard to self-control gener- 
 ally, and to moral conduct as bearing upon sexual 
 relations throughout all types and grades of 
 education. Such instructions should be based on 
 moral principles and spiritual considerations, and 
 should by no means be concentrated on the physical 
 consequences of immoral conduct. 
 
 " 220. The problem differs in the different types
 
 REPORT OF ROYAL COMMISSION 103 
 
 of schools. In the case of the elementary schools 
 the fact that the children leave school at about 
 fourteen years of age raises serious difficulties. The 
 degree of such instruction will vary with the age 
 and circumstances of each child, but we are of the 
 opinion that in the case of children under fourteen 
 years of age their immaturitymakes detailed instruc- 
 tion on every ground most undesirable. Marked 
 differences in temperament and also in the degree 
 of knowledge possessed by the children must also 
 be borne in mind. In overcrowded districts very 
 young children acquire precocious information on 
 sexual subjects in the most undesirable way. In 
 better conditions, children grow up in ignorance of 
 such matters, and this ignorance is carefully and 
 often unwisely fostered by their parents. The 
 most experienced elementary teachers are strongly 
 opposed to class teaching on these subjects, or to 
 any elaborate syllabus leading up to them. In the 
 words which Mr. J. J. Paton, the Headmaster of 
 Manchester Grammar School, used in regard to 
 public schools generally, they object to * schematic 
 instruction.' 
 
 " We agree entirely with this view, but we under- 
 stand that the custom is growing for headmasters 
 to have private interviews with pupils before they 
 leave school, or if they show special need of guid- 
 ance, in order to give moral instruction and to offer 
 warnings against probable temptations. This prac- 
 tice we commend, and we consider that it should 
 become general. 
 
 " The foundations should be laid in the element- 
 ary schools for fuller instruction, and more effective
 
 104 PREVENTION OF VENEREAL DISEASE 
 
 help during the critical years of adolescence, when 
 the combination of impulse and inexperience may 
 lead to the most harmful results. In the case of 
 the children passing through the elementary schools, 
 the great majority of the school population of the 
 country, such complete instruction can only be 
 given, if at all, in evening continuation schools, 
 and there only if knowledge and discretion can be 
 counted on in the teacher. While attendance at 
 continuation schools is voluntary, this instruction 
 could only reach a limited number, but we think 
 that something can be done, provided the training 
 and aptitude of the teacher can be trusted. It 
 would probably be wise to enlist the aid of properly 
 constituted voluntary associations in giving such 
 instruction, both in evening continuation schools 
 and in factories and workshops where this can be 
 arranged. If such voluntary co-operation is to be 
 utilised, it is essential that a high standard of effi- 
 ciency and tact shall be required, and especially 
 that the guidance of medical practitioners shall 
 be secured. 
 
 " 222. In public and secondary schools, both the 
 need of teaching on these subjects and the oppor- 
 tunity for giving it are greater than in the ele- 
 mentary schools, owing to the fact that the pupils 
 remain to a much later age. We believe that the 
 subject is receiving increasing consideration on the 
 part of headmasters and headmistresses of such 
 schools. We trust that the publication of our 
 Report may tend to direct their attention more 
 effectively to it. 
 
 " Much also remains to be done in the Univer-
 
 REPORT OF ROYAfc COMMISSION 105 
 
 sities by those who are responsible for the moral 
 welfare of the undergraduates. 
 
 " Careful attention should be given in the 
 training colleges to the preparation of all those 
 who enter the teaching profession to deal with these 
 subjects, and we trust that the best means of giving 
 such information will be considered by those who 
 are responsible for these institutions. 
 
 " 223. In all such educational efforts as we 
 recommend, the active support of the responsible 
 authorities is essential. As public attention is 
 increasingly drawn to the urgency of the subject, 
 and as teachers become better fitted to deal with it, 
 a great advance will become possible. We desire, 
 however, to emphasise our opinion that, if satis- 
 factory results are to be obtained, everything will 
 depend on the thorough preparation and the wise 
 initiative of the teachers, not on elaborate schemes. 
 Such schemes are often unsuitable in particular 
 cases, and if carried out by unsuitable persons are 
 likely to do more harm than good. 
 
 " 224. We have intimated the need for carefully- 
 considered instruction in schools and colleges ; we 
 desire to point out that such instruction cannot 
 relieve parents of their responsibility in this 
 respect. We hope that the wider knowledge of 
 danger which the publication of our Report may 
 secure will have the effect of bringing home 
 to 'parents the duty of warning and guidance 
 which they should be able ^and willing to ^dis- 
 charge. 
 
 " 225. While some literature has been published 
 which is well suited for the purposes of instruction
 
 106 PREVENTION OF VENEREAL DISEASE 
 
 in these difficult subjects, books and pamphlets 
 have been brought to our notice which are not 
 only unsound from a medical point of view, but 
 are calculated to be injurious by reason of the way 
 in which the questions are treated. We consider 
 that no such publications should be countenanced 
 by educational authorities unless issued with the 
 imprimatur of the National Council for Combating 
 Venereal Diseases. 
 
 " 226. Among means, other than those which 
 can be adopted by purely educational institutions, 
 of giving warning and instruction, we look to the 
 various voluntary agencies which have been formed 
 for promoting the welfare of the young of both 
 sexes as important aids in carrying out the objects 
 we have in view. Associations such as the White 
 Cross League and the Alliance of Honour have 
 already done valuable work, but much can also 
 be done by properly managed boys' and girls' 
 clubs, the Boy Scouts, the Boys' Brigade, and other 
 similar agencies. If our proposals for providing 
 facilities for treatment are accepted, it will be 
 possible for such agencies to secure that advice, 
 which can be followed by good treatment, should 
 be given whenever cases of disease come to their 
 notice. 
 
 " The co-operation of rescue and preventive 
 agencies in this matter is of much importance, and 
 without their active assistance the realisation of 
 the full utility of the provision of treatment may 
 be delayed. But the fact that we recommend that 
 free treatment should be provided for all sufferers 
 makes it, in our opinion, all the more necessary
 
 REPORT OF ROYAL COMMISSION 107 
 
 that the young should be taught that to lead a 
 chaste life is the only certain way to avoid 
 infection. 
 
 " 229. We hope that the information which 
 our Report contains, and the important evidence 
 which we have received, will have an educational 
 effect in the widest sense. We believe that they 
 will go far to secure enlightenment of the general 
 public in regard to the grave dangers to the national 
 health arising from the prevalence and spread of 
 the venereal diseases, and that the knowledge may 
 lead to some change in the attitude of mind which 
 still persists with respect to these diseases. That 
 they are intimately connected with vicious habits 
 is evident, but it is too often forgotten that large 
 numbers of sufferers are absolutely innocent. 
 Not only can the diseases be conveyed, as we have 
 pointed out, in a variety of ways involving no sort 
 of immorality, but innocent wives and children 
 infected before their birth form a large proportion 
 of the total number of cases. 
 
 " 236. We recognise that the measures which we 
 propose will need for success more than legislative 
 and administrative measures taken by the Govern- 
 ment. Continuous and consistent efforts will be 
 required to keep the complex question of combating 
 venereal disease before the public mind, and to 
 secure the constant assistance of voluntary agencies 
 concerned in prevention and rescue work. We 
 hope that the National Council established with this 
 object will become a permanent and an authorita- 
 tive body, well capable of spreading knowledge and 
 giving advice in regard to this question in its varied
 
 108 PREVENTION OF VENEREAL DISEASE 
 
 aspects, and that it will be recognised as such by 
 the Government. 
 
 " 237. Our Report must issue at a time when all 
 public activities are preoccupied in fulfilling the 
 manifold needs of the war. We are conscious of 
 the disadvantage thus arising, and we feel that 
 there is some risk that our recommendations may 
 not receive the immediate attention which their 
 national importance demands. We desire, therefore, 
 to place on record our strong opinion that the con- 
 ditions now existing, and those which must follow 
 on the conclusion of the war, imperatively require 
 that action should be taken without delay. There 
 is no reason to believe that the percentage of in- 
 fection in the naval and military forces is now 
 greater than in normal times ; but there can be 
 no doubt that the total number of infected persons 
 has increased. The military authorities are doing 
 their utmost to provide treatment, but the civil 
 population requires corresponding measures, and 
 all experience shows that after a war an excessive 
 incidence of disease is certain to occur, even in 
 districts previously free. In order to meet present 
 and future conditions it is essential to make pro- 
 vision, and no time should be lost. 
 
 " 238. We are, therefore, convinced that it will 
 not suffice to establish treatment centres in places 
 where sailors and soldiers are congregated, and that 
 these will be needed in most of the larger and in 
 some of the smaller towns. We realise the claims 
 of economy at the present moment ; but, for the 
 reasons we have given, we believe that all necessary 
 expenditure will be recouped by the results obtained ,
 
 REPORT OF ROYAL COMMISSION 109 
 
 " 239. Lastly, we wish to lay stress upon the 
 needs of the future. The diminution of the best 
 manhood of the nation, due to the losses of the war, 
 must tell heavily on the birth-rate already de- 
 clining and upon the number of efficient workers. 
 The reasons for combating, by every possible 
 means, diseases which in normal times operate with 
 disastrous effects alike upon the birth-rate and 
 upon working efficiency are, therefore, far more 
 urgent than ever before. Now, and in the years to 
 come, the question of public health must be a 
 matter of paramount national importance, and no 
 short-sighted parsimony should be permitted to 
 stand in the way of all means that science can 
 suggest and organisation can supply for guarding 
 the present and future generations, upon which 
 the restoration of national prosperity must depend." 
 
 The Royal Commission then made recommenda- 
 tions both as to the prevention and the cure of 
 venereal diseases. In this book we have no direct 
 concern with the recommendations for cure, except 
 in so far that every case cured is a source of in- 
 fection removed. Cure, therefore, is a means of 
 prevention. If every case were cured before it 
 propagated itself, venereal disease would soon be 
 a thing of the past. Unfortunately, both syphilis 
 and gonorrhoea are diseases of long duration, and 
 are seldom disabling during their most virulently 
 infective stages. The sufferer is usually able to 
 pursue his avocations and pleasures ; and his 
 avocations sometimes, and his pleasures very often, 
 lead to the infection of other people. All sorts of 
 horrors may await him death, paralysis, insanity,
 
 110 PREVENTION OF VENEREAL DISEASE 
 
 blindness, agonising aneurism, cystitis, intractable 
 rheumatism, and the like, but for a long period 
 he may suffer little. Often he becomes careless, 
 supposing himself cured, or sufficiently cured. 
 Being infected, he fears not infection, and not 
 infrequently he is a brute, callous of the suffering he 
 may inflict. If ignorant, he may even seek cure by 
 " passing it on." Practically all men who acquire 
 disease soon learn the nature of their illness ; but 
 many women never learn. They do not neces- 
 sarily suffer greatly, especially at first. They may 
 know they are ill, but they attribute their sufferings 
 to other causes. If they consult a doctor, he also 
 may be deceived, or doubtful. To tell a woman 
 she has venereal disease is in effect to accuse some 
 one else, a serious matter unless one is very sure. 
 Usually all the ordinary doctor has to judge by is 
 some effect of venereal disease leucorrhcea, abscess, 
 pelvic pain, and the like which might well be 
 otherwise produced. Prostitutes and amateurs 
 are invariably, and usually genuinely, indignant 
 when theu* paramours accuse them of conveying 
 infection. I suppose that every doctor in general 
 practice has been asked, not once but often, to 
 furnish certificates of health to women whose 
 young men have made injurious allegations. 
 Mere cure, therefore, is unlikely to banish venereal 
 disease. It has never banished any disease. 
 
 As to prevention, though the medical world 
 was then ringing with Metchnikoff 's discovery that 
 syphilis could be aborted by chemicals, and though 
 his method was at the moment being applied for 
 the protection of more than 20,000,000 young men
 
 REPORT OF ROYAL COMMISSION 111 
 
 engaged in the Great War, the Royal Commission 
 limited its recommendations to what is known as 
 " moral hygiene." It was of the " opinion that in 
 the case of children under fourteen years of age their 
 immaturity makes detailed instruction on every 
 ground most undesirable," but recommended that 
 older persons should be given " moral instructions " 
 and " warnings against probable temptations," 
 but " only if knowledge and discretion can be 
 counted on in the teacher," and thought " that, if 
 satisfactory results are to be obtained, everything 
 will depend on the thorough preparation and wise 
 initiative of the teachers, not on elaborate schemes." 
 In effect, then, all that this most remarkable Com- 
 mission for the Cure and Prevention of Venereal 
 Disease recommended was public support for the 
 National Council for Combating Venereal Disease, 
 improved facilities for treating unfortunates already 
 infected, and increased opportunities for preaching 
 to people not yet infected. We shall have some- 
 thing to say concerning the National Council and 
 the facilities for treating ; but why did not the 
 Royal Commission, which had such faith in preach- 
 ing, and whose whole Report is one long preach- 
 ment, give to the " wise " teachers endowed with 
 " knowledge and discretion " some idea of what to 
 say to their innocent pupils ? Simply because it 
 could not. No human being could. It was easier 
 to leave it to the teachers. But let the reader 
 imagine himself a headmaster at the end of a term, 
 about to interview, one by one, thirty, forty, or 
 fifty leaving boys, and expected to address them in 
 words so eloquent and wise that they shall cast off
 
 112 PREVENTION OF VENEREAL DISEASE 
 
 immediately the effects of years of ribald training 
 received during the most impressionable period of 
 life, and ever after be proof against the temptations 
 of the world. Can he think of an effective speech ? 
 Or let him conceive himself as lecturing an audience 
 of that kind of boy who used to cover the walls 
 of public urinals, before these were defensively 
 glazed, with obscene jokes and drawings, and who 
 still decorates our doorposts with filth, or an audi- 
 ence of village lads, or factory hands, or clerks, or 
 medical students, or university undergraduates, or 
 soldiers, or sailors. Can he think of the rhetoric 
 which will straighten the long bent tree ? The whole 
 Report indicates an extreme ignorance of elemen- 
 tary psychology. It takes the preacher's stand- 
 point. 
 
 Why was MetchnikofFs preventive treatment not 
 mentioned ? Because of the composition of the 
 Commission. It consisted of fifteen members, six 
 doctors, and nine others. Of the doctors one was a 
 woman, and one has since distinguished himself not 
 only as a preacher of moral lectures to adults, but also 
 as a vigorous opponent of preventive disinfection. 
 Of the nine non-medicals, two were clergymen of 
 the Church of England, and two were women, one 
 of whom was the widow of a clergyman. Some of the 
 doctors, as I happen to know, wished to give Metch- 
 nikoff's discovery the prominence its importance 
 merited, but to a Commission so compounded the 
 very thought of prevention would be terrible, and 
 almost unspeakable. Therefore, as I say, a dis- 
 covery, with which the medical world was ringing, 
 and which was then being employed for the
 
 REPORT OF ROYAL COMMISSION 118 
 
 protection of 20,000,000 of fighting men, was 
 passed almost in silence. Here was a Commission 
 bound in honour not only to tell the truth, but also 
 the whole truth, and it suppressed the best part 
 of the truth. An immensely important item of 
 sanitary information was placed in an index ex- 
 pur gatorius. The Government which had appointed 
 the Commission, and the public which had ap- 
 pointed the Government, were led to suppose that 
 Metchnikoff had achieved nothing more than the 
 production of syphilis in a few monkeys. The 
 fanatic is always unscrupulous, always arrogant, 
 always stupid. What hope was there of per- 
 manently concealing the facts from the public ? 
 A few millions more of the ill -trained guilty might 
 be poisoned, a few millions more of the well-trained 
 innocent might perish ; but in the end the truth, 
 if truth it were, was bound to be diffused. And 
 with the knowledge was sure to come also repug- 
 nance and contempt not only for the fanatic, but 
 also for the whole system which created him. 
 Nothing fails like failure. I think most modern 
 men, especially among progressive peoples, feel 
 distrust, more or less pronounced, or more or less 
 vague, if not for the churches, yet for ecclesiastics 
 as a class. If one tries to analyse this distrust, 
 such names as Wycliffe, Luther, Galileo, and Darwin 
 leap to the mind. These men may have been right 
 or they may have been wrong ; but what, in the 
 event, has always proved disastrous to authority 
 is an attempt to suppress " pernicious " ideas 
 otherwise than by open discussion and disproof. 
 Human beings are so constituted that an index 
 8
 
 114 PREVENTION OF VENEREAL DISEASE 
 
 expurgatorius invariably creates not only curiosity, 
 but an opposing enthusiasm. It is employed when 
 bias is not completely established and facts are 
 dreaded. 
 
 However, the Commission had some excuse, not 
 for suppressing the truth, but for hoping that the 
 suppression might not bear evil fruit. About the 
 time that Metchnikoff published his experiments, 
 another very important discovery was announced. 
 Ehrlich, a famous name, declared that by means 
 of a few doses of salvarsan, an arsenical compound 
 which he had found after prolonged experiment, 
 syphilis could be quickly and certainly cured. 
 Like his compatriot Koch, he was incautious. 
 He claimed too much. The event has proved that 
 while his treatment was of the first value, it does 
 not cure so quickly or certainly as he supposed. 
 At the present day syphilis is as prevalent, or more 
 prevalent, than before salvarsan was introduced. 
 Apparently, however, the Commission swallowed 
 Ehrlich's early claim wholesale. It eagerly ac- 
 cepted the advice given by Major L. W. Harrison, 
 R.A.M.C., the pathologist at the Rochester Row 
 Hospital for Venereal Diseases, who proposed a 
 multiplication of moral lectures and the establish- 
 ment all over the country of Early Treatment 
 Centres. At that time, it was calculated that there 
 were in the country 3,000,000 people actually 
 suffering from syphilis, and, since gonorrhoea is 
 five or six times as common as syphilis, many 
 millions more suffering from gonorrhoea. However, 
 the Commission gave its blessing to the National 
 Council, which thereupon started hopefully on its
 
 REPORT OF ROYAL COMMISSION 115 
 
 mission of emptying the Atlantic with a teacup 
 decorated with a text. 
 
 Numerous moral lectures were given to soldiers, 
 and, I suppose, sailors. As far as my experience 
 enables me to judge, they were accepted, like 
 church parade, by the men as part of the day's 
 job. I never met a man who appeared impressed. 
 Whenever possible, civilians also were addressed, 
 people belonging to brotherhoods and associations 
 of that sort. Doubtless many of the converted 
 were confirmed in their faith, but it is at least 
 doubtful whether those people who should have 
 been most concerned prostitutes and " amateurs," 
 actual or prospective, and their male associates 
 were reached in any numbers. Very laudable 
 and more successful attempts were made also 
 to persuade hospitals and towns to establish 
 cliniques for the special treatment of venereal 
 disease. Nothing but good can be said of these 
 cliniques, which indeed have achieved very much 
 good. Unfortunately, " When we drew up the 
 regulations of the Society (i.e. Council), care 
 was taken to avoid suggesting that means should 
 be taken to prevent infection. For this reason 
 the term * prevention ' first employed was changed 
 to ' Combating.' " l "I strongly feel that there 
 is a distinct moral difference between telling 
 people to go about with disinfecting packets in 
 their pockets, and urging them if they fell into 
 temptation to take the earliest possible treatment. 
 My Council gave earnest consideration to the point, 
 and decided to have nothing to do with the former 
 1 Sir Charles Symonds, The Lancet, 6th December 1919.
 
 116 PREVENTION OF VENEREAL DISEASE 
 
 policy." l The following is the Council's own 
 description of its present " Aims 'and Objects," 
 "Policy," and "Literature." 
 
 AIMS AND OBJECTS 
 
 " (1) To provide accurate and enlightened 
 - information as to the prevalence of these 
 diseases, and as to the necessity for early 
 treatment. 
 
 " (2) To promote the provision of greater 
 facilities for their treatment. 
 
 " (8) To increase the opportunities of medical 
 students and practitioners for the study of 
 these diseases. 
 
 " (4) To encourage and assist the dissemina- 
 tion of a sound knowledge of the physiological 
 laws of life, in order to raise the standard both 
 of health and conduct. 
 
 " (5) To co-operate with existing associa- 
 tions to seek their approval and support, and 
 to give advice when desired. 
 
 " (6) To arrange in connection with such 
 organisations for courses of lectures, and to 
 supervise the preparation of suitable literature. 
 
 " (7) To promote such legislative, social, 
 and administrative reforms as are relevant to 
 the foregoing aims and objects." 
 
 As to " Policy," " The National Council works 
 in close co-operation with the Local Government 
 Board, and the County and Borough Medical 
 Officers of Health, in making known to the general 
 
 1 Lord Sydenham, Debate In the House of Lords, 2nd April 1919.
 
 REPORT OF ROYAL COMMISSION 117 
 
 public the facilities which now exist for the diag- 
 nosis and treatment of Venereal Disease, and the 
 vital importance of the fullest possible use being 
 made of these facilities. 
 
 " Lectures can be arranged as follows : 
 
 " (1) To those responsible people who need 
 sufficient information to enable them to in- 
 struct others, e.g. men and women teachers, 
 ministers of religion, scoutmasters, women 
 social workers, etc. 
 
 " (2) To audiences of the general public, 
 including membership meetings of social or- 
 ganisations, e.g. friendly societies, mothers' 
 unions, girls' clubs, and to military estab- 
 lishments, munition workers, etc." 
 
 " Literature. In addition to the Synopsis of the 
 Report of the Royal Commission, and pamphlets 
 designed for the general public, special literature 
 has been prepared to meet the needs of the various 
 people co-operating in the campaign, e.g. medical 
 practitioners, local authorities, teachers, social 
 workers, and ministers of religion." 
 
 With the prevalence of venereal disease in- 
 creasing, with half the population infected, with 
 more than a million innocent sufferers, with 
 millions of broken lives, with hospitals and asylums 
 crowded, with seven wasted years behind the 
 National Council, can anything more miserably 
 inadequate than its Aims, Objects, and Policy be 
 conceived ?
 
 CHAPTER IX 
 
 VENEREAL DISEASE IN THE ARMY 
 
 r I ^HE outbreak of war in 1914 found us provided 
 J. with a great Navy, but with an Army small 
 compared to the forces maintained by the con- 
 tinental powers. But, under the stress of dire 
 necessity, and through the labours of a few great 
 men, the British land forces continually expanded, 
 till at last not only were they the most widely 
 distributed of all, but they ranked among the most 
 numerous in the world. Before the end almost 
 the whole, certainly the best, of the youth and 
 manhood of the nation was under arms. At once 
 venereal disease began to claim an enormous toll 
 of victims. Apart from battle casualties, and 
 those resulting from hardship, it was probably 
 from first to last the principal cause of sickness 
 and disablement among the troops. Trench fever 
 caused great losses on the Western Front ; malaria 
 pressed us severely in the East and in Africa ; 
 typhoid was rife in Gallipoli ; but venereal disease 
 was universal. And England, as always, was the 
 plague spot of the world. Other nations tried to 
 shield their soldiers by means of Metchnikoff's 
 calomel cream, and doubtless the British auth- 
 
 118
 
 VENEREAL DISEASE IN THE ARMY 119 
 
 orities, had they dared, would have snatched at 
 every possible means of protection ; but they 
 feared that a Parliamentary and pulpit cam- 
 paign might prejudice recruiting. It was better 
 to get recruits, have them poisoned, and cure 
 them if possible, than to get no soldiers 
 at all. 
 
 The pestilence fell with especial severity on the 
 Colonial and American troops. European armies 
 were composed largely of mature, married men, 
 who were restrained by love of their wives and by 
 the honourable tradition to " play the game " and 
 keep the plighted troth ; but the splendid fighters 
 who came to the war from overseas were, with few 
 exceptions, unmarried and in the full vigour of 
 early manhood. Moreover, in accordance with 
 Anglo-Saxon tradition, they were untaught save 
 by children. No mothers or sisters welcomed them 
 when on leave ; but they were met at every port 
 and railway station by crowds of prostitutes and 
 amateurs. They had plenty of money, and no 
 intimates, especially among young people, save 
 such as their money bought, and they were eager 
 for pleasure. Under the conditions, incontinence 
 was certain, and venereal poisoning equally certain. 
 In London, particularly, they fell sick by the 
 thousand ; but every port and halting place on 
 the way to the war, Egypt and the Cape, for in- 
 stance, furnished its quota of infection. So greatly 
 did the Colonial troops suffer, that at one time, 
 it is said, the Australasian governments threatened 
 to withdraw their forces unless better protective 
 measures were taken. Throughout the Dominions
 
 120 PREVENTION OF VENEREAL DISEASE 
 
 one of the principal election cries against conscrip- 
 tion was furnished by venereal disease. Parents 
 were implored not to send their boys into that 
 cesspool England. In the end, the Colonial troops 
 took independent action, and issued prophylactic 
 packets and established venereal ablution rooms 
 with considerable, but unequal benefit. Success 
 depended on the care with which the officers in- 
 structed their men, and care was not always taken. 
 Men tend to seek the spectacular. Sometimes an 
 officer who will risk his life to save one man under 
 fire, will not devote an hour to save a thousand men 
 from disease in camp. 
 
 In France, British authorities, often, I believe, 
 officers commanding units, acted early. All sorts 
 of devices, including licensed houses for certified 
 women, were tried ; but usually with moderate 
 success. Even when some degree of success was 
 achieved in camp, the men on leave, especially to 
 England, fell ill by the thousand, and on returning 
 to their units were sent to hospital. 
 
 By the summer of 1916, venereal disease had 
 become so prevalent among the troops in home 
 garrisons, depots, and training camps that the 
 authorities, compelled again by dire necessity, 
 established what are known as " venereal ablution 
 rooms." It is understood that a sort of bargain 
 was made with the preachers. The authorities 
 agreed not to issue " prophylactic packets," and 
 the preachers agreed not to raise trouble if only 
 ablution rooms were established. Of course the 
 purpose of both a " packet " and of a venereal 
 ablution room is exactly the same to enable the
 
 VENEREAL DISEASE IN THE ARMY 121 
 
 sinner to disinfect himself before the microbes 
 have time to penetrate and set up disease. 
 In any case the erring soldier knows that the 
 disinfectants are ready for him, and for what 
 purpose ; in any case he is led to believe that the 
 means of prevention are effective and the best that 
 science can devise ; in any case he is promised 
 protection ; but in the one case he is not told the 
 truth. Since identically the same antiseptics are 
 used, the assumption that the soldier is as effec- 
 tually protected by slow as by quick disinfection 
 is, of course, merely crazy. The thing does not 
 bear discussion. It is sheer lunacy to suppose that 
 microbes are as certainly destroyed if they be given 
 time to penetrate as when they are dealt with 
 without delay. However, the ecclesiastical con- 
 science is a delicately balanced thing. It seems 
 that it is impossibly immoral to tell the soldier to 
 disinfect at once ; but, if not quite moral, yet not 
 impossibly immoral to direct him to disinfect with 
 delay. It appears there is some subtle virtue in 
 the delay, the deception, the inefficiency, and 
 the danger which assuages this remarkable con- 
 science. 
 
 In March 1915 I was appointed to the medical 
 charge of about 2000 troops, who inhabited various 
 barracks in Portsmouth, belonging to many diverse 
 units, and who came and went like the colours in a 
 kaleidoscope. Some men, who were in barracks 
 when I joined, were still there when I left at the 
 end of April 1919. Others, birds of passage, stayed 
 a day or a week, a month or a year. Among the 
 larger units were British and Colonial Field and
 
 122 PREVENTION OF VENEREAL DISEASE 
 
 Garrison Artillery, Infantry, Army Service Corps, 
 Royal Engineers, Ordnance, Conscientious Ob- 
 jectors, Royal Defence Corps, Labour Corps, 
 convalescents from the hospitals, a class of 200 
 gymnastic instructors which was changed every 
 month, and, I suppose, in time included men from 
 almost every unit in the British and Colonial 
 Services, and once there were Blacks from Bar- 
 badoes. At first we had many regular soldiers, 
 but presently these were swamped by Kitchener's 
 recruits, who were replaced by Lord Derby's men, 
 who were followed by conscripts, who in the end 
 gave place to veterans out of hospital hardening 
 for the furnace again. The majority belonged, of 
 course, to the labouring classes, but I have seen 
 privates returning from leave in their own motor 
 cars, and once I saw, staggering under a bucket 
 of swill, and with rings glittering on his hands, 
 an elderly Jewish stockbroker an excellent and 
 humorous man who made light of his troubles, and 
 offered me financial tips. I remember a Welsh, a 
 very Welsh, Field Artilleryman, who often com- 
 plained of rheumatism and " a-pain-at-the-back- 
 of-my-knee," a dark, sallow fellow, with flaming, 
 fanatical eyes, instinct with a curious vitality. It 
 was his habit to tell me that his heart was bleeding 
 for this or that, and I put him down as some sort 
 of preacher. But one day, having looked on the 
 whisky while it was still strong, he knocked the 
 military police about like ninepins. We found he 
 was a noted professional pugilist. My orderly, 
 a music-hall artist, looked, unclad, like a 
 statue of Hermes. He could lift a heavy person
 
 VENEREAL DISEASE IN THE ARMY 123 
 
 into the air with one hand, and claimed to be the 
 strongest man in the world. Once he laid me on a 
 ladder and tossed me perilously about like a feather. 
 I am somewhat fat, and feared the fate of a dropped 
 gooseberry. I remember, too, a big upstanding 
 young gunner who came to me with a right ear that 
 stuck out like a dock-leaf. He had been helping to 
 train Sergeant Smith, of the Oxford and Bucks, to 
 fight Bombardier Wells, and the sergeant had 
 smitten with vigour and given him what is tech- 
 nically known as a " thick un." I told him to 
 return in a week, and not to spar till then. 
 When he returned, we had the following 
 dialogue : 
 
 " H'm. You seem much better." 
 " Yessir. I feel quite well, sir.' 3 
 " You'll soon be all right." 
 " Yessir. May I use it again, sir ? " 
 Then there were the men of the Royal Defence 
 Corps, ancient veterans with the scars and ribbons 
 of battles long ago upon them, back to service from 
 plough-tail and factory. Never in my experience 
 did a private of the R.D.C. " go sick " unless he 
 were deadly sick indeed. One grey old fellow 
 whom I had bidden to bed dwells in my memory. 
 Next morning he was before me with " I feels 
 quite well, sir, and I wishes to return to my 
 duty." His temperature was 103 Fahrenheit, 
 and it was white winter. Another, a still block of 
 a man, had crepe on his buttons as well as ribbons 
 across .his breast. " For whom are you in mourn- 
 ing ? " said I. "I have lost three sons in the war." 
 " Any left ? " " None that are ready yet, sir."
 
 124 PREVENTION OF VENEREAL DISEASE 
 
 Said ever mortal man anything more heroic, and 
 tragic, and terrible ? But this is the heroic age. 
 Earth never looked upon such men as those that 
 gathered for the Great War, and may not see their 
 like again. 
 
 Such were the men to whom I was appointed. 
 A most lovable, and certainly a very glorious 
 crowd, valiant, cheerful, laughter-loving, tolerant, 
 kindly, the best of comrades, stoical in sickness and 
 under my knife, responsive to my feeblest chatter 
 and jokes, but very shy about their ribbons and 
 decorations. Once I put a V.C. to public shame 
 and manifest discomfort by calling him from the 
 ranks and shaking hands with him. 
 
 The officers were such as the men deserved. 
 I, a civilian, joined in a crabbed spirit, determined 
 to " keep my end up," and met only good humour 
 and a jolly friendliness. The colonel who com- 
 manded my largest unit, and who stayed with us 
 longest, took me captive without effort, a man 
 without thought of self, a chevalier sans peur et sans 
 reproche, a Bayard, devoted to duty ; one who 
 followed right because right is right, in scorn of 
 consequence ; authoritative and decisive in office 
 and on parade, but in private life of a blazing 
 and inexplicable diffidence ; a dignified but ex- 
 travagantly unassuming man ; a very noble 
 gentleman indeed. Beloved of his men, revered 
 of his officers, if he ever reads this, he will 
 wonder of whom I write, for to himself he is a 
 nobody. 
 
 Doubtless, nearly all the married and some of 
 the single men in my charge were chaste. But
 
 during the first eighteen months venereal disease 
 was terribly common. Nearly every day I sent men 
 to hospital. As in civil life, most of the bachelors 
 had no idea of continence. They were not so much 
 immoral as unmoral. All sense of wrong-doing 
 was lacking. Even when old they would look 
 back to past intrigues with satisfaction. Notwith- 
 standing the talk of the padre and the doctor, they 
 conceived chastity as a thing officially, but not 
 actually, expected of them. As long as they broke 
 no law or military regulation, they stoutly believed 
 they had a right to spend their leisure as they 
 pleased. I gave them moral lectures, but always 
 with a horrible sense of futility. I was dealing with 
 material no longer plastic. I could no more in- 
 fluence them than they could influence me. Then 
 I tried to get the officer commanding the unit 
 that suffered the worst to set up some sort 
 of disinfecting centre ; but he declined on the 
 ground that it was forbidden. At last the 
 authorities established the venereal ablution rooms. 
 I was ordered to arrange for four of them. 
 
 In each room was a metal drum or pail, filled 
 with a solution of permanganate of potash (Condy's 
 Fluid), and elevated on a shelf. The fluid could 
 be syphoned off from the drum by means of a 
 rubber tube, on which was a clip by which the flow 
 could be controlled, and a glass nozzle by means 
 of which the man was supposed to irrigate the 
 pipe of his penis. As his clothes were very liable 
 to get stained with the disinfectant, waterproof 
 aprons were provided. In addition, there was a 
 pot of calomel ointment which the man was directed
 
 126 PREVENTION OF VENEREAL DISEASE 
 
 to rub into the skin of his penis. Directions were 
 posted on the walls, which the medical officer was 
 requested to supplement in his periodic health 
 lectures. In addition, it was his duty to keep an 
 eye on the venereal ablution room, and see that 
 everything was kept clean, disinfected, and in 
 good condition. 
 
 As soon as I received orders to erect these 
 venereal ablution rooms, I called on my superior 
 medical officer, a most able and zealous man, and 
 proposed an alternative, and, as I thought, a 
 better scheme. I insisted that the method pro- 
 posed by the authorities was clumsy and un- 
 surgical. If there were infection, the proper time 
 for disinfection was immediately, when any of 
 the simple disinfectants in common use would be 
 effective. For a variable, but always appreciable, 
 time after exposure, the microbes are all on the 
 surface ; none have penetrated into the pipe or 
 below the skin ; for the movements of even the 
 most active microbes are only microscopical. It 
 was simple common sense, therefore, to disinfect 
 at once. It was folly to wait for hours before 
 taking action. It would be in every way better 
 simpler, cheaper, more effective if the men carried 
 on their persons a little disinfectant, of which there 
 was plenty in every medical inspection room. I 
 asked permission, therefore, to adopt this method 
 rather than the official one. Such was my sim- 
 plicity or depravity, that it absolutely did not 
 occur to me that it was more wicked to recommend 
 quick and efficient, than slow and inefficient, dis- 
 infection.
 
 VENEREAL DISEASE IN THE ARMY 127 
 
 My superior was better informed. " Your idea 
 may be all right, but it is against express regu- 
 lations," said he. " We must obey orders. If 
 we gave the men disinfectants to carry we should 
 have trouble with all the purists in the country." 
 Since I had gone to him officially he was obliged 
 to return an official answer ; but I do believe he 
 regretted my going. He was of such a type that 
 he would have closed his eyes tightly while I 
 was doing good, and then would have cham- 
 pioned me most strenuously after I was found 
 out. 
 
 I built my venereal ablution rooms, and I am 
 bound to say they did a great deal of good. Even 
 slow disinfection is very much better than no 
 disinfection. I sent many fewer venereal cases to 
 hospital. Nevertheless I still saw many. At last, at 
 the beginning of 1917, I lost patience, and resolved 
 to try my experiment. I was not dependent on 
 the Army, and could only be dismissed. I suddenly 
 developed an immense zeal for sanitation. To 
 begin with, I delivered a sanitary lecture one after- 
 noon to the whole of my men, telling them how 
 nearly all diseases were caused by different kinds 
 of microbes, how these microbes travelled from 
 victim to victim, and how they could be evaded. I 
 expatiated at length about air, earth, water, food, 
 and insect-borne diseases, and I laid especial stress 
 on the contagious diseases. " Disinfect at once, 
 at once, at once," was the burden of my song. 
 " Prevention is better and much easier than cure. 
 Cure is slow, difficult, and uncertain even in the 
 hands of the best doctors. You may die or be
 
 128 PREVENTION OF VENEREAL DISEASE 
 
 ruined for life in spite of all their efforts. In any 
 case, while you still have the disease, you will be a 
 leper to every man and woman who knows of it. 
 Would you like to shake hands with a man with 
 itch, or use the same pillow as a man with ringworm, 
 or drink out of the same cup as a man with syphilis ? 
 What would be the sensible thing to do if by acci- 
 dent you got in danger of any of these infections ? 
 Why, of course, you must disinfect at once. What 
 do you think I would do if I got the poison of 
 syphilis or gonorrhoea on my hands when examining 
 one of you fellows ? Of course, I would wash my 
 hands and disinfect for all I was worth. If a 
 pin-point of that poison got into my eye I might 
 lose my sight. You know of the barrack venereal 
 ablution rooms. Well, they are the best the Army 
 authorities can do for you. But they are not good 
 enough. You must use your common sense as 
 well, and help yourselves like intelligent men. I 
 have talked to you till I am tired about keeping 
 straight. But there are always a lot of you who 
 go wrong. If you won't keep straight, yet I will 
 not have you bringing these beastly infections back 
 to barracks, where they are a danger to your 
 comrades. I have told you what to do. In future 
 if any of you get disease it will be altogether your 
 own fault. It will look as if you were funking the 
 firing-line. If any of you think you are likely to 
 go wrong, then you must take your disinfectant 
 about with you. You don't need much. A 
 tablespoonful is sufficient. For a few pence you 
 can get from a chemist an ounce of solution of 
 permanganate of potash of a strength of one in a
 
 VENEREAL DISEASE IN THE ARMY 129 
 
 thousand ; or, if you take a bottle, small enough to 
 carry in your waistcoat pocket, to my orderly he 
 will fill it for you, and give you as well a little 
 cotton-wool. If you are fool enough to get into 
 danger, then you must go as soon as possible to 
 some retired place, for instance, a water-closet or 
 dark doorway, wet the cotton-wool with the dis- 
 infectant and swab yourself carefully and thor- 
 oughly, taking care to get the disinfectant into 
 every cranny. Remember that the microbes are 
 all on the surface at first, but that every moment 
 of delay in disinfecting adds to the danger. The 
 best kind of bottle to get is one of those flat, screw- 
 stoppered things they put tabloids into. If it 
 isn't watertight you can easily make a washer. 
 A round bottle causes the pocket to bulge, and an 
 ordinary cork is apt to work loose, and then you 
 get your clothes stained." 
 
 I suppose that no officer or man who heard me 
 suspected anything unusual. They all thought 
 they were getting the ordinary sanitary lecture. 
 It was encouraging to see the close attention I was 
 accorded when the talk was about venereal disease. 
 The men's eyes were intent, and the heads of the 
 rear ranks were craned over the shoulders of those 
 in front, sure signs of interest. 
 
 There was an order that every man joining 
 station should be medically examined within 
 twenty-four hours. This gave me the opportunity 
 to deal with all newcomers. At half-past eight 
 every morning I had them paraded, and, even 
 if only one man appeared, he had his lecture. 
 At a later date I had in addition a poster giving 
 9
 
 130 PREVENTION OF VENEREAL DISEASE 
 
 precise directions exhibited in all my venereal 
 ablution rooms. 1 
 
 The effect of this simple advice was extra- 
 ordinarily good. Immediately venereal disease 
 vanished from my units. For six months not a 
 single case occurred. In two years and four 
 months, during which quite 20,000 men must have 
 passed through my hands, only seven men were 
 infected. I saw many cases of venereal disease, 
 but these were all among men who had contracted 
 it elsewhere. Some of the latter developed it 
 immediately after joining, but most were men en 
 route to the local venereal hospital, to which I had 
 to send all my cases, and where, fortunately for me, 
 every man was questioned, and the place and date 
 of his exposure to infection recorded. Of course I 
 myself would know how long the man had been 
 with us. I had to render monthly reports to the 
 Assistant Director of Medical Services for the Ports- 
 mouth Area reports in which I stated the number 
 of venereal infections among my men, but made no 
 remarks as to time and place of origin. Later, 
 when the method of quick disinfection was under 
 consideration, this officer, who had no idea as to 
 why the information was required, was asked by 
 the authorities in London for the number of cases 
 which had occurred among my men. He reported 
 twelve in a month, during which I claimed none had 
 occurred. I fear his reply must have awakened 
 some doubts of my good faith. But fortunately 
 I got wind of the affair, and was able to refer the 
 authorities to the hospital records. Presumably 
 * See Appencjix I., pp. 343-4.
 
 VENEREAL DISEASE IN THE ARMY 131 
 
 some inquiry was made ; for since then my results 
 have never been questioned, but have often been 
 quoted by the authorities themselves. However, 
 as I say, I am fortunate in being able to claim 
 detailed confirmation from independent records 
 which are compiled as part of the hospital routine. 
 
 The seven cases of venereal disease six of 
 gonorrhoea and one of syphilis which occurred 
 among my units deserve analysis. Two of these 
 were contracted from their own wives by men on 
 leave. Two occurred in men so helplessly drunk 
 at the time of infection that they had little or no 
 recollection of what had happened, and could only 
 be sure they had used no antiseptics. One man 
 joined station late in the afternoon, and con- 
 tracted disease the same evening. He had re- 
 ceived no lecture, and had used no disinfectants. 
 The last two men, of whom one developed syphilis, 
 delayed disinfection till they returned to barracks 
 and the ablution room, one more than an hour and 
 the other more than two hours after intercourse. 
 They told me that they had thought it would be 
 sufficient if they followed official directions and used 
 both the permanganate and the calomel. 
 
 Besides these men I sent many others to the 
 venereal diseases hospital ; but, as I say, they were 
 all men who had contracted their disorders elsewhere 
 before joining me. I think at least a dozen men 
 have said to me : " I wish to God, sir, I had heard 
 your lecture before. This wouldn't have happened 
 then." I remember, in particular, a splendid young 
 man with syphilis, a sergeant, with the military 
 medal, the Mons chevron, three wound stripes,
 
 132 PREVENTION OF VENEREAL DISEASE 
 
 and a long variegated ribbon across his chest. I 
 thought of him the other day when I read : 
 
 " These in the day when Heaven was falling, 
 The hour when Earth's foundations fled, 
 Followed their mercenary calling 
 And took their wages, and are dead. 
 
 Their shoulders held the sky suspended, 
 They stood, and Earth's foundations stay ; 
 
 What God abandoned they defended, 
 And saved the sum of things for pay." 
 
 That man was just as truly the victim of a vile 
 fanaticism as any of those who formerly perished 
 at the stake. If they suffered because they had 
 been wrongly taught, so did he. 
 
 I remember also, but this was an exceptionally 
 bad case, 200 men, belonging to one unit, 
 who came for demobilisation from the Con- 
 tinent, and arrived at our barracks one evening 
 in the last week of April 1919, which was also 
 my last week of service with the troops. Next 
 morning I found twenty-one fresh cases of venereal 
 disease among them. That is to say, 200 
 men in one day furnished thrice as much disease 
 as 2000 men in two years and four months 
 eight hundred and forty days. I questioned 
 scores of officers and men home from the Front 
 after the declaration of the armistice, when the 
 Army moved from the trenches into villages and 
 towns, and they all, without exception, gave a 
 terrible account of the spread of venereal disease. 
 I caused a question to be asked in the House of 
 Commons, and the Minister of State for War
 
 VENEREAL DISEASE IN THE ARMY 133 
 
 
 
 replied that the troops abroad were not suffering 
 exceptionally. I think he was misinformed, or 
 else that he had odd ideas as to the meaning of the 
 word " exceptionally." Certainly nearly all the 
 troops from France and Germany which came to 
 me in the earlier part of 1919 and they were very 
 many were shockingly and increasingly infected, 
 not only as compared with my men, but as com- 
 pared to the troops in England generally.
 
 CHAPTER X 
 
 QUICK DISINFECTION 
 
 MY experiment demonstrated on a large scale 
 what was really never in doubt, and what 
 had often been demonstrated before that the 
 microbes of venereal disease may be destroyed, 
 when accessible on the surface of the body, by the 
 antiseptics ordinarily used by surgeons. These 
 antiseptics, the product of half a century of 
 experience and experiment, destroy even the 
 hardy organisms of the surgical fevers. It would 
 be a wonder, therefore, if they failed against 
 those of the venereal diseases, which, owing to 
 their sheltered mode of existence, should be very 
 delicate. Metchnikoff himself had demonstrated 
 the fact, but naturally he laid no great stress on 
 what was antecedently certain. Doubtless if the 
 microbes of venereal disease had proved very 
 resistant he would have dwelt on the marvel. His 
 endeavour was to find a way of destroying the 
 microbes of syphilis after they had penetrated the 
 tissues, and so ceased to be accessible to ordinary 
 antiseptics, and in this he succeeded perfectly. 
 
 He used calomel made up into a cream with 
 about twice or thrice its quantity of lanoline. This 
 cream was rubbed into a part which, one or more 
 
 134
 
 QUICK DISINFECTION 135 
 
 hours before, had been severely inoculated with 
 syphilis. It was found that the disease was 
 thereby checked with certainty. Calomel is a 
 compound of mercury which has long been known 
 as curative of syphilis. In other words, mercury 
 is especially poisonous to the microbes of syphilis. 
 If calomel, an insoluble and chemically stable 
 substance, be injected into a man suffering from 
 that disease, it tends to cure it, even in distant 
 parts of his body. That is to say, it poisons 
 the microbes far from the point of injection. This 
 means that it has become soluble, which in turn 
 means that it is no longer calomel. Probably it 
 has become very slowly, owing to its stability 
 a soluble albuminate of mercury. Similarly, if it 
 be taken by the mouth, most of it passes unchanged 
 through the individual ; but some of it becomes 
 an albuminate, which acts not only as a purge and 
 as an antiseptic on the contents of the bowel, but 
 also enters into the tissues and acts there. 
 
 The ordinary characteristics of an efficient anti- 
 septic are solubility, whereby it is brought into 
 contact with the microbes, and instability, whereby 
 it tends readily to act chemically upon and so 
 destroy them. At first, therefore, I believed that 
 calomel was not itself an antiseptic, but that it 
 became one only after the lanoline had carried it 
 into the tissues and brought it into contact with 
 albumen. I supposed that it was inert on the 
 surface of the body, and that calomel cream, like 
 soap and water, prevented venereal disease only 
 by mechanical action, removing the microbes, and 
 protecting and clogging the skin. However, Sur-
 
 136 PREVENTION OF VENEREAL DISEASE 
 
 geon-Commander Shaw, R.N., was good enough to 
 conduct some experiments which clearly demon- 
 strated that calomel is an antiseptic even on the 
 surface of the body, and I have since learned that 
 the fact had been antecedently demonstrated. My 
 ignorance was inexcusable. Probably the calomel 
 in the cream combines with the albumen in the 
 microbes, and so poisons them. However, at 
 best it is a very slow and feeble antiseptic, as is 
 evidenced by the great concentration in which it 
 is used. Doubtless it would always prevent 
 syphilis if it were rubbed in soon enough and 
 thoroughly and carefully. But this really requires 
 the hand of an expert. The ordinary man using 
 it on himself is apt to find the process tedious and 
 painful. He tends, therefore, merely to smear it 
 over the surface. On the other hand, swabbing 
 with a fluid antiseptic requires no skill, and is 
 neither tedious nor painful. No surgeon would 
 dream of using calomel as a preventive of the 
 surgical fevers. As used by Metchnikoff, and 
 for the purpose for which he used it, this feeble 
 antiseptic, but good medicine, is the only possible 
 chemical. But his successors have used it as a 
 disinfectant on the surface, where it is much in- 
 ferior to more active antiseptics. Hence the large 
 number of failures to prevent gonorrhoea which 
 have followed its use, whereas, as far as my know- 
 ledge goes, there has not as yet been a trust- 
 worthy record of a single failure to the discredit 
 of the ordinary antiseptics quickly used after 
 intercourse. 1 Doubtless such failures will occur 
 
 1 See pp. 214-8, 317-21.
 
 QUICK DISINFECTION 137 
 
 in time, for even the most careful surgeons some- 
 times fail to secure disinfection, even when the 
 conditions seem most favourable ; but I think 
 they will always be rare. In brief, calomel should 
 be used, as Metchnikoff used it, to eradicate 
 the microbes of syphilis when these have pene- 
 trated below the skin, a thing that rarely, if 
 ever, happens unless there is an abrasion. Even 
 when there is an abrasion, the microbes are all on 
 the surface for some minutes after danger has been 
 incurred. Ordinary antiseptics, therefore, are in- 
 finitely superior to calomel if quick action be 
 taken. After their use, as an additional precaution, 
 calomel might be rubbed in. But if delay occurs, 
 then calomel should by all means be used, and used 
 thoroughly and ruthlessly. It then affords little 
 protection against gonorrhoea, but it gives the last 
 chance of preventing the development of syphilis. 
 Another point of capital importance demon- 
 strated by my experiment (but not for the first 
 time) was the fact that even such reckless and 
 careless people as young soldiers readily accept 
 and closely follow advice when the reasons for it 
 are thoroughly understood. It always seemed to 
 me of the utmost importance that they should 
 understand. It was not sufficient to tell them to 
 do this and that. The reasons had to be explained. 
 Afterwards there was no difficulty. They hated 
 suffering as much as other people, and when they 
 understood they were able to act efficiently. The 
 proof that they followed advice is furnished not 
 only by the circumstance that we had the lowest 
 venereal disease rate on record (1'5 per thousand
 
 138 PREVENTION OF VENEREAL DISEASE 
 
 per annum), but also by the fact that no men on 
 leave, except the two who suffered by their own 
 wives, returned infected. This meant that they 
 took the disinfectant with them, or bought it 
 from chemists as they needed it. 
 
 In 1917, 1 learned from an old friend, Sir Bryan 
 Donkin, that he also was interested in the 
 problem .of venereal disease. He had been a 
 member of the National Council, but, dissatisfied 
 with its programme of preaching and treating, 
 had early in the year written to the Times urging 
 preventive measures. That letter was fateful. 
 Finding that the National Council had decided to 
 have nothing to do with immediate prevention by 
 self-disinfection, Sir Bryan resigned his member- 
 ship. Since then the history of the movement 
 for the medical prevention of venereal disease is 
 mainly the history of his labours on its behalf. 
 
 I told him of what I had done. Previously I 
 had contemplated no consequences save, perhaps, 
 dismissal from the service of the Army ; but in 
 consultation with him I decided to publish a 
 description of my experiment. Accordingly, an 
 account of it, in which I was careful not to mention 
 soldiers, appeared in The Lancet of 3rd Novem- 
 ber 1917. 1 The authorities took no notice. Pos- 
 sibly the letter escaped their observation, or possibly 
 my fears were groundless, and they would not have 
 blamed me in any case. I showed the letter to 
 many of the officers commanding the troops of 
 which I was in medical charge, and met with only 
 cordial approval. I believe, however, that on one 
 
 1 See Appendix II., pp. 344-6.
 
 QUICK DISINFECTION 189 
 
 occasion complaint was made to the colonel I 
 have mentioned that I was spoiling the effect of 
 the moral lectures given by the chaplains and other 
 people ; but he replied decisively that, while he 
 would be delighted to hear of the success of the 
 lectures, he could not think of interfering in the 
 very successful endeavours of his medical officer 
 to preserve the health of the troops. Coming from 
 such a man the encouragement was great. 
 
 But I received some surprises. One officer, 
 after hearing me lecture to the men under his 
 command, said : " When my battalion (the 1st 
 Yorkshires) was at Delhi before the war our M.O. 
 gave us exactly that advice. We had hardly any 
 disease afterwards." It seems that this battalion, 
 which had been at a hill station where there were 
 no women, and, therefore, no venereal disease, 
 received orders to proceed to Delhi which was a 
 hotbed of infection. The Commanding Officer, in 
 alarm, consulted with the doctor, who gave the men 
 pill-boxes containing crystals of permanganate of 
 potash, and told them to make a solution and swab 
 themselves with it immediately after exposure to 
 infection. In four years that battalion had only 
 six cases of infection, instead of hundreds. Another 
 officer told me that at Mhow, a station in India, 
 venereal disease had been reduced by similar 
 means to " negligible proportions." Subsequently 
 I learned that the method had been tried in Bom- 
 bay and South Africa with excellent results, and 
 still later, that it was commonly used in Japan. 
 Curiously enough, my informants were nearly all 
 combatant officers. Presumably the British Army
 
 140 PREVENTION OF VENEREAL DISEASE 
 
 doctors who employed it, though willing to risk 
 their careers for the sake of their men, had thought 
 it wise to abstain from publication. I, a part- 
 time civilian practitioner temporarily employed 
 with the troops, was in a different position. I had 
 little to fear, and nothing of importance to lose. 
 In any case, it is evident that I am not the inventor 
 of the method, though I appear to have been the 
 first to publish it. Others, who risked more, had 
 employed it long before. After all there is nothing 
 wonderful about it. It is simply an application 
 of ordinary surgical procedure which might occur 
 to any one, and which undoubtedly has been 
 practised by millions of endangered people. Even 
 the cleaner prostitutes have long used disinfectants 
 and supplied them to their clients. 
 
 Meanwhile Sir Bryan had been busy in London. 
 Mainly through his efforts, a deputation, consisting 
 principally of leading medical men, was received 
 by the then Minister of State for War early in 
 1918 shortly after the publication of my letter 
 to The Lancet. I accompanied this deputa- 
 tion, and explained the method I had used. 
 Up to then only two or three of my men 
 had contracted venereal disease. I had used 
 Government stores, and I suppose the whole cost 
 to the State of my experiment had amounted to 
 something less than a shilling. Probably, indeed, 
 the cost was less than a penny ; for nothing more 
 than small quantities of the permanganate lotion 
 and scraps of the cotton-wool in ordinary use had 
 been taken. Doubtless most of the members of 
 the deputation did not attend with a view of
 
 QUICK DISINFECTION 141 
 
 advocating any particular system of prevention. 
 All they desired was quick disinfection ; and I 
 suppose what they understood by that was the 
 " packet system," which was in force in most 
 continental armies and in the British Navy. 
 However, I was allowed to explain the method I 
 had employed, and to tell of the antecedent ex- 
 periences at Delhi and Mhow. The authorities 
 seemed to be favourably impressed, and the de- 
 putation withdrew with the understanding that 
 quick disinfection would in all probability be 
 employed in the Army. Secrecy was enjoined. 
 
 I expected that all medical officers, of whom I 
 was one, would shortly receive an order to teach 
 quick disinfection by means of permanganate of 
 potash (the antiseptic commonly present in all 
 medical inspection rooms) to their charges. 
 However, none came, and I wrote asking the reason 
 for the delay. Thereupon I learned to my dismay 
 that the authorities were waiting for the manufac- 
 ture and delivery of 4,000,000 bottles and 1,500,000 
 small squeezable tubes of calomel. I wrote again 
 imploring the authorities to abandon the idea, 
 declaring the tubes were unnecessary, for perman- 
 ganate had proved sufficient ; that the bottles were 
 unnecessary, for the men had shown themselves 
 willing to find their own bottles ; that the bottles 
 and tubes introduced the " packet system," 
 and so gave an unnecessary handle to the enemy ; 
 that the expense was unnecessary, for ample 
 disinfectants were already present in every medical 
 inspection room ; that all that was required 
 was a simple order to medical officers to teach
 
 142 PREVENTION OF VENEREAL DISEASE 
 
 quick disinfection ; and that the case was urgent, 
 for there was a shortage of trained and mature 
 men. The German offensive was impending, the 
 venereal diseases hospitals were full, and thousands 
 of soldiers were flowing into them. 
 
 However, the authorities persisted in forcing the 
 packets on the Army I presume under the advice 
 of the officer who was now placed in charge of the 
 arrangements for the prevention and cure of 
 venereal disease in the Army. Above all, the 
 authorities could not be persuaded to do the one 
 thing necessary to insist on, and enforce the 
 careful instruction of the men. At the present 
 day, if demobilised officers and men be questioned, 
 it will be found that ninety-nine out of a hundred 
 know nothing, or next to nothing, about disin- 
 fection for venereal disease. 
 
 When I found that I could not shake the deter- 
 mination of the authorities to supply packets, I 
 wrote begging that at least the bottles should be of 
 a proper shape, with proper corks. I had found 
 that round bottles caused a bulging in the pocket 
 to which the men objected, and that ordinary 
 corks, if long, tended to work loose and spill the 
 contents and stain the men's clothes, and, if short, 
 to be difficult of extraction on emergency. I sent 
 to the authorities the bottle I had used for demon- 
 stration purposes a flat bottle with a screw top ; 
 I think one of Burroughs & Welcome's small 
 tabloid bottles, into which I had fitted a washer. 
 
 One of my units, a company of Royal Engineers, 
 was employed on the searchlights in a fort defending 
 Portsmouth Harbour, The officer in command
 
 QUICK DISINFECTION 143 
 
 represented to me that he could not send his men to 
 be lectured because they worked all night and slept 
 all day ; and asked if I would jot down the heads 
 of a lecture which he could deliver himself. At a 
 leisure moment I sat down to the task, but my pen 
 ran on, and in the end it was not the heads of a 
 lecture, but the lecture itself which he received. 
 I had some copies typed in case similar difficulties 
 arose with other units. One of these I sent to 
 Sir Bryan Donkin, and through him it found its 
 way into the hands of the authorities at the War 
 Office, who altered it somewhat, therebv srreatlv 
 
 German offensive had opened, the bottles and tubes 
 were distributed to the troops fat, round bottles 
 with particularly long corks. Moreover, they were 
 preceded by instructions which implied, if they implied 
 anything at all., that the men were to use the contents 
 in the old, inefficient way. Among other instructions 
 came my altered lecture. In it the men were now 
 instructed to return to barracks after exposure, and 
 then to provide themselves with the disinfectants. 
 Thereafter they were to seek " some quiet spot a 
 W.C. or a dark doorway, for instance and there 
 * See Appencli* III. pp. 346-53.
 
 142 PREVENTION OF VENEREAL DISEASE 
 
 quick disinfection ; and that the case was urgent, 
 for there was a shortage of trained and mature 
 men. The German offensive was impending, the 
 venereal diseases hospitals were full, and thousands 
 of soldiers were flowing into them. 
 
 However, the authorities persisted in forcing the 
 packets on the Army I presume under the advice 
 of the officer who was now placed in charge of the 
 arrangements for the prevention and cure of 
 venereal disease in the Army. Above all, the 
 authorities could not be persuaded to do the one 
 thing necessary to insist on, and enforce the 
 
 ERRATUM. 
 Page 143, line 15 from top, for "before" read "after," 
 
 that round bottles caused a bulging in the pocket 
 to which the men objected, and that ordinary 
 corks, if long, tended to work loose and spill the 
 contents and stain the men's clothes, and, if short, 
 to be difficult of extraction on emergency. I sent 
 to the authorities the bottle I had used for demon- 
 stration purposes a flat bottle with a screw top ; 
 I think one of Burroughs & Welcome's small 
 tabloid bottles, into which I had fitted a washer. 
 
 One of my units, a company of Royal Engineers, 
 was employed on the searchlights in a fort defending 
 Portsmouth Harbour, The officer in command
 
 QUICK DISINFECTION 143 
 
 represented to me that he could not send his men to 
 be lectured because they worked all night and slept 
 all day ; and asked if I would jot down the heads 
 of a lecture which he could deliver himself. At a 
 leisure moment I sat down to the task, but my pen 
 ran on, and in the end it was not the heads of a 
 lecture, but the lecture itself which he received. 
 I had some copies typed in case similar difficulties 
 arose with other units. One of these I sent to 
 Sir Bryan Donkin, and through him it found its 
 way into the hands of the authorities at the War 
 Office, who altered it somewhat, thereby greatly 
 improving it in many ways ; for it was only a 
 rough draft. But they made one alteration which 
 was fatal. They introduced the words " before 
 exposure." This lecture was printed and sent to 
 all Army medical officers as a " Specimen Lecture 
 to Troops on the Prevention of Disease." The 
 reader will find it in the Appendix with the signifi- 
 cant alteration indicated. 1 
 
 Months passed, and at length, long after the 
 German offensive had opened, the bottles and tubes 
 were distributed to the troops fat, round bottles 
 with particularly long corks. Moreover, they were 
 preceded by instructions which implied, if they implied 
 anything at all, that the men were to use the contents 
 in the old, inefficient way. Among other instructions 
 came my altered lecture. In it the men were now 
 instructed to return to barracks after exposure, and 
 then to provide themselves with the disinfectants. 
 Thereafter they were to seek " some quiet spot a 
 W.C. or a dark doorway, for instance and there 
 * See Append!* III. pp. 346-53.
 
 144 PREVENTION OF VENEREAL DISEASE 
 
 disinfect." Had this advice been followed, the 
 drains of every military latrine would have been 
 choked within a week. Think of it ! Not only 
 were the men to wait till they returned to barracks 
 before disinfecting themselves, but they were not 
 to disinfect in the venereal ablution room where 
 they had previously always disinfected themselves. 
 They were to seek the water-closets and dark door- 
 ways of the barracks. I do not suppose any men 
 were so foolish ; but, had they followed the direc- 
 tions, the cells of the guardrooms would have been 
 full, and outraged commanding officers would have 
 held courts-martial every day. Imagine a respect- 
 able sergeant-major catching a recruit disinfecting 
 himself in a dark doorway ! 
 
 But think of the real imbecility of the whole 
 procedure. Many thousands of pounds had been 
 spent at a time when the national finances were 
 on the brink of disaster, 4,000,000 bottles and 
 1,500,000 tubes had been manufactured at a time 
 when the whole nation, men, women, and even the 
 bigger children, were straining breathlessly to keep 
 pace with the national work, and all for no other 
 purpose than to shift identically the same chemicals 
 from pails and pots into bottles and tubes. To 
 crown all, so slack and inefficient was the adminis- 
 tration, the instructions to remove and return the 
 pails and pots to store arrived before the bottles and 
 tubes. Return the pails and pots many command- 
 ing officers, honest men striving to obey orders, 
 promptly did, their men being left without any 
 protection whatever. My men, having long dis- 
 carded the venereal ablution, rooms, continued to
 
 QUICK DISINFECTION 145 
 
 bring their bottles to my orderly, but there must 
 have been a rise in the venereal rate elsewhere. 
 
 The preachers had triumphed. They had got 
 wind of the nefarious attempt to preserve the 
 health of the troops in this hour of national stress, 
 and had intimidated the authorities. Or perhaps 
 the official in charge of the arrangements did not, 
 for some reason, wish quick disinfection to be a 
 success. I have no very accurate information ; 
 but sometimes the worker or thinker proposes, and 
 an official disposes. The events occurred as I 
 describe. I do not know how they occurred. 
 
 Now consider the consequences. On the 21st 
 of March 1918 the German offensive, so long fore- 
 shadowed, opened. A British Army was defeated, 
 with enormous loss in dead and wounded. Nearly 
 100,000 British soldiers went into captivity. 
 Thousands of guns, immense stores of material, 
 and fifty miles of territory, which many valiant 
 men had died to gain, had to be abandoned. 
 Henceforth, for months, the troops fought " with 
 their backs against the wall." A quarter of a 
 million immature boys and elderly half-trained 
 men, mostly married, were hurried from England 
 to the front, there to perish, many of them. The 
 black draperies of mothers and widows suddenly 
 multiplied in our streets. Men spoke to each other 
 with twisting faces. The allied cause was brought 
 to the verge of ruin. The war was prolonged, and 
 thousands of millions were added to the national 
 debt. And at that time there were in the venereal dis- 
 eases hospitals of the Allies, or in depots convalescent 
 from venereal diseases, enough officers and men,fully- 
 10
 
 146 PREVENTION OF VENEREAL DISEASE 
 
 trained soldiers, to have furnished, not one army corps 
 or two, but a great army complete from almost G.O.C. 
 to trumpeter. Experience had proved that all but 
 perhaps one in a hundred or a thousand of these 
 unfortunates could have been in the firing-line if 
 certain gentlemen, accidentally influential, but 
 otherwise perfectly insignificant, -whose business was 
 preaching or treating, had kept to their preaching or 
 treating, or if certain officials who happened at the 
 moment to be at the wheel, and whose business it 
 was to preserve the health and efficiency of the 
 troops, had kept to their business of preserving 
 the health and efficiency of the troops. 
 
 My men had been accustomed to come to my 
 orderly to obtain their disinfectants. The fact 
 that venereal disease had almost vanished from 
 among them showed that they had no shyness in 
 appealing to him. But with the bottles came a 
 leaflet couched in very peremptory terms ordering 
 commanding and medical officers, on the one hand, 
 to place the filled bottles and tubes in a retired 
 place in the medical inspection room, or in an annexe 
 thereto, so that the men could help themselves 
 without being observed, and, on the other hand, to 
 exercise a strict supervision. I wrote at once to 
 the War Office and to District Headquarters, say- 
 ing it was impossible to follow instructions ; one 
 could not at the same time supervise and not 
 supervise at all. I pointed out also that, if the 
 bottles and tubes were left unprotected, they would 
 be at the mercy of any fanatic, and besides, would 
 certainly be used for unauthorised purposes. I 
 received no reply, and was obliged to tell com-
 
 QUICK DISINFECTION 147 
 
 manding officers when they came for enlightenment, 
 that they had better put the outfits in charge of an 
 N.C.O., for, as far as I could judge, the peremptory 
 leaflet was just " eye-wasbu" But whose eyes the 
 authorities intended to wash, the preachers or the 
 Army doctors, I did not know. Later, a superior 
 medical officer discovered my arrangements, de- 
 clared they were contrary to regulations, and in- 
 sisted on the outfits being placed where the men 
 could help themselves unobserved. This was done. 
 One of my units a quiet, comfortable party, 
 composed mainly of elderly, married, home-service 
 men inhabited a battery on the sea-front. While 
 the outfits were in charge of an N.C.O. they had 
 been used at the rate of one or two a week ; but 
 as soon as the change was made the bottles, but 
 not the tubes, began to disappear at the rate of 
 forty a day truly a scandalous rate for men of 
 that character, or indeed, any character. The 
 superior medical officer was triumphant, and I 
 admitted, pro tern., that he knew more of the 
 psychology of the soldier than I did the elderly 
 ruffians, too shy to ask a N.C.O. for disinfectant, 
 but not too shy to pursue amatory adventures with 
 suspect ladies 1 However, contrary to regulations, 
 I had a watch set, and it was discovered that the 
 permanganate of potash had become fashionable 
 in that battery as a tooth-wash. The men were 
 admonished, and the illicit usage ceased, but later 
 some one took to abstracting all the outfits at one 
 fell swoop, and we could never catch him. I do 
 not know whether he was a fanatic acquiring merit, 
 or a speculator who sold his spoils in the town,
 
 148 PREVENTION OF VENEREAL DISEASE 
 
 but in the end the N.C.O. took charge again. As 
 we had to make a return of the bottles " used," 
 Headquarters must have formed a bad opinion of 
 that battery. 
 
 After the outfits arrived, I lectured my men 
 exactly as before, except that I told them that they 
 need not any longer find bottles. But in most 
 military areas orders were obeyed, and the men 
 were bidden not to carry the bottles, but return to 
 barracks for them. In some places they were 
 actually kept under lock and key, so that at night 
 the soldier had to waken an orderly. One pious 
 general forbade then* use altogether in the district 
 under his command, which gives an idea of the 
 vagueness of the instructions issued, and the laxity 
 with which they were enforced. 
 
 After the new instructions were issued, I wrote, 
 and I believe Sir Bryan Donkin and others wrote, 
 begging the authorities to fight the matter in the 
 open. We insisted that, if the whole truth were 
 made known, the nation would sweep the futile 
 preachers and their tools aside as decisively and 
 with more abiding contempt than it had already 
 swept the far less guilty conscientious objectors. 
 Our efforts were unavailing. The authorities were 
 not looking for trouble. Or, more probably, they 
 accepted the advice of the official in charge of the 
 arrangements. This official was either almost 
 unbelievably slack and incompetent, or he was 
 determined that the arrangements should not 
 succeed, or he had been intimidated. Apparently 
 he was in sympathy with the National Council 
 for Combating Venereal Disease by preaching and
 
 QUICK DISINFECTION 149 
 
 treating. This body was professedly semi-official. 
 It was subsidised by the Government and at the 
 time very powerful. It was in touch with high 
 ecclesiastical dignitaries, and some of its members 
 were on an Advisory Medical Council, to which 
 the Army authorities paid great deference. I 
 learned privately that one of the members of the 
 National Council was principally instrumental in 
 making that alteration in my lecture to which I 
 have alluded.
 
 CHAPTER XI 
 
 COMPARATIVE STATISTICS 
 
 WHILE I was still conducting my experiment 
 in secret, I received, in common with all 
 commanding officers and Army doctors, a circular 
 that contained copies of two letters which had 
 been addressed by the Army Council to General 
 Officers Commanding-in-Chief, and which gave 
 me very great encouragement. These letters are 
 so important that I quote them at length. The 
 first, which is dated 18th March 1916, orders the 
 establishment of the venereal ablution rooms ; 
 the second, which is dated 9th August 1917, 
 deplores their failure. 
 
 WAR OFFICE, LONDON, S.W., 
 18th March 1916. 
 
 24/General No./4812 (A.M.D.2). 
 
 " SIR, I am commanded by the Army Council to 
 inform you that they have had under consideration 
 the question of the prevalence and prevention of 
 the venereal diseases. 
 
 " The Council cannot accept suggestions made 
 with regard to prevention which would imply the 
 adoption of any system of prophylaxis which might 
 
 150
 
 COMPARATIVE STATISTICS 151 
 
 be said to afford opportunities for unrestrained 
 vice. They are of opinion that the inculcation of 
 temperance, and of a knowledge of the immediate 
 and remote consequences of the venereal diseases 
 form the best foundations for prophylaxis. They 
 have encouraged the giving of lectures on these 
 matters, in order that all Officers, non-commissioned 
 officers, and men shall become acquainted with 
 the subject, which is usually not one for public 
 discussion. 
 
 " While it cannot be doubted that these lectures 
 have been productive of good, yet experience shows 
 that large numbers of men do contract disease. 
 It is felt by many that such men should be afforded 
 the earliest possible opportunity of seeking medical 
 advice and treatment, and it is thought that they 
 will be more willing to do so since they are now 
 largely acquainted with the far-reaching conse- 
 quences of these diseases to themselves and to 
 posterity. 
 
 " I am, therefore, to convey to you the express 
 wishes of the Army Council in regard to this 
 subject. In every barracks and camp an organised 
 system should be established under which soldiers 
 who have exposed themselves to the dangers of 
 venereal infection should be required to attend for 
 treatment within twenty-four hours of infection. 
 Officers should impress upon all non-commissioned 
 officers and men that drugs are efficient to prevent, 
 in the vast majority of cases, the results of self- 
 indulgence, if applied properly and in good time. 
 
 " Medical Officers should be required to arrange 
 for the establishment in medical inspection rooms,
 
 152 PREVENTION OF VENEREAL DISEASE 
 
 or elsewhere, of means of using antiseptic injections, 
 the application of calomel ointment, or such other 
 applications as may seem best to them. Men 
 returning to barracks at any hour of the day or 
 night should have immediate access, under proper 
 means of privacy, to the room, or rooms, established 
 for this purpose. The attention of all Commanding 
 Officers should be drawn to the necessity of the 
 establishment of such a system, and their personal 
 attention should be given to the matter. 
 
 " Administrative Medical Officers should take 
 steps to assure themselves that the instructions of 
 the Council in this matter are being carried out, 
 and should report any instance in which the system 
 is not receiving the fullest support. 
 " I am, Sir, 
 
 Your obedient Servant, 
 (Signed) B. B. CUBITT." 
 
 "The General Officer Commanding-in-Chief, Southern 
 Command." 
 
 This letter gives some indication of the terror 
 with which the preachers inspired the authorities. 
 The latter pretend that they are establishing Early 
 Treatment Centres places to which endangered 
 men shall resort for treatment by doctors or other 
 trained persons. Actually, places in which the men 
 shall practise self -disinfection are established. In 
 the next letter the authorities are more candid. 
 They mention the word " prevention," and de- 
 scribe the venereal ablution rooms in their true 
 character.
 
 COMPARATIVE STATISTICS 153 
 
 WAR OFFICE, ADASTRAL HOUSE, 
 VICTORIA EMBANKMENT, E.C., 
 
 9th August 1917. 
 24/General Number/4812 (A.M.D.2). 
 
 " SIR, I am commanded by the Army Council 
 to invite your attention to the serious wastage 
 which is resulting from venereal disease. 
 
 " Taking into consideration the fact that re- 
 admissions to hospital on account of syphilis have 
 now been reduced to a minimum, the present ratio 
 of admissions does not represent such a decrease 
 in the incidence of venereal disease as should occur 
 if the instructions regarding the prevention and 
 early treatment of these diseases, as conveyed 
 in War Office Letter 24/General Number /4812 
 (A.M.D.2) of the 18th March 1916, and the various 
 leaflets and " suggestions " which have been issued 
 on the subject, were faithfully carried out. 
 
 " From reports which have been received, it is 
 clear that Officers Commanding and Officers in 
 Medical Charge of units are not giving this subject 
 that close personal attention which the seriousness 
 of the matter demands. In this connection, I am 
 to attach hereto a table showing the monthly ad- 
 missions from venereal disease from two separate 
 barracks in the same town during the year 1916 
 and the early part of 1917, which clearly illustrates 
 the very substantial reduction in the incidence of 
 venereal disease which can be effected where the 
 early treatment system is energetically carried out. 
 
 " In some units the early treatment installation 
 is left to manage itself, while in others, although
 
 154 PREVENTION OF VENEREAL DISEASE 
 
 maintained in excellent order, it is kept under lock 
 and key, so that an orderly has to be wakened to 
 open it. In some units there appears to be no 
 installation at all. 
 
 " From the foregoing, it is evident that as a 
 general rule that interest and hearty co-operation 
 of Commanding Officers and of Medical Officers 
 which is necessary for the success of the early 
 treatment scheme, does not exist and that in order 
 to prevent this very serious diminution in the 
 fighting efficiency of the troops on account of 
 wastage from venereal diseases, much more strin- 
 gent measures are essential. 
 
 " The Council, therefore, desire you to give this 
 matter your serious personal attention, with a view 
 to ensuring that their wishes as conveyed in their 
 letter of 18th March 1916, and any subsequent in- 
 structions on the subject which are from time to 
 time issued, are given effect to in every unit through- 
 out your command. 
 
 " Officers commanding units should be informed 
 that they will be held personally responsible for 
 taking every possible step within their power for 
 preventing this wastage from venereal diseases, 
 and any increase in the incidence of these diseases 
 in the units under their command will be liable to 
 be looked upon as a failure to carry out the Council's 
 instructions, and will be seriously dealt with. 
 " I am, Sir, 
 
 Your obedient Servant, 
 
 B. B. CUBITT."
 
 COMPARATIVE STATISTICS 
 
 155 
 
 " TABLE SHOWING MONTHLY ADMISSIONS FOB V.D. 
 
 FROM TWO SEPARATE BARRACKS IN THE SAME 
 TOWN DURING 1916 AND PART OF 1917 : 
 
 
 M.O. Indifferent 
 about early treat- 
 ment. Average 
 monthly strength, 
 1853- 
 
 M.O. keen on 
 early treatment 
 from May 1916 
 onwards. Average 
 monthly strength, 
 2091. 
 
 1916. 
 
 
 
 January . 
 
 9 
 
 10 
 
 February . 
 
 14 
 
 16 
 
 March 
 
 9 
 
 20 
 
 April 
 
 18 
 
 19 
 
 May . 
 
 22 
 
 12 
 
 June 
 
 12 
 
 7 
 
 July 
 
 12 
 
 7 
 
 August 
 
 4 
 
 6 
 
 September 
 
 19 
 
 4 
 
 October 
 
 23 
 
 5 
 
 November . 
 
 18 
 
 4 
 
 December . 
 
 18 
 
 9 
 
 1917. 
 
 
 
 January 
 
 20 
 
 7 
 
 February . 
 
 11 
 
 10 
 
 March 
 
 20 
 
 9 
 
 April 
 
 12 
 
 10 
 
 May . 
 
 19 
 
 10 
 
 Total . 
 
 260 
 
 165
 
 156 PREVENTION OF VENEREAL DISEASE 
 
 The " Table showing Monthly Admissions for 
 Venereal Disease from two separate Barracks " 
 covers a period of seventeen months, during which 
 time the ablution rooms were established. Pre- 
 sumably their establishment is indicated by the 
 fall in the venereal rate of the men in charge of the 
 M.O. who was " keen," in which case I think his 
 rooms must have been equipped somewhat before 
 mine. This officer and I had the care of about the 
 same number of troops, and in seventeen months 
 the number of his cases was 165, while in twenty- 
 eight months the number of my cases was 7. 
 At his rate my number should have been 271 '76. 
 At my rate his number should have been 4-25. 
 He averaged 9-1 men sick of venereal disease a 
 month ; I averaged 0-25. His rate per thousand 
 per annum was 58 '38 ; mine was 1'5. In other 
 words, he had nearly forty times as much sickness 
 from venereal disease among his men as I had. 
 And he was held up as a model 1 The M.O. who 
 was " indifferent " had a venereal disease-rate of 
 about 104 per thousand per annum, and his sick 
 were nearly seventy times as numerous as mine, 
 and nearly twice as numerous as those of the 
 other M.O. 
 
 However, I have no desire to claim undue credit. 
 I believe these statistics are deceptive. I think 
 there must have been circumstances which unduly 
 raised the venereal rates of these two doctors as 
 compared to mine. In the first place, the highest 
 monthly rates among the men in charge of the keen 
 M.O. occurred during the earlier months of 1916, 
 when he had no ablution rooms, and, therefore, no
 
 COMPARATIVE STATISTICS 157 
 
 means of preventing venereal disease. If we ignore 
 these months, his annual rate works out at forty- 
 five per thousand per annum, a very material 
 reduction. In the second place, his returns deal 
 with a period earlier in the war than mine ; and, as 
 I have already indicated, married soldiers are usually 
 faithful to their wives, whereas unmarried men are 
 usually incontinent. Early in the war the pro- 
 portion of young unmarried men as compared to 
 the older married men was greater than later. 
 Therefore, presumably, given equal conditions, 
 the men I had in my charge were, on the average, 
 less likely to expose themselves to infection than 
 those in his charge. Nevertheless, even after all 
 allowances have been made, the disparity between 
 his results and mine is enormous. For example, 
 in the first five months of 1917, when he had forty- 
 six cases, I had none. My success, therefore, was 
 due mainly to the superiority of the method I 
 adopted. 
 
 As far as my knowledge goes, exactly the same 
 success as mine has attended the efforts of officers 
 in medical charge of troops who have used similar 
 methods, and taken pains to make them successful. 
 As already stated, long before I tried it, others had 
 achieved remarkable success with it at Mhow and 
 Delhi. During 1918-19, Surgeon-Commander P. 
 H. Boyden, M.D., R.N., used the method of 
 immediate swabbing with permanganate among 
 the sailors of H.M.S. Excellent (an island, not a 
 ship). " Amongst 496 men employing this method 
 one case of syphilis is recorded, but he used the 
 treatment six hours after exposure. There have
 
 158 PREVENTION OF VENEREAL DISEASE 
 
 been no cases of gonorrhoea or chancroid." 1 At 
 first no one but myself used the method of quick 
 disinfection in Portsmouth. But I told other 
 medical officers, and gradually its use was extended 
 till I believe it is now employed, almost to the ex- 
 clusion of other methods, over almost two counties. 
 Venereal disease has almost vanished among 
 soldiers belonging to the British Army throughout 
 nearly the whole of this area. What there is 
 of it occurs mainly among troops joining from 
 outside the area and bringing their infections 
 with them. The area is served by a venereal 
 diseases hospital. When I last had an opportunity 
 of ascertaining the facts, of the hundreds of men 
 who had passed through the hospital nearly all 
 had employed slow disinfection, and not one had 
 employed quick disinfection. It has been said by 
 people, who, I think, desire to " crab " the method 
 rather than to praise those who have practised it, 
 that the success has resulted from the " wisdom, 
 tact, and energy " of the medical officers. But is 
 it conceivable that all these officers, and no others, 
 should have possessed " wisdom, tact, and energy " ? 
 Personally, I had no time, even had I the power, 
 to exercise these desirable qualities. I am sure I 
 did not spend on the average more than five minutes 
 a day on venereal disease. As I attended to the 
 sick, the orderly would say : " Party joining station, 
 sir." Thereupon I would snatch up a small bottle 
 of permanganate solution and a swab of cotton- 
 wool, go out, walk along the line looking for in- 
 fectious diseases (measles, scabies, and the like), 
 1 See Appendix IV. pp. 406-7.
 
 COMPARATIVE STATISTICS 159 
 
 and then gabble off my little lecture. The one 
 and only thing I tried to be impressive about was 
 the urgent necessity for speed in disinfection. 
 
 When instructions came down from the War Office 
 that the bottles and tubes were to be used by the 
 men when they had returned to barracks after 
 exposure to danger, I was indignant. We had been 
 led to understand that quick disinfection was to 
 be introduced. Obviously, quick disinfection was 
 intended originally, as is abundantly proved by the 
 extravagant manufacture and purchase of bottles 
 and tubes at such a time. It was then that I had 
 posters, which instructed the men to carry the 
 chemicals on them, typed and pasted up in every 
 venereal ablution room under my control. I 
 wrote to the authorities at the War Office enclosing 
 a copy of the poster, and saying I had had it pasted 
 up. I received a civilly-expressed reply to the effect 
 that it was a dangerous procedure, as the clergy 
 would be sure to raise trouble if they heard of it. 
 I answered that in that case I would accept the 
 whole responsibility, and would under no circum- 
 stances shelter behind the War Office. To that 
 note I received no answer. The clergy never 
 troubled ; possibly they never heard of the poster ; 
 but my inspecting medical officer noted it at once, 
 and declared it was not a proper document, not a 
 poster which authority had sanctioned. I answered 
 that I had communicated it to Supreme Auth- 
 ority, who had been good enough not to order its 
 removal. I suppose that Supreme Authority ex- 
 pected that the inspecting officer would insist on 
 its removal, while the inspecting officer did not care
 
 to order the removal of that which Supreme 
 Authority seemed to have sanctioned. Anyhow, 
 I kept the posters flying, and preserved the health 
 of my men. Later, other medical officers adopted 
 the same plan. Its use became general in the 
 district, and so venereal disease practically vanished 
 from a wide area. 
 
 Nothing can be more simple and easy than to 
 keep venereal disease from soldiers. The men are 
 just as eager to avoid suffering as you and I or any 
 other civilian. Like us, they know thoroughly 
 well the dangers they run ; but in the absence of 
 bias this fear is not sufficient to keep them moral 
 any more than it keeps unmarried civilians moral. 
 It is impossible, in the lack of early bias, to 
 make them chaste ; but brief and clear in- 
 structions and explanations will make them adopt 
 sanitary precautions, and preserve them from 
 disease. Here we are concerned with facts. In- 
 structions alone are not sufficient. The men 
 must be treated like reasonable beings. They 
 must be told not only what to do, but also the 
 reasons for doing it. They must know that 
 venereal diseases are microbic, that all microbes 
 may be destroyed by antiseptics, that the microbes 
 of venereal disease are particularly delicate, that 
 at first they are all on the surface and may then 
 be killed if quick action be taken, and that every 
 moment of delay increases the danger. It is very 
 necessary to explain also that " amateurs " are 
 very dangerous people, and that a girl who is un- 
 chaste with them is likely to have been unchaste 
 with others also. Thereafter, they act intelli-
 
 COMPARATIVE STATISTICS 161 
 
 gently, and disinfect with speed and care. As I 
 say, whenever and wherever such teachings have 
 been given, they have never been followed by 
 failure. It is because the practice of giving them 
 by word of mouth or by posters, or both, has 
 become general in the Portsmouth Area that the 
 soldiers of the British Army resident in that dis- 
 trict are almost free from disease. It is because 
 they have not been given in other areas that the 
 latter are still steeped in disease, notwithstanding 
 a lavish provision of bottles and tubes. 1 
 
 There can be no shadow of doubt that originally 
 the authorities were quite genuine in their intention 
 to introduce quick disinfection. Unquestionably 
 they were satisfied with the evidence. Indeed, it 
 is not possible that any man, not blinded by the 
 glare of his own fanaticism, could doubt it. Fana- 
 ticism plays queer tricks. The fanatic is ready to 
 believe that Jonah swallowed the whale. But here 
 the evidence was peculiarly decisive and convincing. 
 A military doctor who teaches his men to disinfect 
 quickly has nothing to gain. On the contrary, he 
 exceeds orders, and is likely to get into trouble. 
 His evidence can be tested to the last detail, for 
 each infected man has to be sent to a particular hos- 
 pital. My men went to Hilsea Venereal Diseases 
 Hospital, where a record was made of when, and 
 where, and by whom (professional or " amateur ") 
 each man was infected, and whether he had 
 disinfected himself, and if so, how long after 
 exposure. What with the prospect of getting into 
 hot water, and what with these independent official 
 
 1 See p. 316. 
 ii
 
 162 PREVENTION OF VENEREAL DISEASE 
 
 records, there is no motive for deception, and no 
 possibility of it. Moreover, the evidence is experi- 
 mental. The peculiarity of experimental evidence 
 is that one instance is sufficient. A single ex- 
 perience convinces us that fire burns, or that water 
 is compounded of oxygen and hydrogen. What can 
 be done by one man, can be done by any number 
 of men who follow the same procedure. In this 
 case, the experiment demonstrated that carefully 
 instructed men tend to follow advice and to dis- 
 infect themselves efficiently. If any medical officer 
 in charge of soldiers, who knows the procedure, 
 fails to get good results, it must necessarily be 
 because he is confronted by special and unusual 
 difficulties, or because he is slack and inefficient, or 
 because he does not wish for success. Up to the 
 present every man who has tried the experiment 
 has been successful. 
 
 What happened behind the scenes at the War 
 Office after quick disinfection had been resolved 
 on, I have no means of knowing. I thought the 
 authorities were acting very unwisely, and wrote 
 letter after letter urging haste and simplicity in 
 action. Impatient at the delay, and to prove that 
 packets were unnecessary, I offered to go, at my 
 own expense, to the worst military district in 
 England, and almost clear it of disease in a fort- 
 night ; or, alternatively, to go to any port of em- 
 barkation and prevent the men passing through it 
 on leave from returning with venereal disease, 
 I have no doubt I should have succeeded ; for 
 already I had learned how readily soldiers accept 
 advice. My offers were not entertained, and I
 
 COMPARATIVE STATISTICS 163 
 
 supposed the authorities thought them unnecessary, 
 and perhaps presumptuous, and was somewhat 
 dashed in consequence. But later, when instruc- 
 tions to use the chemicals in the old, inefficient way 
 with delay were issued, it became clear that there 
 was no longer any intention of protecting the men 
 by quick disinfection. Nothing as regards the 
 facts had changed except that the evidence had 
 grown stronger. Evidently new influences were 
 at work behind the scenes. One had to con- 
 sider whether it was mere incompetence and 
 stupidity, or whether it was fanaticism, or whether 
 it was some other motive that had become potent. 
 
 Against the idea that incompetence was the 
 cause of the failure, was the fact that it was hardly 
 possible for the most stupid man to go astray. 
 All that was necessary to achieve success was to 
 issue a confidential but stringent order to com- 
 manding and medical officers to teach their men 
 why and how to disinfect quickly ; and afterwards 
 to inquire into all cases of excessive prevalence of 
 disease, and deal rigorously with slackness and 
 incompetence. It really required some ingenuity 
 to go wrong in a matter so simple. 
 
 Against the idea that fanaticism, or some such 
 motive, was at the bottom of the failure was the 
 shocking nature of the crime. It would have to 
 be committed by military doctors, men sworn to 
 preserve, and paid to preserve to the best of their 
 ability, the health and efficiency of the troops in 
 their charge. That was their whole duty. More- 
 over, the time was of dire national peril, when every 
 fit man was required at the front, and practically
 
 164 PREVENTION OF VENEREAL DISEASE 
 
 every man who contracted venereal disease was a 
 fit man. Again, it was poison that was the danger 
 to the troops. Yet, again, that poisoning was utterly 
 useless ; it did not keep the men moral. But the 
 psychology of the fanatic is an amazing thing. 
 Blind to facts, and utterly immoral in the ordinary 
 sense of the word in all that conflicts with his 
 particular craze, he is capable of anything. Indeed, 
 the very combination of stupidity and wickedness 
 in the crime indicates fanaticism. However, I 
 know no more about the secret history of this affair 
 than the reader. He is in possession of my data, 
 and must form his own opinion. 
 
 Of course, there is the possibility that the men 
 who prevented quick disinfection sincerely believed 
 on common-sense grounds that it did not check 
 disease. But these men had the whole evidence in 
 their hands. I and others had made statements. 
 But the means of checking them lay in the hospital 
 records which were in their hands. If my state- 
 ments were not true, the error or misstatement 
 could be discovered at once. If they were true, no 
 one not crazy, or so deeply prejudiced as to be in- 
 capable of rational thought, could doubt the efficacy 
 of quick disinfection, and the fact that it was easy 
 to get soldiers to adopt it. It must be borne in 
 mind that the moment it became evident that the 
 authorities no longer intended to introduce the 
 practice of quick disinfection, a ceaseless campaign 
 began, conducted not merely by me, but also by 
 Sir Bryan Donkin and many others. The burden 
 of our cry always was : " The evidence we have 
 offered you is either true or untrue ; if it be true,
 
 COMPARATIVE STATISTICS 165 
 
 you are bound, in the interest of the Army and the 
 civil population, to act on it ; if it be untrue, you 
 are bound to prove it so, and you have the means 
 of doing it." Not the faintest attempt has ever 
 been made to impugn the evidence.
 
 CHAPTER XII 
 
 THE VENEREAL DISEASE ACT, 1917 
 
 A LMOST from its foundation the position of the 
 ./]L National Council for Combating Venereal 
 Disease tended to become difficult. A good name 
 is a good thing, but it becomes embarrassing if 
 practice does not equal profession. At first every 
 one wished the Council well. No one so much as 
 offered opposition or criticism. The testimonial 
 granted by the Royal Commission gave it prestige. 
 It was accepted for what its name implied, a cor- 
 poration which would strive by every means in 
 its power to diminish the prevalence of venereal 
 disease. There were four separate ways in which 
 the problem could be attacked. 
 
 (1) Children could be so taught as to receive a 
 bias against unchastity. Such teaching, owing to 
 the convention of reticence between adults and 
 children is, for generations at least, impracticable. 
 The mass of parents could not be got to adopt it ; 
 and, in any case, the influence of mere admonition 
 would be slight compared to the teaching imparted 
 during intimate companionship by other children. 
 I have never heard the National Council blamed for 
 not advocating the teaching of children, and, as a 
 
 MM
 
 VENEREAL DISEASE ACT, 1917 167 
 
 fact, it has lately begun to advocate the teaching 
 of, or rather the preaching to, elder children. 
 
 (2) Adults could be preached to. Such preaching 
 could do no harm, even if it did not do much good. 
 Though it may not often reach the unconverted, 
 it tends to arouse sympathy and to confirm the 
 bias of the converted. No one has objected to 
 it. But very strong objection was raised when it 
 was found that the Council's endeavour to promote 
 " moral hygiene " involved a very obvious resolve 
 to discredit and suppress physical hygiene. 
 
 (3) The sick could be treated, and, as far as 
 possible, isolated, so as to reduce the danger of 
 infection. In view of the enormous prevalence of 
 venereal disease, opinions might differ as to the 
 amount of good which might be achieved by this 
 method ; but there could be no two opinions as 
 to the necessity and urgency of it. The sick could 
 not be treated as criminals and forced to undergo 
 examination, treatment, and isolation (as prosti- 
 tutes were treated in some districts under the 
 Contagious Diseases Acts), but large numbers 
 might be persuaded to isolate themselves sexu- 
 ally, and every facility could be given for 
 treatment. 
 
 (4) The practice of physical hygiene prevention, 
 disinfection could be taught. It was known that 
 the hardiest pathogenic microbes can, when access- 
 ible, be destroyed by antiseptics ; that the microbes 
 of venereal disease are among the most delicate of 
 all microbes ; that several doctors have aborted 
 venereal disease in deeply infected individuals by 
 swift treatment ; and that others have prevented
 
 168 PREVENTION OF VENEREAL DISEASE 
 
 its prevalence under the most difficult conditions 
 among large bodies of men by the employment of 
 prompt disinfection. 
 
 But while the Council was willing to preach and 
 to treat, and even, in an ineffectual way, to teach, 
 it set its face against disinfection. Thereupon, be- 
 sides Sir Bryan Donkin, some of its medical mem- 
 bers, complaining that it was sailing under false 
 colours, resigned, and an opposition began to come 
 into being. In 1916 the Army Council was forced 
 to establish venereal ablution rooms, and the 
 National Council with its ecclesiastical patrons was 
 obliged to acquiesce, saving its face, however, by 
 pretending that the object of the rooms was not 
 prevention, but Early Treatment. But now sol- 
 diers began to tell civilians about prophylaxis. 
 More especially Colonial soldiers, whom their 
 medical authorities provided with " packets," 
 talked about it. A civilian demand for packets 
 sprang up, and chemists began to stock them. As 
 a fact, for many years past, the use of means of 
 protection better than packets had been common 
 among civilians. The packets, containing calomel 
 cream, and sometimes a silver salt, such as nargol, 
 for injection into the pipe, were adapted for abortive 
 treatment rather than for immediate disinfection. 
 As I have already described, civilians had used 
 such active antiseptics as permanganate of potash 
 and lysol, or, in default of antiseptics, soap and 
 water. The cleaner prostitutes had been accus- 
 tomed, quite as a routine measure, to provide their 
 paramours with antiseptics, and, of course, with 
 soap and water. But packets had prestige as
 
 VENEREAL DISEASE ACT, 1917 169 
 
 especially devised by medical men for the prevention 
 of venereal disease. 
 
 When chemists began to stock and advertise 
 packets on a large scale, the National Council 
 proceeded to action. Chemists have always had 
 the right to advertise preventives and cures for 
 every ill to which the flesh is heir. If a freeborn 
 Englishman desires unqualified help, the law very 
 properly allows him the liberty. The sale of patent 
 medicines has produced several enormous fortunes, 
 and the State has benefited through the imposition 
 of a special tax. But, as regards venereal disease, 
 the zealous National Council resolved to protect 
 the public from quack advertisements which, it 
 seems, tend to produce a false confidence that 
 causes immorality and delays treatment. Accord- 
 ingly, the " Venereal Disease Act, 1917 " was 
 promoted and passed. 
 
 This short Act has been so much misunderstood 
 that I quote it in full. 
 
 [7 & 8 Geo. 5] Venereal Disease Act, 1917 [Ch. 21]. 
 
 CHAPTER 21 
 
 An Act to prevent the treatment of Venereal Dis- 
 ease otherwise than by duly qualified medical 
 practitioners, and to control the supply of 
 Remedies therefor ; and for other matters 
 connected therewith. [24th May 1917.] 
 Be it enacted by the King's most Excellent 
 Majesty, by and with the advice and consent of 
 the Lords Spiritual and Temporal, and Commons,
 
 170 PREVENTION OF VENEREAL DISEASE 
 
 in this present Parliament assembled, and by the 
 authority of the same, as follows : 
 
 PREVENTION OF THE TREATMENT OF VENEREAL 
 DISEASE OTHERWISE THAN BY DULY QUALI- 
 FIED PERSONS 
 
 1. (1) In any area in which this section is in 
 operation, a person shall not, unless he is a duly 
 qualified medical practitioner, for reward either 
 direct or indirect, treat any person for venereal dis- 
 ease or prescribe any remedy therefor, or give any 
 advice in connection with the treatment thereof, 
 whether the advice is given to the person to be 
 treated or to any other person. 
 
 (2) This section shall operate in any area to 
 which it is applied by order of the Local Govern- 
 ment Board, or, in Scotland and Ireland, the 
 Local Government Board for Scotland and Ireland 
 respectively : 
 
 Provided that no order shall be made in respect 
 of any area until a scheme for the gratuitous treat- 
 ment of persons in that area suffering from venereal 
 disease has been approved by the Local Government 
 Board, or, in Scotland and Ireland, the Local 
 Government Board for Scotland and Ireland 
 respectively, and is already in operation. 
 
 RESTRICTION ON ADVERTISEMENTS, &c. 
 
 2. (1) A person shall not by any advertisement 
 or any public notice or announcement treat or 
 offer to treat any person for venereal disease, or 
 prescribe or offer to prescribe any remedy therefor,
 
 VENEREAL DISEASE ACT, 1917 171 
 
 or offer to give or give any advice in connection 
 with the treatment thereof. 
 
 (2) On and after the first day of November 
 nineteen hundred and seventeen a person shall not 
 hold out or recommend to the public by any 
 notice or advertisement, or by any written or 
 printed papers or handbills, or by any label or 
 words written or printed, affixed to or delivered 
 with, any packet, box, bottle, phial, or other 
 enclosure containing the same, any pills, capsules, 
 powders, lozenges, tinctures, potions, cordials, 
 electuaries, plaisters, unguents, salves, ointments, 
 drops, lotions, oils, spirits, medicated herbs and 
 waters, chemical and officinal preparations what- 
 soever, to be used or applied externally or internally 
 as medicines or medicaments for the prevention, 
 cure, or relief of any venereal disease : 
 
 Provided that nothing in this section shall apply 
 to any advertisement, notification, announcement, 
 recommendation, or holding out made or published 
 by any local or public authority or made or pub- 
 lished with the sanction of the Local Government 
 Board, or in Scotland and Ireland the Local 
 Government Board for Scotland and Ireland re- 
 spectively, or to any publication sent only to duly 
 qualified medical practitioners or to wholesale or 
 retail chemists for the purposes of their business. 
 
 PENALTIES 
 
 3. If any person acts in contravention of any of 
 the provisions of this Act, he shall be liable on 
 conviction on indictment to imprisonment, with or 
 without hard labour, for a term not exceeding two
 
 172 
 
 years, or on summary conviction to a fine not ex- 
 ceeding one hundred pounds, or to imprisonment, 
 with or without hard labour, for a term not ex- 
 ceeding six months. 
 
 DEFINITION 
 
 4. In this Act the expression " venereal disease " 
 means syphilis, gonorrhoea, or soft chancre. 
 
 SHORT TITLE 
 
 5. This Act may be cited as the Venereal Disease 
 Act, 1917. 
 
 On the one hand, the Act forbids the treatment of 
 venereal diseases for reward otherwise than by 
 duly qualified doctors. On the other hand, it 
 forbids the advertisement of remedies and pre- 
 ventives by any one and on any pretext. No one 
 but a doctor may for reward undertake the cure 
 and relief of a person actually suffering from 
 venereal disease. No one but local authorities, 
 not even a doctor, may, with or without reward, 
 by means of writing or print, advertise preventives 
 of venereal disease. It follows that a chemist 
 commits an offence if he recommends for reward 
 in any way a remedy for venereal disease ; he 
 commits an offence if he places in his window a 
 packet labelled as a preventiveot venereal disease; but 
 he does not commit an offence if he verbally advises 
 a customer to buy a chemical as a preventive. I 
 think chemists, as a rule, suppose that they must 
 not advise on, or sell, preventives ; but, obviously,
 
 VENEREAL DISEASE ACT, 1917 173 
 
 they are mistaken. They may recommend or sell 
 them to any extent, but not by advertisement. 
 
 In spite of the feeling that the promoters of the 
 Act were influenced by more than a pure desire to 
 preserve sufferers from unskilful doctoring, I think 
 that nothing but good can come of the prohibition 
 as regards treatment. The modern treatment of 
 venereal diseases requires a special knowledge, 
 instruments, and a technique which, as a rule, are 
 acquired only by specialists. The average doctor 
 (of whom I am one), let alone the chemist, the 
 manufacturer, and the quack, is not fully qualified 
 to deal with it. But, as regards prevention, the 
 case is different. It is extremely simple and easy 
 if taken in hand immediately after exposure to 
 danger. The chemicals required, ordinary disin- 
 fectants, are very cheap. At the cost of a few 
 shillings enough may be provided to supply 
 thousands of men. The temptations to fraud, 
 therefore, are reduced to a minimum. Fraud is 
 much less likely than in the case of preventives for 
 obesity, cancer, influenza, and the like, the advertise- 
 ment of which is unrestrained. The notion that the 
 public are liable to employ disinfectants which are 
 intended only for prevention as medicaments for 
 the cure of actual disease, is, I am sure, unreal. I 
 have never met a soldier who made this mistake. 
 It can easily be guarded against by careful ex- 
 planations and directions, especially when they 
 are printed just such directions and explanations 
 as now prevent patients from swallowing the 
 lotions, linaments, and ointments which are sold 
 for the relief of other maladies.
 
 174 PREVENTION OF VENEREAL DISEASE 
 
 But the section of the Act which concerns pre- 
 vention applies to more than unqualified advice. 
 If any physician, or collection of physicians, 
 horrified by the spread of venereal disease, issues 
 any written or printed notice that, in their con- 
 sidered opinion, such or such a chemical is a 
 disinfectant which will prevent venereal disease, 
 he, or they, are liable to " imprisonment, with or 
 without hard labour, for a term not exceeding two 
 years." 
 
 I do not think this book comes within the four 
 corners of the Act, but it is very probable that the 
 publications of the Society for the Prevention of 
 Venereal Disease, which includes very many of the 
 leading physicians in England, do come within 
 them. In that case the Government may be 
 compelled to prosecute, and then we shall behold 
 such men as Sir Frederick Treves, Sir Bryan 
 Donkin, Sir Arbuthnot Lane, and Sir Frederick 
 Mott standing in the dock charged with quackery, 
 in company with Lord Willoughby de Broke, Mr. 
 Rudyard Kipling, and General Sir Francis Lloyd. 
 I confess I should be glad if this prosecution were 
 undertaken. It would be the end of an impudent 
 section of the Act. Probably hardly any of the 
 politicians who voted for its imposition understood 
 its real meaning. Personally, I should be proud 
 to stand, even in the dock, with such men as I 
 have named in support of such a cause. In passing, 
 it may be noted that while chemists are often 
 consulted concerning the prevention of venereal 
 disease, doctors are consulted only by people already 
 infected,
 
 CHAPTER XIII 
 
 CIVILIAN EARLY TREATMENT CENTRES 
 
 WHEN, in 1916, the National Council permitted 
 without public protest, the establishment 
 of venereal ablution rooms for soldiers, it took 
 a fatal step. The principle of disinfection was 
 thereby admitted. Henceforward the Council 
 stood in slippery places. Its feet were on the 
 downward path. It could call the ablution rooms 
 " Early Treatment Centres," and pretend that 
 cure, not prevention, was the object in view, and 
 it could make the Army Council declare that it 
 would never " accept suggestions made with regard 
 to prevention which would imply the adoption of 
 any system of prophylaxis which might be said 
 to afford opportunities for unrestrained vice," but 
 whatever the language used, the fact remained that 
 the object of the venereal ablution rooms was 
 prevention by self-disinfection. The disinfection 
 might be slow and unscientific, the prevention 
 might be imperfect, plenty of men might be 
 poisoned ; but disinfection it was, and prevention 
 it was, and many men were saved. Moreover, the 
 soldier believed he was being protected. He had 
 never been restrained by fear, or at least fear had 
 never done rnpje thftn divert his attention from the 
 
 176
 
 176 PREVENTION OF VENEREAL DISEASE 
 
 prostitute to the amateur ; therefore he did not 
 become more incontinent ; but now he had, or 
 thought he had, what were called " opportunities 
 for unrestrained vice." Never again could the 
 National Council protest convincingly against dis- 
 infection. All it could now do was to hope and 
 work for the inefficient administrations of the prin- 
 ciple by the Army authorities, and later on appeal 
 to the results of inefficiency as a proof that dis- 
 infection increased rather than prevented disease. 
 This was precisely the policy pursued. The control 
 of the Army measures for preventing venereal 
 disease was placed in the hands of people who were 
 sympathisers with the National Council, who had 
 had no personal experience of quick disinfection, 
 and who, certainly, through design or incapacity, 
 did their best to ensure the failure of disinfection. 
 As already described, the one thing necessary, the 
 instruction of the men, was neglected, or rather 
 the men were positively misdirected, while material, 
 already present in the hands of the medical officers 
 in abundance, was multiplied, and thus an appear- 
 ance of activity created. 
 
 Sir Bryan Donkin's letter, which appeared in 
 The Times in January 1917, and other communica- 
 tions which he published as opportunity offered, 
 brought him an introduction from Sir J. W. Barrett, 
 M.D., then serving as A.D.M.S. with the Australian 
 Force in Egypt, to Miss Ettie Rout, who, by pro- 
 fession a journalist, had come with the Australian 
 and New Zealand Forces with the object of ameli- 
 orating, as far as possible, the hardships of the war. 
 She had been horrified by the pestilence of venereal
 
 CIVILIAN TREATMENT CENTRES 177 
 
 disease which broke out among the troops in Egypt, 
 England, and elsewhere, and, with extraordinary 
 resolution and courage, had embarked almost 
 single-handed on a campaign for prevention. She 
 furnished Sir Bryan, and later myself also, with 
 much valuable information, and for her own part 
 fought the battle most strenuously living among 
 the men, lecturing, finding and instructing lec- 
 turers, providing disinfectants, importuning auth- 
 orities, writing most trenchant letters, establishing 
 medical clubs in England and France, and the like. 
 I think that when the names of those who opposed 
 her are forgotten, the memory of this brave lady 
 will still be green among the descendants of the 
 valiant men for whose welfare she struggled. 
 
 Sir Bryan Donkin and I were able to give each 
 other mutual support. He was in a position to 
 influence public opinion, especially the opinion of 
 leading members of the medical profession ; I was 
 able to furnish an object lesson in immediate 
 disinfection. In the beginning of 1918 very valu- 
 able help came to us. Surgeon-Commander P. H. 
 Boyden, R.N., who was then in medical charge of 
 the Naval Gunnery School at Whale Island (H.M.S. 
 Excellent), had long been especially interested in 
 the treatment and prevention of venereal disease. 
 After careful inquiry, he asked and obtained per- 
 mission from the Admiralty to try, as a means of 
 preventing venereal disease, the method of quick 
 swabbing with permanganate of potash. Pre- 
 viously the sailors of the fleet had been supplied 
 with the " Dreadnought Outfit," a packet which 
 contained calomel ointment and a preparation of 
 
 12
 
 178 PREVENTION OF VENEREAL DISEASE 
 
 " nargol," a trade name for a silver salt. The 
 nargol was found to be very inefficient, and its 
 use had been abandoned. The conditions under 
 which Dr. Boyden worked differed somewhat from 
 those with which I had to deal. I had found no 
 difficulty in lecturing to every man who came under 
 my care ; but this was found impossible on Whale 
 Island, where the population was larger, even more 
 fluctuating, and under very strenuous training. 
 However, he lectured to as many men as possible. 
 Again, while he had authority to try the perman- 
 ganate method, he was not empowered to set aside 
 the dreadnought system ; the men, therefore, had 
 a choice, and very many, with the traditional 
 conservatism of sailors, preferred the dreadnoughts. 
 He had, however, one considerable advantage over 
 me. Instead of abandoning his material in out- 
 houses, he was able to keep it under his own 
 control. It had always been the rule in the Navy 
 to exercise strict supervision over venereal pro- 
 phylactics, and to issue them only to such men as 
 asked for them. As a consequence, the destination 
 of every bottle of permanganate was known and 
 recorded, and every man who received one was 
 given, in addition to Dr. Boyden's lectures, per- 
 sonal instruction by the sick-bay attendant. The 
 bottles, though with ordinary corks, were of a more 
 reasonable shape than those provided for soldiers. 
 In the year beginning with the first day of April 
 1918, and ending with the last day of March 1919, 
 496 men used the permanganate lotion. One 
 man only contracted disease, and he disobeyed 
 instructions and disinfected himself six hours
 
 CIVILIAN TREATMENT CENTRES 179 
 
 after exposure. Immediate disinfection with per- 
 manganate of potash, therefore, was effective in 
 every case in which it was employed. The 
 extreme importance of this precise record will be 
 perceived presently. Ultimately he and I jointly 
 published a communication to The Lancet.* 
 
 During 1918 and 1919, the agitation for sani- 
 tary measures against venereal disease steadily 
 grew in volume and strength. Many letters and 
 
 1 See Appendix VII. pp. 437-42. The reader should carefully 
 study this Appendix. It consists of a paper contributed by 
 Surgeon-Commander P. H. Boyden, R.N., with the permission 
 of the Admiralty, to the Proceedings of the Congress of the Royal 
 Institute of Public Health which was held in Brussels in May 
 1920. It was not read at the Congress, being crowded out, but 
 doubtless will appear in the Journal of the Institute before the 
 publication of this book. It contains not only the evidence 
 which Dr. Boyden published in the letter that he wrote with me 
 to The Lancet, but also an account of a second year's experience. 
 It will bejperceived that he has reduced the incidence of venereal 
 disease among the men in his charge from 71-6 to 37-2 per 1000 per 
 annum. During these two years 923 bottles of permanganate 
 solution were issued with one infection, and in that case the 
 sufferer, disobeying instructions, disinfected himself six hours 
 after exposure. Dr. Boyden, unlike me, was able to keep an 
 exact account of the bottles he issued ; for his men could get 
 them only when they specifically asked for them. The reader 
 will perceive the importance of his exact figures when he reads 
 about the Inter-Departmental Committee (Chapters IV. and XV., 
 and Appendix IV.), the Debate in the House of Lords (Chapter 
 XVI.), and the White Paper published last February by the 
 Ministry of Health (Chapter XVI. and Appendix VI.). On the 
 one hand Dr. Boyden and I, whose returns can be exactly 
 checked from independent sources, never met an instance of 
 the failure of quick disinfection ; on the other hand, the statis- 
 tician who compiled the various sets of figures issued by the 
 Ministry of Health reports hundreds of cases. Obviously, 
 some one has blundered. However, more of this anon.
 
 180 PREVENTION OF VENEREAL DISEASE 
 
 articles appeared in the public Press, especially 
 in The Times, which, realising earlier than other 
 journals the terrible nature of the burden the 
 nation was bearing, pronounced strongly against 
 mere " exhortation " and in favour of prevention. 
 The truth that public opinion is now, and for 
 long past has been, in favour of sanitation, and 
 would very readily welcome its application, is 
 seldom fully grasped. Almost every man with 
 whom the subject is discussed will pronounce for 
 it. But hitherto this vague but real preponderance 
 of opinion has been denied expression, and, above 
 all, organisation. The public has not known the 
 extent of the evil ; it has not known that anything 
 could be done to check it ; it has had no leaders. 
 Public expression has been monopolised by what 
 may be termed professional moralists pulpit and 
 " Exeter Hall " orators, and the like. The letters 
 and articles which appeared in The Times and else- 
 where tended to draw the veil aside and organise 
 opinion. The National Council began to find the 
 demand for sanitation ominously insistent. Sol- 
 diers had been successfully, sometimes very success- 
 fully, protected by disinfection. Why should not 
 civilians be similarly protected ? The Council met 
 the demand in the spirit of its own peculiar morality. 
 It did not dare tell the naked truth that it sought 
 physical hygiene only by the road of moral hygiene, 
 that for moral reasons it preferred poisoning to 
 disinfection, that it regarded the problem from an 
 ecclesiastical rather than a sanitary point of view. 
 The naked truth would fatally weaken its position 
 by transferring to opponents, who were clamour-
 
 CIVILIAN TREATMENT CENTRES 181 
 
 ing for quick disinfection, the support of all that 
 growing multitude who desired, if only for the 
 protection of the innocent, that venereal diseases 
 should be checked by every possible means. 
 Doubtless the National Council would repudiate 
 this description of its attitude. But at its very 
 foundation, when its regulations were drawn up, 
 " care was taken to avoid suggesting that means 
 should be taken to prevent infection." During its 
 career it had received decisive evidence that 
 prevention could be successfully taught and prac- 
 tised ; but, as yet, it has neither attempted to 
 impugn that evidence nor to proclaim it. It has 
 merely ignored the evidence, and pretended to the 
 public that it did not exist. Clearly, therefore, the 
 description of its attitude is just. Accordingly, 
 when the Council became conscious of the growing 
 demand for sanitation, it announced its intention 
 of applying to Town Councils for the establishment 
 of Early Treatment Centres for civilians. It would 
 not perpetrate the abomination of preventing 
 disease, it would not " accept suggestions made 
 with regard to prevention which would imply the 
 adoption of any system of prophylaxis which might 
 be said to afford opportunities for unrestrained 
 vice," but in the proposed municipal centres it 
 would abort, or make believe to abort, disease so 
 quickly that the sinner would think it was pre- 
 vented, while virtuous people thought it was cured. 
 It would hunt with the hounds, and pretend to 
 the hare that it was running with it. 
 
 The municipal centres, however, were to differ 
 in two respects from the military ablution rooms.
 
 182 PREVENTION OF VENEREAL DISEASE 
 
 The latter were present in all barracks and camps, 
 and the soldier was supposed to receive (but usually 
 did not receive) adequate instruction in the use of 
 the disinfectants. At any rate, every soldier was 
 supposed to know of the ablution rooms, and the 
 purpose for which they were instituted. If he 
 sinned, they were ready for him in his quarters, 
 with printed instructions complete. But civilians 
 did not sleep in barracks, and it was impossible, 
 and in the Council's view most undesirable, to 
 furnish each man's home with materials for early 
 treatment. Moreover, the Council suddenly dis- 
 covered that self-disinfection was inefficient and 
 dangerous, and Colonel Harrison, who has since 
 left the Army and joined the National Council and 
 the Ministry of Health, obligingly furnished it 
 with a certificate to that effect that same Colonel 
 Harrison under whose directions and with whose 
 approval the whole British Army had been prac- 
 tising self-disinfection, but delayed disinfection, 
 for years. Civilians, therefore, unlike soldiers, 
 were not to have the means for disinfection in their 
 dwelling-places, and they were not to be taught the 
 methods of disinfection ; they were to hasten as 
 soon as possible after sinning to the municipal 
 Early Treatment Centre, there to receive, if not 
 absolution, at least ablution, from the hands of 
 expert operators. 
 
 The reader should ponder this remarkable pro- 
 posal. It sheds a very clear light on the mentality, 
 the objects, and the methods of the National 
 Council. Quick disinfection consists in swabbing 
 the endangered parts with a little weak solution of
 
 CIVILIAN TREATMENT CENTRES 183 
 
 some antiseptic, for instance, permanganate of 
 potash, in a strength, say, of one part of the 
 chemical to one thousand parts of water (or "Condy's 
 Fluid " diluted to a port-wine colour). Owing to 
 the shape and position of the male organ, the 
 operation is less difficult and no more perilous than 
 washing the hands with soap and water. It is 
 effective, but, it seems, wicked. 
 
 .The operation of delayed disinfection is more 
 arduous and dangerous. As we have seen, the 
 microbes of venereal disease are all on the surface 
 at first, which is the reason why quick disinfection 
 is so effective. But every moment of delay in- 
 creases the danger, and the difficulty of destroying 
 the microbes. Presently it becomes necessary to 
 disinfect the interior of the pipe with a carefully 
 graduated preparation of permanganate of potash 
 or some other antiseptic, and to rub calomel oint- 
 ment vigorously into the surface. If the disin- 
 fectant for the pipe be too strong, it is apt to injure 
 it, and so, apart from the direct harm, to weaken 
 its powers of resisting infection. If it is too weak, 
 it tends to carry the microbes deeper. During and 
 after intercourse, the pipe is a collapsed tube 
 coated inside with a sticky fluid, and with various 
 pits and folds in its surface. Microbes, therefore, 
 cannot easily enter it, but, once they have entered, 
 the irrigation must be very thorough to be effective. 
 Again, the mucous membrane on the surface of 
 the male organ is usually very tender and sensitive, 
 especially after intercourse, and more especially 
 if it be habitually covered by the foreskin. The 
 operation of rubbing in the mercurial ointment,
 
 184 PREVENTION OF VENEREAL DISEASE 
 
 which must be thoroughly done, tends, therefore, to 
 be not only tedious, but painful also, and, on that 
 account, is apt to fail when the individual operates 
 on himself. Simple swabbing may be done by any 
 one with material prepared by himself ; abortive 
 treatment requires material prepared by a skilled 
 chemist, and must be administered by the hands 
 of an expert ; or, if not an expert, at least a resolute 
 and patient man, one who will not spare trouble 
 and does not feel the pain and discomfort himself. 
 The ingenuity of the National Council is un- 
 deniable. First it procures an edict which prevents 
 chemists from advertising disinfectants combined 
 in safe proportions ; next it announces that the 
 operation of self-disinfection is dangerous ; lastly 
 it undertakes the task of self-disinfection itself in 
 Early Treatment Centres. Consider the kind of 
 people who sin, and the conditions and places in 
 which they sin generally at night, under hedge- 
 rows and bushes, in parks and dark passages, in 
 brothels, hotels, and private houses. Imagine 
 these sinners, the sin consummated, hastening 
 with all possible speed to the municipal Early 
 Treatment Centres. How many of them are likely 
 to seek public aid ? I do not know whether 
 it is intended that the male shall go alone, or 
 whether the guilty pair shall go together or separ- 
 ately. Try to imagine the meeting of lovers at 
 the centre after an affectionate and romantic 
 parting. Unless the centres were well situated and 
 advertised, sinners would never hear of them. They 
 would be useless, and the considerable sums spent 
 on their establishment and maintenance would
 
 CIVILIAN TREATMENT CENTRES 185 
 
 be wasted. If they were well advertised and 
 situated, and dealt with a fiftieth part of their 
 possible customers, we should have a new kind of 
 queue with many interested spectators, among 
 whom would, doubtless, be some who came with 
 a view to future pleasure or profit, by way of 
 prostitution or blackmail. 
 
 I do not know whether any town authorities 
 have been gullible enough to establish these Early 
 Treatment Centres, but in any case they are for 
 show, not for use. They are examples of window- 
 dressing. Their purpose is to produce an impres- 
 sion of zeal and activity, and so throw dust in the 
 eyes of the public ; to create a belief that something 
 effective was being done, and so prevent anything 
 effective being done. Of course, no one would 
 attend such an Early Treatment Centre. The real 
 intention is that sinners and their millions of 
 innocent victims shall continue to stew in their own 
 juice. The reader will find all this hard to believe, 
 but what other explanation, except an unbelievable 
 degree of folly on the part of the Council, can be 
 thought of ?
 
 CHAPTER XIV 
 
 THE INTER-DEPARTMENTAL COMMITTEE 
 
 National Council's abortive proposal to 
 A establish Early Treatment Centres for civi- 
 lians did not increase its credit. But some of its 
 supporters highly-placed ecclesiastics and others 
 were very influential. Such people, working 
 both socially and officially, are still potent behind 
 the scenes, and are often able to get things done, 
 or, more usually, to prevent things being done. 
 In this case, the thing to be prevented was " the 
 adoption of any system of prophylaxis which 
 might be said to afford opportunities for unre- 
 strained vice." At any rate, during 1918, some 
 one among the supporters of the National Council 
 appears to have remembered the Royal Commission 
 on Venereal Diseases of 1913-16. Another testi- 
 monial would be useful ; official sanction always 
 carries weight. Accordingly, an Inter-Depart- 
 mental Committee was appointed in January 1919 
 to consider "Prophylaxis against Venereal Disease." 
 The Hon. Waldorf Astor was chairman, and two or 
 three civilians, and various medical representatives 
 from the Navy, Army, and Air Force were members. 
 Two methods of preventing venereal disease had 
 been used in the Navy and Army ; quick dismfec- 
 
 186
 
 INTER-DEPARTMENTAL COMMITTEE 187 
 
 tion and delayed disinfection. Two ways of dealing 
 with the men had been employed in the Army ; 
 some units had been carefully instructed in the 
 use of the superabundant disinfectants which had 
 been provided, but most units had received little 
 or no instruction. It is admitted on all hands 
 that efficient disinfection prevents disease ; there- 
 fore the real questions before the Committee 
 were : (1) whether immediate or delayed disin- 
 fection was the better ; and (2) whether it was, 
 or was not, possible to instruct men so that they 
 would learn to disinfect themselves efficiently. 
 
 Obviously, the Committee should have had 
 among its members either no representatives of 
 any point of view, but merely impartial and intelli- 
 gent men ; or else it should have had representa- 
 tives of every point of view. The latter is the plan 
 usually pursued as, for example, in the case of the 
 Royal Commission on Coal. In no other way is it 
 possible to ensure that the right evidence shall be 
 elicited and fairly considered. 
 
 As far as I am aware, the Committee had among 
 its members no representative of the opinion that 
 men liable to contract venereal disease ought to 
 be taught to protect themselves and the com- 
 munity by speedy disinfection with an active anti- 
 septic. Nor, as far as I am aware, had any of 
 its members experience of that method. Some of 
 them had practised the method of placing anti- 
 septics within the reach of soldiers, who, if they 
 were instructed at all, were instructed to use them 
 with delay. Most of the rest had no experience 
 of any method whatever. On the other hand, one
 
 188 PREVENTION OF VENEREAL DISEASE 
 
 of its members was believed to be responsible for 
 the method of delayed disinfection actually prac- 
 tised in the Army, and the course of events had been 
 such that he was regarded with great distrust by 
 those who advocated quick disinfection. Thus 
 constituted, the suspicion was inevitable that the 
 Committee would not collect or examine evidence 
 fairly. Consider what would have been thought 
 had the Government excluded from the Coal 
 Commission representatives of the miners, or of 
 the owners. It was believed at the time that, in 
 effect, only one man would have weight in the 
 Committee, that, as far as possible, only evidence 
 furnished by him would be considered, and that, 
 no matter what evidence was forced on the Com- 
 mittee, it was sure to make certain pronouncements. 
 Sir Bryan Donkin and I shared this opinion, and, 
 failing to obtain amendment, limited our efforts 
 to getting Surgeon-Commander Boyden's evidence 
 and my own placed on record. We anticipated 
 that later, when the facts became known, the nation 
 would probably demand another inquiry. 
 
 A Commission or Committee appointed by 
 Government always has prestige. Presumably it 
 is composed of experts, or of intelligent and im- 
 partial men. The more obscure the subject with 
 which it deals, the greater is its authority, especially 
 with people who are biased in favour of its con- 
 clusions, or who have no acquaintance with the 
 matter in hand. This Committee furnished no ex- 
 ception. Its pronouncements have been extensively 
 quoted as most wise. Nevertheless, more than 
 anything that had previously happened, it lowered
 
 INTER-DEPARTMENTAL COMMITTEE 189 
 
 the prestige of the National Council which it 
 sought to support. It was felt by many that 
 its course, from origin to conclusion, was marked 
 by profound uncandour. Very active opposition 
 sprang into being. Criticism, having now some- 
 thing very concrete to bite on, became sharper 
 and more insistent. Presently the Society for the 
 Prevention of Venereal Disease, which now includes 
 many eminent members of the medical profession, 
 as well as some famous laymen, was founded. 
 
 I have to give the reasons for the distrust which 
 influenced so many men. My task is not without 
 its difficulties. I have had no access to the official 
 sources of information on which the Committee 
 relied, and I am not even able to draw on all the 
 facts known to me. Publication might injure my 
 informants. I must, indeed, be very sparing in 
 all mention of names, even the names of those who 
 I think have been most indifferent to the welfare 
 of the Army and the nation ; for we have here a 
 question of measures, not men. On the other hand, 
 I have had a prolonged and, in some ways, a 
 unique experience. When in actual contact with 
 the men in the ranks, I have proposed some meas- 
 ures relating to venereal disease, opposed others, 
 and seen in operation, from the point of view of the 
 regimental medical officer, every measure which 
 has been tried with British troops serving in 
 England. I have heard from many hundreds of 
 men and officers of all ranks a great deal about 
 measures which have been tried abroad. I think 
 I know passably well how most of these schemes 
 have worked in practice.
 
 190 PREVENTION OF VENEREAL DISEASE 
 
 The Report which the Inter-Departmental Com- 
 mittee presented to the Minister of Health should 
 be carefully studied, not so much for what it 
 reveals as for what it conceals. When discussing 
 matters in which bias or prejudice plays a great 
 part, we are often able to get a clearer vision by 
 considering a parallel group of circumstances. I 
 venture, therefore, to begin with an allegory or 
 illustration. In this I have substituted the words 
 " weapons " and " equipment " for the word 
 " disinfectant." Disinfectants are our weapons 
 against microbes. The reader should compare the 
 report of my imaginary committee with that of the 
 real Inter-Departmental Committee, which he will 
 find in the Appendix. 1 
 
 A nation in peril decides to raise an army. A 
 noted pacifist, who has been so far connected with 
 the profession of arms that he has manufactured 
 them, is given the command. The troops are formed 
 into regiments, and arms and equipment are sent 
 to them in abundance, together with elaborate in- 
 structions for their storage and maintenance. At 
 the end of a year or two it is found that one or two 
 regiments are efficient, but that the rest of the 
 Army is a rabble. The colonels of the efficient 
 troops report that they have achieved success 
 by carefully training their men and teaching 
 them the use of weapons, and they beg that 
 similar measures shall be taken with the rest 
 of the Army. Their advice is not accepted ; 
 on the contrary, they are told that they have 
 exceeded instructions, and that, if they persist in 
 
 1 See Appendix IV, pp. 353-410,
 
 INTER-DEPARTMENTAL COMMITTEE 191 
 
 teaching " any system of training which might be 
 said to afford opportunities for unrestrained 
 murder," there may be trouble with the clergy. 
 Instead, more equipment superabundant equip- 
 ment is sent to the troops, and inspecting officers 
 are appointed who personally view that equipment, 
 and report defects. Another year or two passes, 
 and the Army, with the exception of the regiments 
 which have been trained to murder and some others 
 which have ventured to follow their example, is 
 still a rabble. Signs of public discontent begin to 
 appear. Thereupon a committee composed of the 
 pacifist general and various sleeping partners is 
 appointed, with the warm approval of the Arch- 
 bishop. The pacifist general prepares selected 
 statistics, which do not specially indicate the 
 efficient regiments, but which do indicate the low 
 average efficiency of the Army in spite of his most 
 arduous efforts in spite of the most abundant 
 supply and anxious care of equipment. Various 
 witnesses are heard, some of whom describe what 
 moral lectures they have given, how earnestly 
 they have exhorted their troops to become good 
 soldiers, and how they have told them that the 
 only certain way to avoid wounds is to keep out 
 of danger. Unfortunately the unmoral enemy 
 had attacked ; the young, wicked, and reckless 
 soldiers had courted danger, and there had been 
 some millions of casualties. One or two of the 
 successful colonels also gave evidence, and are 
 treated with great politeness. Their facts, which 
 are verifiable from independent official records, are 
 not impugned, but they themselves are shown to
 
 192 PREVENTION OF VENEREAL DISEASE 
 
 be slack and unreliable by means of irrelevant 
 questions, for instance, questions as to the numbers 
 of rifles received by them per month and the 
 numbers re-issued to the men. Finally the Com- 
 mittee publishes its Report, which also receives 
 the hearty approval of the Archbishop. Among 
 other things it states : 
 
 " The Committee are satisfied that, while certain 
 weapons and equipment may be relied on to remove 
 or destroy danger from the enemy if applied by 
 skilled attendants, such satisfactory results cannot 
 be secured if those weapons and equipment are 
 used unskilfully or too long a time after ex- 
 posure. 
 
 "As shown in this note, experience indicates 
 that however carefully the storeage, and however 
 scientifically effective the weapon itself, it fre- 
 quently fails to protect when applied by the indi- 
 vidual, even when this self -application is supported 
 later by additional skilled assistance. The con- 
 sumption of alcoholic liquors, carelessness, natural 
 excitement, forgetfulness, or ignorance, has been 
 the cause of numerous failures, even amongst 
 those troops where such weapons and equipment 
 have been most efficiently provided and stored. 
 
 " For purposes of reference the figures showing 
 the incidence of casualties among the troops and 
 also in the Navy are set out in separate tables. 
 The Committee invite their careful consideration. 1 
 
 " In regard to the general experience of weapons 
 distributed before exposure to danger, as prevailing 
 
 1 See p. 357.
 
 INTER-DEPARTMENTAL COMMITTEE 193 
 
 in the various Services, the Committee have come 
 to the following conclusions : 
 
 " That certain weapons, if properly applied, are 
 efficacious in preventing casualties. 
 
 " That if these weapons are not properly and 
 skilfully applied their efficiency cannot be relied 
 on. 
 
 " That the issue of weapons tends to give rise 
 to a false sense of security, and thus to encourage 
 the taking of risks which would not otherwise be 
 incurred, and the neglect of facilities for seeking 
 assistance when available, and, in certain circum- 
 stances, might even increase the number of 
 casualties. 
 
 " That when the weapons are in the hands of a 
 skilled attendant, the results are better than when 
 the same weapons are used by the soldier affected, 
 even after the most careful storage of his weapons. 
 
 " That the excessive consumption of alcoholic 
 liquors not only diminishes the sense of respon- 
 sibility, but also tends to prevent the proper use of 
 weapons, and to delay the soldier's application for 
 skilled assistance. 
 
 " That the most carefully organised system of 
 storing weapons, such as now exists in the Army 
 (a system which would be unattainable in the civil 
 community), has not produced such a general 
 reduction in the incidence of casualties as to 
 counteract the disadvantages mentioned in these 
 conclusions. 
 
 " That the organisation of recreation and social 
 amenities has assisted in the reduction of the 
 incidence in casualties in the Services before the 
 '3
 
 194 PREVENTION OF VENEREAL DISEASE 
 
 war, and has also assisted in preventing that in- 
 crease in the incidence of casualties which, from 
 past experience, might have been anticipated 
 during the war. 
 
 " That energies should not be dissipated on 
 measures of doubtful value, but concentrated 
 rather on wise peace propaganda, and the pro- 
 vision of early, prompt, and skilled hospital treat- 
 ment in order to diminish the prevalence of wounds. 
 It should be recognised that the failure to cure these 
 wounds is the main causes of their prevalence, and 
 that failure to cure, in the most skilled hands, 
 results largely from failure to treat them in their 
 early stages. 
 
 " I have been asked on behalf of the repre- 
 sentatives of the different Departments who have 
 assisted at various times in our deliberations on 
 this subject, to record their unanimous view that 
 the true safeguards against wounds is individual 
 peacefulness and a high standard of moral life. 
 This implies a sound public opinion and a healthy 
 national tone. The Committee set out to examine 
 the evidence placed before them from the scientific 
 and soldierly point of view, and it is strictly in 
 this spirit that they desire to record it as their 
 opinion that the irreplaceable effect of the moral 
 factor has been frequently neglected or forgotten. 
 
 GENERAL CONCLUSION 
 
 " In view of these findings, the Committee are 
 not satisfied that there has been sufficient evidence 
 put before them of the beneficial results gained by
 
 INTER-DEPARTMENTAL COMMITTEE 195 
 
 the distribution of weapons in the various forces 
 to prove the value of the system, or to justify them 
 in recommending its encouragement among the 
 civil population, who may be attacked by, and 
 have already greatly suffered from, the attacks of 
 our admittedly ruthless enemy. Unquestionably, 
 there have been many individual cases which 
 appear to afford positive evidence in favour of a 
 system of teaching the use of weapons before 
 exposure to danger ; but the volume of such evi- 
 dence is too small and too exceptional, and the 
 instances of its failure, even under favourable 
 circumstances, are too numerous to allow of any 
 other conclusion than that, in view of the considera- 
 tions mentioned above, and of the administrative 
 difficulties involved, the official application of 
 teaching the use of weapons to the civil community 
 is neither desirable nor practical." 1 
 
 My imaginary army and committee belong to the 
 region of farce. But they are not more grotesque 
 than the reality. Mutatis mutandis, that which is 
 supposed to have happened in burlesque is exactly 
 parallel to what actually occurred in the British 
 Army and in the Inter-Departmental Committee 
 appointed by the British Government. The bur- 
 lesque army was supplied with rifles for employ- 
 ment against a human foe, the British Army with 
 disinfectants for use against a microbic enemy ; 
 but in both cases the weapons were stored, and for 
 instruction in the use of them was substituted moral 
 exhortation, the futility of which had been pre- 
 1 See pp. 372-4.
 
 196 PREVENTION OF VENEREAL DISEASE 
 
 viously demonstrated by an experience of some 
 thousands of years among some hundreds of thou- 
 sands of millions of men. Thereafter, when the 
 exhortations failed once again, the weapons were 
 blamed and more exhortation was recommended. 
 In the British, as in the imaginary army, the 
 training of the troops lay in the hands of men who 
 apparently desired nothing so little as the success 
 of that training ; and in the Inter-Departmental, 
 as in the imaginary committee, the elucidation of 
 the truth was undertaken by men who apparently 
 desired nothing so little as the elucidation of the 
 truth. 
 
 Consider, for example, the opinion expressed in 
 the " General Conclusion " of the Report that the 
 volume of evidence in favour of quick self-disin- 
 fection " is too small and too exceptional, and the 
 instances of its failure, even under favourable 
 circumstances, too numerous to allow of any other 
 conclusion than that the official application of a 
 packet system to the civil community is neither 
 desirable nor practical." * 
 
 (a) No responsible person that I am aware of 
 has recently suggested a packet system for the 
 civil community. The real suggestion was, and 
 is, that the endangered section of the civil com- 
 munity shall be instructed in the use of disinfec- 
 tants, as, for instance, by leaflets posted in public 
 urinals. The idea of a packet system is employed 
 merely as a bogey. The packet system was 
 forced on the Army against the strenuous appeals 
 of those who had succeeded in preventing venereal 
 1 See p. 374.
 
 INTER-DEPARTMENTAL COMMITTEE 197 
 
 disease ; the very people who insisted on supplying 
 packets directed that they should not be used as 
 packets ; everything that a perverse ingenuity 
 could suggest was done to make quick disinfection 
 appear a failure ; finally, evidence from an army 
 which had been directed not to use packets as 
 packets was brought into court to prove that 
 packets used as packets were useless, and on 
 this evidence the Inter-Departmental Committee 
 founded its conclusions. The situation would be 
 Gilbertian, were it not so loaded with tragedy for 
 the nation and for innocent men and women and 
 little children. 
 
 (b) The evidence submitted to the Committee 
 in favour of instructing men who could not be 
 prevented from placing themselves in danger was 
 experimental. The statement of the Committee 
 that the volume of the evidence is too small 
 and too exceptional is, therefore, exactly of the 
 same order as that of the servant girl who pleaded 
 that her baby was a very little one. But actually, 
 the evidence that properly instructed men do not 
 acquire venereal disease is immense in volume 
 and unexceptional in quality ; for whenever and 
 wherever such instruction has been given 
 before, during, and after the war, in Japan, India, 
 South Africa, and England it has invariably 
 succeeded ; and in most instances the records 
 of the instructed units are in the hands of the 
 Army authorities, and can be compared by them 
 with the records of other units similarly situated, 
 but not carefully instructed. There is the clearest 
 possible evidence that whenever disinfectants
 
 198 PREVENTION OF VENEREAL DISEASE 
 
 have been provided, and disease has neverthe- 
 less been prevalent, the instruction of the men 
 has been neglected. The fault then has not been 
 with the disinfectants nor with the men, nor even 
 with the medical officers in charge of the men. 
 It has been with the superior authorities, who 
 failed to give proper directions to the medical 
 officers. The reader may test the matter for 
 himself, for the manhood of the nation was drawn 
 upon to such an extent that every one numbers 
 among his acquaintances numerous demobilised 
 officers and men. If almost any of these be 
 questioned, it will be found that he never heard of 
 the disinfectants ; or, if he heard of them, that 
 their use was never clearly explained ; or, if it was 
 explained, that it was done roughly and per- 
 functorily by a non-commissioned officer or an 
 orderly. In some cases it will be found that the 
 disinfectants were kept under lock and key, and 
 that the sinner, after having sinned, had to apply 
 to the custodian of the keys and explain what he 
 wanted and why he wanted it. When the cus- 
 todian had to be wakened in the dead of night the 
 sinner would naturally feel diffident. Hardly ever 
 will it be found that the doctor in charge of the 
 unit devoted personal time and care to impressing 
 on every man that joined the importance of speedy 
 disinfection, and to explaining why and how it 
 should be done. I have known many military 
 medical officers, and, possibly through good fortune, 
 I have not met among them all a slack or lazy man. 
 Often have I been shamed by their superior zeal 
 and efficiency. Beyond question, they did all that
 
 INTER-DEPARTMENTAL COMMITTEE 199 
 
 was required of them. But they did not do, 
 indeed ought not to have done, what they believed 
 was contrary to the letter and spirit of their orders. 
 Civilian-like, I broke orders, and doubtless therein I 
 was influenced by the feeling that the consequences 
 to me could not be very serious. The regular did 
 what he thought was required of him. Had the 
 people who were in charge of the arrangements 
 for preventing venereal disease in the Army really 
 wished for success, they would have issued clear 
 orders to the medical officers, and then, when any 
 unit showed an excess of cases, would have asked 
 the reason, insisting that where one man had suc- 
 ceeded and succeeded easily others could do the 
 same. Instead, as far as I am able to judge, every 
 effort was made to ensure the failure of the measures 
 for the protection of the troops to which the 
 authorities consented in 1918. Such are the 
 " favourable " circumstances to which the Inter- 
 Departmental Committee alludes. 
 
 Or consider the Committee's statement " that 
 there was an almost continuous fall in the venereal 
 rate in the British Army and Navy during a long 
 period before the war ; throughout that period 
 there was no organised system of any form of 
 prophylaxis, but continuous improvement was 
 taking place in social and other conditions affecting 
 the incidence of these diseases." 1 The venereal rate 
 in the Army fell from 275-4 per 1000 per annum 
 in 1885 to 50-9 in 1913. In the Navy it fell from 
 166-35 in 1884 to 73-11 in 1914. The Committee 
 would have us believe that owing to the provision of 
 1 See p. 370.
 
 200 PREVENTION OF VENEREAL DISEASE 
 
 more cricket, football, theatricals, and the like, the 
 soldiers of the present day are more than five times, 
 and the sailors more than twice, as moral as their 
 fathers. Can any sane man, having an ordinary 
 experience of life, believe this ? The young men of 
 to-day are merely more cleanly and more addicted 
 to the use of disinfectants than their parents. The 
 following, which I quote from Miss Ettie Rout, was 
 written in advocacy of disinfection for women, but 
 it has an obvious bearing on the point. 
 
 " Irregular relationship contracted in the 
 woman's own room, or in a licensed house, where 
 toilet appliances are available, is, of course, much 
 less risky than relationship contracted out-of- 
 doors where no appliances are available ; that is, 
 there is far more danger to women in out-door 
 relationships than in in-door relationships. In 
 1915-16 at Havre there was a high rate of infec- 
 tion among soldiers ; the medical supervision 
 was improved and increased, more instruction was 
 given, and more care shown in removing diseased 
 women to hospital. With a daily average of 60,000 
 troops at Havre, the average number of infections 
 per week with syphilis and gonorrhoea was only 
 15'5, i.e. one for every 4000 soldiers, on the 
 average. But in April 1918 these efforts were 
 rendered nugatory by the putting out-of-bounds of 
 the licensed houses. The women came out into 
 the streets and consorted with the soldiers, and the 
 weekly average very soon doubled, and afterwards 
 still further increased, simply because immediate 
 self-disinfection was not available to the women 
 (or to the men), and they were not under medical
 
 INTER-DEPARTMENTAL COMMITTEE 201 
 
 supervision. Similarly, in Amiens and Abbeville 
 and other places, the amount of disease increased 
 for the same reason. Occasionally, when certain 
 licensed houses have been badly conducted, or 
 overcrowded with soldiers, temporary gain has 
 resulted from putting them out-of-bounds, but in 
 the long run the putting out-of-bounds of licensed 
 houses, by cutting the women off from their toilet 
 arrangements, resulted in a general spread of disease 
 and immorality. In Paris, however, the order 
 putting the houses out-of-bounds was never en- 
 forced, and the soldiers freely resorted to these 
 places. It is notable that during 1917 only five 
 cases of disease were recorded at the Medical 
 Report Centre as having come from licensed houses 
 in Paris, and up to April 1918 no case was con- 
 tracted in licensed houses (that is the latest record 
 available in this respect). The low rate of infection 
 in Paris may be contrasted with the high rate in 
 London : the Army calculation is that London 
 alone gave the Army over a thousand fresh infec- 
 tions every week ; this mainly because immediate 
 self -disinfection was not available in London either 
 to soldiers or to women. ... In France . . . most 
 of the relationships practically all of them take 
 place indoors, not out-of-doors, as in England." 
 
 Miss Rout continues : "In advocating a wide- 
 spread knowledge of disinfection for women in 
 these after-war conditions, I think the main point 
 to emphasise is that many many thousands of 
 ex-soldiers are returning to their wives and homes 
 in a more or less infective condition. It is utter 
 rubbish to say that men are not demobilised till
 
 202 PREVENTION OF VENEREAL DISEASE 
 
 cure is certain. How can the Army give such a 
 guarantee in the case of syphilitics ? Does any 
 experienced M.O. suggest that all the discharged 
 men are all clear of gonorrhoea ? The soldiers 
 themselves know that they are not. Numbers of 
 them have consulted me as to their course of 
 conduct, and how much they are to tell. I have 
 always advised the men to be perfectly frank and 
 truthful, and to secure the help of the woman 
 who is their wife or will become then* wife. . . . 
 For all of us the Sex Problem has taken on new and 
 sometimes dreadful complications ; but whatever 
 the future holds for us, as women we must stand by 
 our men, not desert them in their hour of need, 
 and as men we must protect our women, and not 
 sow in their bodies the seeds of disease picked up 
 in moments of excitement." 
 
 Or consider my own evidence, and the stress 
 laid on particular points of it by the Committee. 
 " At Portsmouth, in a body of troops 2000 strong, 
 the men were supplied with a solution of potassium 
 permanganate and swabs of cotton-wool, and were 
 directed to swab themselves immediately after ex- 
 posure. Only six cases of gonorrhoea and one of 
 syphilis occurred. Of these seven cases (a) two 
 were infected by wives, no precautions being 
 taken ; (b) two were intoxicated, and so no pre- 
 cautions were taken ; (c) one had just arrived in 
 camp, and had not yet received instructions, and 
 took no precautions ; and (d) two did not use any 
 disinfectant for an hour or more (one of these was 
 syphilis). 
 
 " In considering the above figures, I am asked
 
 INTER-DEPARTMENTAL COMMITTEE 203 
 
 by the Committee to point out that Sir Archdall 
 stated that he did not know : 
 
 (1) The percentage of men who used the perman- 
 ganate solution and were subsequently (a) infected ; 
 (b) not infected. 
 
 (2) The percentage of men who did not use the 
 solution. 
 
 (3) The number of men who had venereal disease 
 (a) on arrival at the camp ; (b) on departure from 
 the camp. 
 
 " He further stated that no routine examinations 
 of the men, who were constantly changing, were 
 made. The Committee have not any figures 
 giving the incidence of venereal disease among 
 civilians in Portsmouth nor in other units in the 
 garrison, and no record was made by Sir Arch- 
 dall to show whether the incidence was higher 
 among those categories who did not use the 
 solution." l 
 
 The reader will perceive that the Committee is 
 trying to minimise the importance of my evidence. 
 It seeks to establish that on several points my 
 evidence was vague and incomplete when it should 
 have been definite and complete, and that I had 
 been, perhaps, rather slack in the performance of 
 certain routine duties which would have yielded 
 more definite information. The member of the 
 Committee who cross-questioned me on these points, 
 very pleasantly indeed, was Colonel Harrison, 
 whom I then met for the first and last time. His 
 questions puzzled me ; I was under the impression 
 that he had been concerned with the arrange- 
 1 See pp. 369-70.
 
 204 PREVENTION OF VENEREAL DISEASE 
 
 ments for preventing venereal disease in the Army 
 from the moment quick disinfection had been 
 determined on in 1918, and that, therefore, he had 
 seen my protests as to the manufacture of bottles, 
 as to their exposure to the chance raider, as to the 
 impossibility of exercising strict supervision and 
 no supervision at the same time, and as to the 
 muddle that would inevitably follow (and did 
 follow) such orders. I had conceived him as 
 struggling valiantly, but vainly, against " in- 
 fluential persons." I now learned with growing 
 wonder that apparently he believed, and wished 
 the Committee to believe, that if 100 bottles 
 were exposed, and 100 taken, and perhaps 100 
 used for tooth-wash, and 100 men contracted 
 venereal disease, this furnished proof that quick 
 disinfection had failed to the extent of 100 per 
 cent. I had not fully grasped his attitude or 
 that of the Committee at the time, but when I 
 returned home I forwarded to the Committee 
 the four notes which are appended to the 
 Report. 1 
 
 If the bottles were to be exposed in such a way 
 that the men could help themselves privately, how 
 was it possible to know " the percentage of men 
 who used the permanganate solution and were 
 subsequently (a) infected ; (b) not infected," or 
 " the percentage of men who did not use the 
 solution " ? I could say no more than that 
 only seven men contracted the disease, and of 
 them five declared that they had not used the 
 solution, and two that they had used it, accord- 
 1 See pp. 403-4.
 
 INTER-DEPARTMENTAL COMMITTEE 205 
 
 ing to the Army plan, only after prolonged 
 delay. 
 
 As to " the number of men who had venereal 
 disease on arrival at the camp," I could have 
 answered this question if I had been given a week or 
 two for the examination of my books, or for making 
 inquiries at Hilsea Hospital. Offhand I could only 
 have said (and did say in my note) that they num- 
 bered 30 or 40. That is, they numbered 30 or 40 
 by the time I gave evidence. Later, when the 
 men began to return for demobilisation, there 
 were many more. As already related, I found 
 21 cases in one morning in a single party of 
 200 new arrivals from overseas. The question 
 had no bearing on the matter on which I was 
 giving evidence the degree of success achieved 
 by a particular procedure for these new arrivals 
 had not followed that procedure. 
 
 As to " the number of men who had venereal 
 disease on departure from camp," the orders, 
 which I obeyed exactly, were that cases of venereal 
 disease must be sent to hospital immediately 
 on discovery. If, therefore, men suffering from 
 venereal disease left for another station, it would 
 be without my knowledge. Colonel Harrison, as 
 a R.A.M.C. officer, knew that perfectly well. At 
 the time I thought he wished to know whether I 
 had information of any cases which had escaped 
 my notice and had been discovered elsewhere. 
 There were no such cases. 
 
 " He further stated that no routine examinations 
 of the men, who were constantly changing, were 
 made." No routine examinations for the special
 
 206 PREVENTION OF VENEREAL DISEASE 
 
 purpose of discovering venereal disease were 
 made ; but the men, stripped to the skin, were 
 constantly examined to ascertain whether they 
 were fit for this service or that, or fit to have their 
 categories raised. As far as I know, no routine 
 examinations for venereal disease were made 
 anywhere in the district during the war, and I 
 have never heard of them being made elsewhere. 
 They would have been useless, for, besides being 
 constantly examined, the men had nothing to 
 gain by concealment. I am unable to prove 
 a universal negative, but I am sure, as I can 
 be of anything for which I cannot furnish 
 proof, that none of my men ever did conceal 
 venereal disease. The first thing they heard on 
 joining was the dreadful consequences of neglect 
 or delay, and the great superiority of the treatment 
 for cure furnished in the Army over anything they 
 were likely to obtain in civil life. I impressed on 
 them the fact that the treatment of venereal disease 
 was properly a matter for a specialist, equipped with 
 appliances which the ordinary doctor, including 
 myself, did not possess. 
 
 As to " the incidence of venereal disease among 
 the civilians in Portsmouth," of course, I knew 
 nothing, and my questioner knew perfectly well 
 that I could know nothing, and so did every member 
 of the Committee. These diseases are not noti- 
 fiable. No one in any town in the United King- 
 dom knows anything definite. I understand, 
 however, that the Naval authorities, who are 
 perhaps best qualified to judge, consider Ports- 
 mouth a very highly-infected town.
 
 INTER-DEPARTMENTAL COMMITTEE 207 
 
 As to " the incidence of venereal disease among 
 . . . other units in the garrison," this information 
 (as stated in my note) * was refused me by the 
 authorities concerned on the ground that it was 
 confidential. But, presumably, it had been for- 
 warded to the authorities at the War Office, and 
 was in the hands of Colonel Harrison. Why he 
 sought it from me, and did not inform the Com- 
 mittee from his own records, is a mystery which 
 the reader must solve for himself. 
 
 As to " no record was made by Sir Archdall Reid 
 to show whether the incidence was higher among 
 those categories who did not use the solution " 
 how on earth could I make such a record ? How 
 could any medical officer in charge of troops ? 
 We were compelled by peremptory orders to expose 
 disinfectants so that the soldiers might help them- 
 selves privately. Who took the disinfectants, and 
 for what purposes, and how, or when, or where they 
 were used, we could not have the remotest idea. 
 As I have related, a lot of my men used the per- 
 manganate solution as a tooth-wash. All I could 
 have said was that we had issued so many packets, 
 that so many had been taken away, that so many 
 men had contracted venereal disease, of whom so 
 many had declared that they had taken no pre- 
 cautions, and so many that they had taken such 
 and such precautions. In my own case, as already 
 described, seven men contracted disease in twenty- 
 eight months, and of them five took no precautions, 
 two the precautions recommended by the Army 
 authorities, and none the precautions recommended 
 1 See p. 404.
 
 208 PREVENTION OF VENEREAL DISEASE 
 
 by me (i.e. immediate disinfection). I do not 
 suppose that many medical officers questioned their 
 men carefully as to the conditions under which they 
 contracted disease, for, unless an officer was parti- 
 cularly concerned, as I was, in testing a particular 
 method of procedure, he could have had no object 
 in doing so. He would merely record each case of 
 infection in his monthly returns and send the 
 infected men to hospital, where, as he would prob- 
 ably know, it was the duty of the authorities to 
 ascertain when and where (in what area) each man 
 was infected, by whom (prostitute or amateur), 
 and whether he took any precautions, and, if so, 
 how long after intercourse. But, even in the 
 hospitals, this routine duty would usually be per- 
 formed by an orderly, and in an extremely per- 
 functory and unsatisfactory manner. In 1918 I 
 saw the books of one hospital where, as it happened, 
 the officer in charge was exceptionally keen. 
 According to the records we found that almost 
 every man had disinfected himself within twelve 
 hours after exposure. The officer expressed himself 
 sceptical of the good results of self -disinfection. I 
 told him my experience. Thereafter, till he left the 
 hospital some months later, he himself questioned 
 every man very carefully, and found that very 
 many men, in order to avoid blame, at first declared 
 that they had disinfected themselves, and that 
 many declared that they had done it immediately, 
 but that, when the men were pressed, many ad- 
 mitted they had not disinfected at all, and that not 
 one claimed to have disinfected within an hour. 
 This officer became a convert to immediate disinf ec-
 
 INTER-DEPARTMENTAL COMMITTEE 209 
 
 tion ; for during the time of his second experience, 
 the practice of teaching quick disinfection had been 
 adopted over a wide area by many medical officers, 
 so that he had excellent opportunities of estimating 
 its effects. As we shall see, his experience was 
 very important and significant. Some months 
 after he had left the hospital, I called again to 
 ascertain results, and found that now, again, the 
 men were only being asked, I suppose by an 
 orderly, whether they had disinfected within or 
 after twelve hours. 
 
 To this day I do not know what the Committee 
 mean by the statement that " no record was made 
 by Sir Archdall Reid to show whether the incidence 
 was higher among those categories who did not 
 use the solution." Of course, I made no record. 
 How could I ? All my men were taught to dis- 
 infect quickly with the permanganate solution. 
 I came in contact with no other men and no other 
 categories, except the two men who were infected 
 after delayed disinfection, and those I did record. 
 If Colonel Harrison was my questioner, he, an 
 army doctor, should have known that such a query 
 addressed to a medical officer in charge of troops 
 was meaningless. I have no recollection of the 
 question, which was one of a number the purport 
 of which puzzled me. I had gone to the Committee 
 to give evidence on the only point about which I 
 was supposed to have definite information quick 
 disinfection. Apparently the Committee was not 
 greatly interested in it, but desired to learn much 
 about matters this among them of which I 
 could have no knowledge, unless information, 
 14
 
 210 PREVENTION OF VENEREAL DISEASE 
 
 properly known only to the heads of departments, 
 had been revealed to me. I do not mean wrongly 
 revealed, but merely that the information could 
 be acquired only through reports which were 
 received by the heads of departments, through 
 whom the Committee should have obtained it at 
 first hand. I answered these questions by saying 
 I had no information. Since reading the Report, 
 I can only conclude that they were asked because 
 my questioners had no idea of the organisation of 
 the Army Medical Service, or because they wished 
 to give me in the Report an appearance of un- 
 reliability. I am aware, of course, that I am 
 imputing to the Committee incapacity or in- 
 tended misrepresentation, but what other interpre- 
 tation can there be ? 
 
 I suppose, really, most of the Committee had 
 vague ideas as to the meaning of the questions 
 addressed to me. Unaware of the protests I had 
 sent to the Army authorities, they thought that 
 my occasional failures to answer definitely some- 
 how weakened my evidence. There does not 
 appear to have been among them any of that class 
 of mind that separates essentials from non-essen- 
 tials. In this case the essentials were that I had 
 stated, in effect, that during a period of 28 months 
 I had, by means of a certain procedure, reduced 
 the incidence of venereal disease among 2000 
 men to 1-5 per 1000 per annum, that no man who 
 had employed the means I recommended had taken 
 the disease, and that my statements could be 
 tested by an appeal to the records of Hilsea 
 Hospital. If my statements were true, the matter
 
 INTER-DEPARTMENTAL COMMITTEE 211 
 
 ended so far. Obviously disease could be pre- 
 vented among soldiers. All questions as to whether 
 I had done this, or not done that, irrelevant thing, 
 and all statistics as to whether disease had, or 
 had not, been prevented in other units became 
 ridiculous.
 
 CHAPTER XV 
 
 THE INTER-DEPAKTMENTAL COMMITTEE 
 (continued) 
 
 IT is impossible to comment adequately on the 
 statistics of venereal disease which appear in 
 the Report of the Inter-Departmental Committee. 
 They are derived from official sources to which 
 we have no access. To some extent we must grope 
 in the dark. But this much is certain, that who- 
 ever compiled them acted in the spirit of a man who, 
 desiring to prove that plum pudding is composed 
 entirely of raisins, produces only the raisins as 
 evidence. In them an endeavour is made to prove 
 that self-disinfection is valueless by selecting for 
 publication from the whole mass of evidence only 
 those items which seem to indicate the failure of 
 sanitation a failure which is supposed to be due 
 to the stupidity and unteachability of British 
 soldiers and sailors, but which really indicates 
 incompetent teaching. It is exactly as if a 
 musketry teacher reported that his men, an 
 average sample, were too stupid to learn musketry. 
 We know that there has been this kind of selection, 
 because we miss from the Report numerous in- 
 stances of successful endeavour to combat venereal 
 disease by means of disinfection. For instance, we 
 
 212
 
 INTER-DEPARTMENTAL COMMITTEE 218 
 
 are told nothing of the magnificent results achieved 
 by Sir James Barrett and Colonel Elgood with the 
 Australian Imperial Force in Egypt and Palestine, 1 
 nor of the great reduction of venereal disease 
 
 1 Sir James Barrett, on his arrival in Egypt, was invited by 
 General Birdwood to do anything he could for the Australian 
 troops, who were being infected at the rate of 800 or 1000 men a 
 day, social and moral measures alone being permitted. ... In 
 the hospitals, on the other hand, besides enlightened literature, 
 the men were provided with prophylactic outfits, consisting of 
 calomel ointment. On the value of prophylactics being chal- 
 lenged, an examination of those Australian troops who had been 
 supplied with outfits established the fact that out of a group of 
 200 men exposed to infection only one contracted disease, and he 
 had not taken precautions. In the lecturer's experience, primary 
 prophylaxis had been practically certain in its results. . . 
 During the latter half of 1915, Sir James Barrett was invalided 
 for a time to England, and there was a period when the work 
 was not pushed, but the result was that an intense moral and 
 restrictive campaign, together with constructive work in the 
 establishment of magnificent soldiers' clubs, produced a moderate 
 amelioration and tolerable decency. But where prophylaxis 
 was properly taught and applied, venereal diseases were prac- 
 tically non-existent. . . . The Australian troops returning from 
 the Dardanelles in the first five months of 1916 included 10,000 
 with venereal infections, and at one time the average infection 
 rate was 2 5 per cent, per annum. After the adoption of measures 
 which included . . . the provision of prophylactics, the in- 
 fection rate became reduced to very modest proportions. . . . 
 The value of prophylactics emerged. In one camp through 
 which 9282 troops passed, 4500 men reported exposure to in- 
 fection, and as a consequence of early treatment only 1 3 infections 
 resulted. The lesson taught by experience in Egypt was that 
 all social methods combined resulted only in a limited reduction 
 in the incidence of venereal diseases, and that unless some form 
 of prophylaxis was adopted many infections were certain to 
 result." Lecture by Sir James Barrett on " The Management 
 of Venereal Diseases in Egypt during the War." Lancet, 2 5th 
 January 1919. Apparently Sir James Barrett gave evidence before 
 the Inter-Departmental Committee, but his evidence has been wilfully 
 or negligently omitted (see p. 356).
 
 214 PREVENTION OF VENEREAL DISEASE 
 
 among the men who used packets in Paris. But, 
 apart from their dishonesty, statistics of this sort 
 are profoundly absurd. " These are but samples 
 of errors frequently committed by men who, hav- 
 ing made themselves familiar with the difficult 
 formulae which algebra affords for the estimation 
 of chances under suppositions of a complex char- 
 acter, like better to employ those familiar formulae 
 in computing what are the probabilities to a person 
 half informed about a case, than to look out for 
 means of being better informed." 1 Suppose 100 
 towns in England were afflicted with typhoid 
 fever ; suppose nearly all of them adopted one 
 system of sanitation, and only two or three 
 adopted a different system ; suppose all of them 
 suffered as much as ever, except the two or three, 
 which now suffered little ; should we be entitled 
 to publish statistics of the towns that suffered 
 much, and then declare that sanitation was useless ? 
 Of course not. On the contrary, we should be 
 entitled to declare that sanitation of the right kind 
 was thoroughly effective. Again, if all the towns 
 adopted the same system of sanitation, and only 
 two or three abolished disease, this would afford 
 evidence not that the system was bad, but that 
 most of the Medical Officers of Health were 
 incompetent. 
 
 Table H 2 of the Report is an excellent example 
 of statistics dubious in every sense of the word. 
 Out of 2193 venereal patients at Rochester Row 
 Military Hospital, 1829, or 83-4 per cent., took no 
 precautions. This remarkable fact is susceptible 
 1 J. S. Mill, Logic, in. xviii. 4. 2 See p. 366.
 
 INTER-DEPARTMENTAL COMMITTEE 215 
 
 of several explanations. The Committee supposes 
 that it " appears to show that many soldiers do not 
 use properly the packets which are provided for 
 them, and a very large number of soldiers do not 
 use packets at all, even when they are readily 
 available. This may partially explain the apparent 
 failure to reduce the V.D. rates, as shown in Table 
 F." It wholly explains it. But out of the 20,000 
 men who passed through my hands only seven were 
 infected, and of these five did not use the packets, 
 two because they were helplessly drunk, two be- 
 cause they contracted disease in intercourse with 
 their own wives, and one because he was not in- 
 structed. The remaining two did not use the 
 packets as packets, but only after prolonged delay 
 and return to barracks. Contrast this with the 
 1892 men who neglected to take precautions in the 
 Rochester Row district. Since the men were of 
 the same type, does not this prove that the men in 
 the Rochester Row area were negligent because the 
 medical officers in charge of them were negligent ? 
 Obviously, the officers must have neglected to in- 
 struct their men properly. When the men are not 
 instructed, or else are instructed not to use the 
 packets as packets, it is something more than mere 
 folly to complain that they " do not use properly 
 the packets provided for them, and that a very 
 large number of soldiers do not use packets at all, 
 even when they are readily available." 
 
 Of the 2193 men questioned at Rochester Row, 
 only 364 took precautions. Now what does this 
 indicate ? It indicates that the teaching of the 
 troops was so slack that few men took precautions,
 
 216 PREVENTION OF VENEREAL DISEASE 
 
 or it indicates that the effect of the disinfectants 
 was so good that few men using them contracted 
 disease, or it indicates both that the teaching was 
 slack and the effects of the disinfectants was good. 
 Probably the last is the proper explanation. 
 Had the teaching been good in the Rochester Row 
 area, the 2193 men who entered the hospital would 
 have been in the fighting line, as would also have 
 been the tens, or hundreds of thousands of men on 
 leave from other areas and from overseas who con- 
 tracted disease in that area and went into hospital 
 elsewhere. 
 
 Of the 1829 infected men recorded in the Table 
 who did not employ disinfection, nearly a tenth 
 were infected by their own wives. Presumably, 
 nearly all these connubial infections were acquired 
 by men on leave, who, therefore, were at home 
 only for short periods. Venereal diseases are not 
 very infective for men. It has been calculated 
 that on the average it takes a hundred exposures 
 with diseased women to infect a man with gon- 
 orrhcea, and fifty to infect him with syphilis. It 
 follows, from Table H, that the wives of soldiers, the 
 ordinary citizen soldiers of war-time, were diseased 
 to an enormous extent. In fact, nearly every 
 woman must have been diseased. This is pernicious 
 nonsense. Married women are as chaste, indeed, I 
 believe, on the average more chaste, than their 
 husbands, who, as already related, are quite seldom 
 unchaste. The real explanation of the high 
 percentage of alleged infections from wives is that 
 the men were lying. They wished to save them : 
 selves from blame. Their wives were distant (or
 
 INTER-DEPARTMENTAL COMMITTEE 217 
 
 non-existent), the information was confidential, 
 neither the wives nor any one else would ever hear 
 of the imputation against their honour. They 
 would suffer nothing, and the soldier would get 
 some sympathy from his questioner, and to some 
 extent his sense of humour would be gratified. 
 The two men whom I reported as suffering from 
 their own wives were very carefully questioned, 
 and were obviously in deep distress and anger. 
 
 Of the men who did disinfect themselves, 227 
 acted within an hour, 68 within four hours, 21 
 within ten hours, and 44 later ; from which it 
 would appear that the greater delay within ten 
 hours in disinfection the better will be the result. 
 I wonder what any surgeon would say to this 
 doctrine. I think I know. More infected men 
 disinfected within one hour than in all the rest of 
 the time. But this occurred in the Rochester Row 
 area, where, according to instructions emanating, 
 it is believed, from Rochester Row itself, the men 
 were directed to exercise delay. The fact that they 
 did not exercise delay would, were it true, furnish 
 eloquent evidence as to the lack of clearness and 
 strenuousness in the teaching. In any case, the 
 Report does not tell us how we are to interpret 
 the figures. Do they mean that quick disinfection 
 conduces to disease ? Or do they mean that re- 
 latively large numbers of men disobeyed instruc- 
 tions and disinfected themselves quickly, but, 
 owing to the vileness of the teaching, inefficiently ? 
 
 In the Rochester Row area during ten months, 
 110 men acquired disease after disinfection within 
 one hour with permanganate lotion. In a year at
 
 218 PREVENTION OF VENEREAL DISEASE 
 
 Whale Island, and during twenty-eight months 
 at my barracks, not one man who had disinfected 
 within one hour acquired disease. At the hospital 
 I mentioned in a preceding page, many men when 
 first questioned declared they had disinfected 
 immediately, but when more closely questioned, 
 all of them admitted they had not done so. I 
 think it will be found, if the matter is ever investi- 
 gated, that the patients in Rochester Row were 
 questioned by orderlies, and that they lied to avoid 
 blame just as the majority of the 178 men, who 
 are alleged to have contracted disease from their 
 wives, lied. 
 
 In the Rochester Row area in ten months 2193 
 men were admitted to hospital with disease. Nearly 
 all these men would be resident within the area. 
 Doubtless many tens of thousands more on leave 
 became infected. Indeed, the infections among the 
 men on leave were supposed to be about 1000 a 
 week ; but, as a rule, their diseases would not 
 declare themselves till after their return to their 
 units, which was a principal cause of the large 
 number of men who went into hospital after re- 
 turning to France, and also a principal cause of 
 the infections among Colonial troops in camp in 
 England. On the other hand, in the whole of the 
 Portsmouth area, since quick disinfection became 
 the rule, I doubt whether 100 men have been in- 
 fected in ten months. In 1917 the Army Council 
 attributed the greater amount of venereal disease 
 among the charges of one medical officer, as com- 
 pared to the amount of disease occurring among 
 the men of another medical officer, to his relative
 
 INTER-DEPARTMENTAL COMMITTEE 219 
 
 incompetency or slackness. 1 I do not know why 
 the same explanation should not be considered as 
 valid in accounting for the difference between the 
 Rochester Row and Portsmouth areas. But it 
 cannot be too often reiterated that in this matter 
 the heads of departments were concerned, not the 
 medical officers in charge of troops. The latter 
 did as they were ordered. They were not to blame, 
 therefore, in the Rochester Row area. The people 
 who issued the orders were to blame. 
 
 In Table D 2 the Report of the Inter-Departmental 
 Committee gives the " Returns for Venereal Dis- 
 ease per 1000 per annum among troops in the 
 United Kingdom " from 1870 to 1913. In Table 
 F 3 it gives the rates for 1916, 1917, 1918, and for 
 the month of May 1919. The rates for 1914 and 
 1915, and also for the first four months of 1919, are 
 omitted. Why are the reports 1914-15 omitted ? 
 Why are those of the earlier months of 1919 not 
 available ? The year 1914 saw the outbreak of war, 
 the gathering of the young, unmarried manhood of 
 the nation into barracks and camps, and presumably 
 a great rise in the venereal rate. At any rate, the 
 incidence of disease was so considerable that the 
 authorities in alarm established venereal ablution 
 rooms in 1916, when the venereal rate fell to only 
 36, as compared to 50-9 in 1913, the last year of 
 peace. Even delayed disinfection is much better 
 than no disinfection. The Committee, with its 
 manifest partisanship, has only itself to blame if 
 we believe that it did not publish the returns for 
 1914-15 because it feared a comparison between the 
 1 See pp. 153-5. 2 See p. 361. See p. 363.
 
 220 PREVENTION OF VENEREAL DISEASE 
 
 results of self -disinfection and no disinfection ; and 
 that it did not publish the returns for the earlier 
 months of 1919 because it feared to reveal the 
 shocking results of neglect of sanitation among the 
 troops returning from the Continent. 1 
 
 It states, in its comments on Table G, 8 that " the 
 provision of packets throughout the Army did not 
 reduce the incidence." But, as already explained, 
 the packets were never really issued inany real sense. 
 They were made accessible to the soldiers it is true, 
 but printed instructions were given which indicated 
 that they should be used after return to quarters, i.e. 
 that they were not to be used as packets. These 
 were the " careful instructions issued by the War 
 Office." As for " the provision of District In- 
 spectors to see that those instructions were carried 
 out," I have already described their procedure. 
 It is certainly true that " conditions in the Army 
 are much more favourable to the imparting of 
 individual instruction and to the pressure of per- 
 sonal influence than could ever obtain in the civil 
 community." But, except in rare instances, 
 this instruction was not given, and this personal 
 influence was not exercised. Whenever the in- 
 struction was given and the influence exercised, 
 venereal disease vanished almost completely. Even 
 in the example recorded in Table G, on which the 
 Committee is here commenting, the instruction was 
 given and the personal influence, if any, was exer- 
 cised, as I happen to know, not by the medical 
 officer, but by his orderlies. Surgeon -Commander 
 Boyden and I did our own lecturing an easy 
 
 1 It has now published them (see p. 419). 2 See pp. 364-5.
 
 INTER-DEPARTMENTAL COMMITTEE 221 
 
 matter. But I, at any rate, exercised no personal 
 influence. I was too busy. The main purpose of 
 my talk to the men was to direct attention as 
 strongly as possible to the precise instructions 
 which were posted up in each of my venereal ablu- 
 tion rooms. The difficulty of persuading civilians, 
 by means of similar posters in public urinals, to 
 disinfect themselves would not be nearly so great 
 as that of persuading them to resort to the ridiculous 
 Early Treatment Centres which the National 
 Council proposes to establish, and which the 
 Inter-Departmental Committee desires to re- 
 commend. 1 Whatever the proposal (a) Early 
 Treatment Centres ; (b) prophylactic packets ; 
 or (c) instructions to swab and disinfect as 
 soon as possible it must be made to the public 
 in print, for the simple reason that spoken 
 words would not reach those who most needed 
 advice. 
 
 In this connection paragraph 11 of the Report 2 is 
 interesting. " The Committee desire me to point 
 out that in their view many of those who wish the 
 Government to utilise in peace-time for the civil 
 population, methods which have been tried among 
 the Forces in war, have not sufficiently appre- 
 ciated the fundamental differences between the 
 two groups, or between the conditions of peace and 
 war." The Committee means to imply that in 
 war, when the manhood of the nation is with the 
 colours and under discipline, it is more easy to 
 afford instructions and enforce compliance than 
 during peace with civilians. This is very true ; but 
 1 See p. 373. 2 Seep. 371.
 
 222 PREVENTION OF VENEREAL DISEASE 
 
 the pity is that, except in isolated instances, no 
 attempt was made to utilise the unique oppor- 
 tunity which war afforded. " Nor have they been 
 aware of the complete failure of packets even in 
 a disciplined force." Not aware of it ! If spoken 
 and written appeals, individual and collective, 
 furnish evidence, many people have been acutely 
 aware of it, and acutely aware, moreover, of the 
 cause of the failure the neglect of the authorities 
 to furnish the soldiers with proper teaching. 
 
 The reader should think over this matter care- 
 fully. The Committee itself bears witness re- 
 peatedly to the importance of instruction to the 
 men. Thus, it opens its comments on Table G 1 
 with : " The above figures show a remarkable re- 
 duction in the venereal rate, commencing imme- 
 diately after the introduction of prophylactic 
 methods. They indicate that careful individual 
 instruction can effect reduction." The italics are 
 not mine. Neither Surgeon- Commander Boy den, 
 nor I, nor any one else that I am aware of who was 
 very successful, gave individual instruction. We 
 taught parties of men. We relied not on indivi- 
 dual, but on clear and definite instruction, which 
 we took care should reach every man concerned. 
 It was demonstrated again and again to the auth- 
 orities that a little clear teaching would almost 
 abolish venereal disease among soldiers and sailors, 
 and that, lacking such teaching, the mere supply of 
 material was useless. The neglect to issue urgent 
 and stringent orders enforcing such teaching was 
 worth more to the enemy than many army corps. 
 
 1 See p. 364.
 
 INTER-DEPARTMENTAL COMMITTEE 223 
 
 Doubtless, if the nation insists, as I hope it 
 will presently, on a stringent Government Inquiry, 
 the people responsible will declare that they did 
 issue orders, and in proof will instance odd sen- 
 tences in Army Council Instructions, and the 
 like, in which medical officers are told to instruct 
 the troops. But these isolated sentences were 
 futile, and I think were meant tojbe futile. Sup- 
 pose typhoid had ravaged the Army, and that it 
 was proved that it could be prevented, would the 
 authorities have been content with a few stray 
 sentences requesting the medical officers to dis- 
 infect with delay ? No : they would have issued 
 full, clear, and insistent orders to teach disin- 
 fection efficiently, and taken good care that they 
 were obeyed. They had always the power to 
 dismiss as incompetent or insubordinate any officer 
 who failed. No stronger condemnation of the 
 authorities could be penned than the Committee's 
 own statement : " The returns from individual 
 units appear to show that a reduction is effected 
 only when the medical officer takes a very special 
 interest in the subject, and neglects no opportunities 
 of impressing the importance of prompt disinfection 
 on the men under his charge ... it is clear . . . 
 the rate has not yet been reduced." x 
 
 The Report of the Inter-Departmental Committee 
 is merely a partisan statement. It is remarkable 
 that the Report is signed only by the Chairman. 
 But, if any members did refuse to sign, they ought 
 to have had the courage of their opinions and made 
 their objections publicly known. 
 
 1 See pp. 364-5-
 
 CHAPTER XVI 
 
 THE SOCIETY FOR THE PREVENTION OF VENEREAL 
 DISEASE l 
 
 Society for the Prevention of Venereal 
 
 _ Disease has for its objects : 
 
 (a) To instruct the public as to (1) the vital 
 importance of disinfection at the time of exposure 
 to risk as a preventive to venereal disease ; and 
 (2) the methods of application. 
 
 (6) To advocate such further steps for prevention 
 of venereal disease as may be deemed advisable. 
 
 Though at present only a few months old, the 
 Society has for President Lord Willoughby de 
 Broke, who has long been identified with the 
 struggle for the extension of sanitation to venereal 
 disease ; for Vice-Presidents Mr. Hugh Elliot, Pro- 
 fessor Leonard Hill, Mr. Rudyard Kipling, Sir E. 
 Ray Lankester, Sir Lawrence Phillips, and H. G. 
 Wells ; and on its Grand Committee are not only 
 such laymen as Lieut. -General Sir Francis Lloyd 
 and Lord Riddell, but very many of the more dis- 
 tinguished names in British medicine, including both 
 the Directors-General of Army Medical Services in 
 England and France at the beginning of the war 
 Its Secretary is Mr. H. Wansley Bayley, the ven- 
 
 1 See Appendix V. pp. 411-2. 
 
 224
 
 SOCIETY FOR THE PREVENTION 225 
 
 erealogist to whom and to Lord Willoughby de 
 Broke the Society owes its inception. 
 
 It is common knowledge that immediately after 
 the foundation of this Society, the National Council 
 for Combating Venereal Disease sought a con- 
 ference, with a view to a compromise, which was 
 declined unless the Council agreed to further the 
 aims of the Society in their entirety. The ethical 
 ideals of the two bodies differ so widely that a 
 conference would be futile and a compromise im- 
 possible. It is not merely that the one side ad- 
 vocates, and the other opposes, sanitation. As the 
 reader is aware, there has been a certain lack of 
 candour which would make negotiations difficult. 
 The Council now proclaims that it has never 
 opposed quick disinfection, except on grounds of 
 efficiency. Probably in a year or so it will discover 
 that it has always advocated it. In any case, it 
 is now impotent. It cannot prevent the Society 
 from imparting to the public knowledge of a kind 
 that spreads very rapidly. 
 
 On the 10th of December 1919 Lord Willoughby 
 de Broke raised a debate in the House of Lords 
 on the prevention of venereal disease. He asked 
 particularly for information concerning the Ports- 
 mouth Area that is the Military Area in charge of 
 the Assistant Director of Medical Services at Ports- 
 mouth, and which includes all Dorsetshire and 
 Hampshire, except Southampton, Netley, and that 
 part of Hampshire which lies in the Aldershot 
 Command. In this area the method of quick dis- 
 infection has been largely applied ; but it has been 
 applied only to troops belonging to the British Army . 
 15
 
 226 PREVENTION OF VENEREAL DISEASE 
 
 The debate was valuable principally for the 
 answer given by Lord Sandhurst, who, I take it, 
 was, like Lord Astor, only a mouthpiece with no 
 personal knowledge of the matter he discussed. 
 His answer " may be verbally true, but it conveys, 
 and was intended to convey, what was untrue." 
 There is every reason to believe that his figures 
 were supplied by the same hand as furnished 
 the Inter-Departmental Committee with its sta- 
 tistics. They are of the same kind and quality 
 as the latter precisely. They indicate the value 
 of the latter precisely. They indicate also that, 
 unless drastic action be taken, the Minstry of 
 Health will be served with the same efficiency and 
 candour as was the contemptible little army in its 
 hour of need. The reader will note that, in the 
 newspaper correspondence which followed, what 
 is virtually an accusation of misrepresentation is 
 answered by a little quibbling. Save a confession, 
 no other answer was possible. I may say I know 
 that Colonel Keble's reports, which were mentioned 
 in the Debate, and on which so much hinges, 
 actually exist. It is within the power of the 
 War Office to procure them at any time. 1 It 
 is to be hoped that care will be taken that the 
 figures from Hilsea Hospital are less misleading 
 than those from the Portsmouth Area and those 
 contained in the Report of the Inter-Departmental 
 Committee. I quote the official report of the 
 Debate in full from Hansard, that the reader 
 may learn the kinds of arguments which are used 
 
 1 As this is passing through the press I hear that the War 
 pffice is now in possession pf them.
 
 SOCIETY FOR THE PREVENTION 227 
 
 by both sides, and how greatly the opponents 
 of sanitation rely on the Report of the Inter- 
 Departmental Committee. The peculiarity of 
 the Report, as well as Lord Sandhurst's figures, 
 is that, while they are very quotable, they are not 
 at all defensible. They have been quoted per- 
 petually, attacked frequently, defended never. 
 Thus, several newspaper controversies (e.g. in 
 The Times, New Statesman, Lancet, and British 
 Medical Journal) sustained for weeks or months 
 by citations from them, have collapsed instantly 
 when their facts were questioned. They were 
 intended for quotation, and, I dare say, it was 
 expected that official prestige would abort attack. 
 
 " None are so surely caught, when they are catched, 
 As wit turned fool." 
 
 VENEREAL DISEASE 
 
 " Lord WILLOUGHBY DE BROKE had the follow- 
 ing Notice on the Paper : 
 
 " To call attention to the prevention of ven- 
 ereal disease by the method of immediate 
 self-disinfection, particularly in view of the 
 Note on Prophylaxis against Venereal Disease 
 by the Chairman of the Inter-Departmental 
 Committee on Infectious Diseases in connec- 
 tion with demobilisation. To ask the Ministry 
 of Health what steps they are taking to in- 
 struct the public in the proper application of 
 immediate self-disinfection at the time of 
 exposure to infection ; what steps they are
 
 228 PREVENTION OF VENEREAL DISEASE 
 
 taking to provide for delayed disinfection at 
 early treatment centres ; and to move for 
 Papers giving information as to the yearly 
 incidence of venereal disease in the Ports- 
 mouth area as compared to the rest of England; 
 and for Colonel Keble's reports and for the 
 Hilsea Hospital records giving information as 
 to the relative frequency in Hospital of men 
 who have used immediate and delayed dis- 
 infection respectively. 
 
 " The noble Lord said : My Lords, I do not make 
 any excuse to your Lordships for calling attention 
 again to this extremely important subject. It is 
 one which, as your Lordships are aware, vitally 
 affects the health and the life of the race, and we 
 cannot study it too closely or avail ourselves too 
 persistently of every possible means of trying to 
 stamp it out. It stands very high on the list of 
 what Dr. Saleeby describes as racial poisons. Sir 
 William Osier, for instance, said, I think before the 
 Royal Commission, that it stood third or fourth in 
 the great killing diseases of the world, and was 
 responsible for blindness, sterility, locomotor ataxy, 
 and general paralysis of the insane, and had all 
 sorts of hideous effects, not only upon those who 
 ran the risk of infection, but also upon the innocent 
 and unborn. The worst of it is that venereal 
 disease has increased and is increasing, and your 
 Lordships will agree with me that it ought to be 
 diminished. In support of this we read in The 
 Times of December 8 that there is a 60 per cent, 
 increase of venereal disease in the London hospitals.
 
 SOCIETY FOR THE PREVENTION 229 
 
 " I am bringing forward this Motion for Papers 
 this afternoon, and I feel sure that the Government 
 will help those for whom I am speaking by granting 
 this Motion ; but if they do not I shall ask your 
 Lordships to divide upon it, because I consider it 
 to be of the very greatest importance. I am bring- 
 ing forward the Motion with the object of ensuring 
 that the general public may know the truth with 
 regard to immediate self -disinfection at the time of 
 exposure to the risk of venereal disease. Last 
 April your Lordships were kind enough to listen 
 to what I had to say on this extremely important 
 subject, and I ventured to prophesy on that 
 occasion that we had not heard the last of this 
 matter of self-disinfection. We have had no 
 official answer to that debate except the publi- 
 cation of the Departmental Committee's Report 
 which I refer to in my question, and which Com- 
 mittee was presided over by Lord Astor. But, as 
 a matter of fact, it seems to me that apart from the 
 lectures given by the National Council, which are 
 admirable in their way as far as they go, no real 
 progress has been made in trying to stamp out this 
 disease. 
 
 " Lord Astor's Report is a very interesting docu- 
 ment, but the whole trend of it is dead against the 
 policy which I have come here to recommend to 
 you this afternoon. It is dead against the whole 
 idea of immediate self -disinfection, although rather 
 curiously it admits that drugs and medical pre- 
 parations may be relied upon to remove or destroy 
 the germs of venereal disease. That is a very 
 valuable admission, but in spite of this the Report
 
 230 PREVENTION OF VENEREAL DISEASE 
 
 appears so incomplete and so unsatisfactory from 
 the point of view of some of the most prominent 
 and learned venerealogists in the United Kingdom, 
 that they have formed themselves into a new body 
 called the Society for the Prevention of Venereal 
 Disease, the object of which is at once evident to 
 your Lordships. Our objects are to protect the 
 health of the race, especially women and children, 
 by instructing the public in the first instance in 
 immediate self -disinfection as a means of prevention 
 without any prejudice whatever to all the other 
 means that are available, some of which we consider 
 to be of the greatest importance. The Society for 
 the Prevention of Venereal Disease, with which I 
 have the great honour to be connected, is charged 
 with recommending nothing but what is called the 
 issue of prophylactic packets. That is a loose 
 statement, and I should like to examine it for a 
 moment. 
 
 " If your Lordships will read the correspondence 
 that took place in The Times when the Society was 
 first formed, you will see that it declined to be tied 
 down in its policy to recommending the issue of 
 prophylactic packets in the sense that they were 
 issued to His Majesty's Forces. What we intend 
 to recommend is that the general public shall be 
 informed as to the proper application of disinfec- 
 tants, and that if they wish to expose themselves 
 to risk and provide themselves with disinfectants, 
 they shall know what to ask for and how to use 
 them. Of course if what they ask for as they 
 can ask for it at any chemist's shop is done up 
 in a parcel, and I suppose it must be, and if that
 
 SOCIETY FOR THE PREVENTION 231 
 
 goes under the name of a packet, then it is indeed 
 a packet. What I particularly wish to disclaim is 
 that I am here on behalf of those for whom I am 
 speaking to recommend the free issue of what are 
 called prophylactic packets, because I am strongly 
 of opinion, if any individual wishes to expose 
 himself (or herself) to risk, and at the same time 
 chooses to take a disinfectant with him, that he 
 ought to do at his own expense, and not at the 
 expense of the general public. 
 
 " I think that your Lordships will agree with me 
 that in this regard prevention is very much better 
 than cure. The cure of venereal disease, as we 
 agreed the last time that we had a debate on this 
 subject, presents an exceedingly difficult problem. 
 It is quite true that since the discovery of Salvarsan 
 the cure of syphilis has become more absolute than 
 ever, but at the same time the cure of gonorrhoea 
 in the sense of the complete sterilisation of the 
 patient and rendering him or her innocuous to 
 others still remains a desperate public problem. 
 Either sex may be carriers of the micro-organisms 
 of this disease. Even when the symptoms have 
 disappeared, and they think they are perfectly 
 clear from it, they may still be in a condition to 
 communicate it to other people. I do not say for 
 a moment that for this reason the scientific dis- 
 coveries with regard to the cure of the disea^l 
 should not be proceeded with. It is a self-evident 
 proposition that they should be. and it is to be 
 hoped that they will be more efficacious than they 
 are at the present moment. 
 
 " In the meantime it does seem to me that we
 
 232 PREVENTION OF VENEREAL DISEASE 
 
 should address ourselves to prevention. You can 
 only prevent the spread of venereal infection by 
 two main methods. One is by universal continence 
 and the other is by disinfection. These are the 
 two main channels into which the prevention of the 
 disease naturally falls. We do not wish to speak of 
 those who are advocating universal marital con- 
 tinence with anything except profound respect, 
 but even the most sanguine of them must admit 
 that continence of that kind is not yet, and that it 
 will take a good many generations before it operates 
 to eradicate venereal disease. But disinfection is 
 here and remains. Disinfection is available, and 
 it is, I submit, the scientific way of dealing with the 
 matter. Disinfection is the acknowledged practice 
 with all contagious diseases, and venereal disease 
 is a contagious disease just as are other diseases 
 such as surgical fevers and skin diseases. Disin- 
 fection is the guiding principle of the whole of 
 modern surgery. It has enabled us to proceed 
 to so satisfactory a result with regard to the 
 treatment of other diseases that we naturally can 
 hope for success in the case of venereal disease, 
 particularly as that is a disease in which disinfection 
 is so easy, because the micro-organisms of thedisease 
 at the time they are communioated are so deposited 
 that and I have this on the highest medical 
 authority they will yield very readily to the appli- 
 cation of a disinfectant. They are not particularly 
 strong micro-organisms in themselves, and it is not a 
 matter of very great difficulty to apply a disinfectant 
 to them in such a manner that they disappear. 
 This is particularly true with regard to the male.
 
 SOCIETY FOR THE PREVENTION 233 
 
 " The last time that we had this debate I was asked 
 why we did not say anything about the self -disinfec- 
 tion of women. That, my Lords, is a difficult sub- 
 ject. The disinfection of women in the sense of using 
 disinfectants in the way we recommend that men 
 shall use them is a difficult matter, because woman 
 is not structurally suited to receive the disinfectant 
 with the same ease as man, and there are perhaps 
 other reasons, which I will not go into, why the 
 disinfection of women presents greater difficulties. 
 But there is this to be said for it, that so far as we 
 know the results of the disinfection of women have 
 been efficacious in preventing venereal disease, 
 because it is acknowledged by every one who knows 
 anything about it that most of the cases of venereal 
 disease something like 70 per cent. have been 
 communicated to men by the amateur and not the 
 professional prostitute, and the reason why the 
 professional prostitute on the whole has been safer 
 than the amateur is because it is a well-known fact 
 that these women have taught themselves how to 
 disinfect, and for that reason the disinfection of 
 women, if properly carried out, is probably a 
 success. 
 
 " We will, however, with your Lordships' per- 
 mission, address ourselves to the disinfection of 
 men. In doing so I am only following Colonel 
 Harrison, whom I shall quote in a moment. There 
 are two known methods of disinfection. No. 1 is 
 slow or delay disinfection ; No. 2 is quick or imme- 
 diate disinfection. The National Council for Com- 
 bating Venereal Disease has apparently accepted 
 the principle of disinfection, and the Ministry of
 
 234 PREVENTION OF VENEREAL DISEASE 
 
 Health have gone so far on the road to disinfection, 
 after a considerable amount of hesitation, that they 
 are prepared to advise the construction of a number 
 of what are called early treatment centres, which 
 means the provision of ablution rooms at the public 
 expense where those who have exposed themselves 
 to risk may repair, if they will do so and if they 
 know where they are, as soon after having connec- 
 tion as possible in order that they may be scienti- 
 fically treated by a skilled attendant. 
 
 " I should like to direct the attention of the noble 
 Lord who is the head of the National Council for 
 Combating Venereal Disease to this. He knows 
 how to frame his own phraseology much better than 
 I can teach him, but I should not call them treat- 
 ment centres. It is not treatment, it is disinfec- 
 tion before the symptoms declare themselves, and 
 if you call them treatment centres I suggest, with 
 great respect, to the noble Lord that it does en- 
 courage the public to think, when they go there, 
 that the disinfectants they find there are really 
 efficacious for treatment and not only for preven- 
 tion, and that they may try to treat themselves 
 with these same disinfectants in an amateur way, 
 supposing the symptoms arise. 
 
 " But in regard to the early treatment centres 
 there is a good deal more to be said than that. I 
 should be very anxious to hear what progress is 
 being made with their provision. The whole case 
 against the early treatment centres is so well put 
 by the Medical Officer of Health for Portsmouth 
 that I shall ask your Lordships to listen to him for 
 a moment and I shall read no quotations that are
 
 SOCIETY FOR THE PREVENTION 235 
 
 not authoritative. He was writing to the Borough 
 of Portsmouth with regard to putting up auxiliary 
 centres, which is the same thing as what are known 
 as early treatment centres, and he says : 
 
 * Medical men are generally unanimous in the 
 opinion that the greatest safeguard against the 
 contraction of venereal disease after exposure to 
 disinfection is the destruction of the germs of the 
 disease by the immediate application of a disin- 
 fectant. But to endeavour to secure the adoption 
 of this practice by the provision of auxiliary centres 
 in various parts of the town appears to me to be 
 clumsy, extravagant, and futile. To mention one 
 fatal objection only. It is said such places should 
 be inconspicuous. In the first place, it is prac- 
 tically certain that the character of the place will 
 become known, consequently persons would not 
 care about being seen to enter them ; in the 
 second, if it were possible to render them so incon- 
 spicuous as to escape public notice they would also 
 be so inconspicuous that persons who wanted to 
 resort there would not know where to find them. 
 Speaking as your Medical Officer of Health, whose 
 principal duty is the prevention of disease, I am 
 bound to state that in my opinion the most effective 
 weapon for the prevention of venereal disease is the 
 instruction of the public in a knowledge of those 
 simple measures, the adoption of which is recog- 
 nised as an almost certain protection against 
 venereal disease.' 
 
 And I am informed that the London County Council 
 has stated its inability to provide these early
 
 236 PREVENTION OF VENEREAL DISEASE 
 
 treatment centres. But supposing the London 
 County Council did provide them. Who is going 
 to use them ? How is everybody to know where 
 these places are ? Will they repair there quickly 
 enough after having connection to do any good ? 
 Because it is a proved scientific fact that the micro- 
 organisms of the disease begin to get a much greater 
 hold upon the organs every minute after they are 
 deposited, and that any delay after one hour very 
 often is prejudicial to success. I should like to ask 
 His Majesty's Government how many of these early 
 treatment centres are wanted and how many you 
 have got already. 
 
 " There is another thing about these early treat- 
 ment centres. For the first time in the whole 
 history of venereal disease there is a danger, if it 
 has not already reached beyond the point of danger, 
 when men coming back from the war will bring 
 these diseases into rural districts, and it is quite 
 impossible to have an early treatment centre in a 
 village in the country. The thing would be watched, 
 everybody would know who went there, and it 
 only needs a moment's consideration to see that 
 the project would be futile. In addition to that, I 
 could well imagine that in urban districts people 
 might easily be subject to espionage, and private 
 detectives might be employed to watch people who 
 were going in there, and it might very easily open 
 the door to an elaborate system of blackmail. I 
 think that this question of what is called early 
 treatment centres requires a great deal of careful 
 examination before it is adopted. And, after all 
 is said and done with regard to disinfection,
 
 SOCIETY FOR THE PREVENTION 237 
 
 it is time that is the whole essence of the 
 matter. 
 
 " I should like to say a word or two about quick 
 or immediate self-disinfection, and by that I mean 
 the state of things by which those who expose 
 themselves to risk carry with them the necessary 
 disinfectants and apply them themselves a few 
 seconds after the exposure to risk. I think that the 
 authorities at the War Office and the Admiralty 
 known something about quick disinfectants, but 
 everybody agrees even those who do not agree 
 with me in advocating it publicly as to its efficacy 
 if it is properly carried out. I should like to quote 
 from the speech that Lord Sydenham made in your 
 Lordships' House in answer to some remarks of 
 mine on a former occasion. He said : 
 
 4 It is perfectly well known that any effective 
 disinfectant, if used deliberately and skilfully and 
 properly, can prevent infection.' 
 
 He goes on to say that unless more information is 
 given than appears in the Lancet, it is impossible 
 to accept the figures which the writer put forward. 
 Later in his speech he said : 
 
 4 Self-disinfection before or after exposure to 
 risk, and after exposure to risk if there is not too 
 long a delay, which might be one or two hours ' 
 
 Rather dangerous 
 
 ' and it is applied with care and deliberation and 
 promptness, will probably in most cases be per- 
 fectly effective.'
 
 238 PREVENTION OF VENEREAL DISEASE 
 
 The noble Lord then goes on to say that in some 
 cases (which is perfectly obvious, and perfectly 
 true) it will first fail because those conditions cannot 
 always be fulfilled ; but, with regard to the efficacy 
 of it, if the proper conditions of its application are 
 fulfilled, surely there cannot be more than one 
 opinion. 
 
 " This whole system of disinfection is based upon 
 the exceedingly valuable discoveries of Metchnikoff 
 with regard to some experiments which were con- 
 ducted by him conjointly with M. Roux, who was 
 the Director of the Pasteur Institute in 1905. 
 First of all monkeys of different kinds were taken 
 by Metchnikoff to be experimented upon, and they 
 were experimented upon with admirable results ; 
 and these results appeared to be so certain and 
 positive that an experiment was made upon a 
 human being with very great success. All the 
 possible safeguards against failure from the thing 
 not being properly undertaken were used. I have 
 it all written down here from an authoritative 
 source, but I will not trouble your Lordships with 
 it because it might take rather too long to read. 
 The reason I bring this forward is that, as far as I 
 can recollect, in the evidence given before the 
 Royal Commission on Venereal Disease the point 
 was not brought out that the experiments of Pro- 
 fessor Metchnikoff who is the father of disin- 
 fection as a prevention of this disease on a human 
 being were not stated at all, I think, and that the 
 Society confined itself to stating his experiments 
 upon the monkeys. 
 
 " I a.m sorry that I have ha.d to read so many
 
 SOCIETY FOR THE PREVENTION 239 
 
 quotations to your Lordships, but it is absolutely 
 necessary to establish what I have to say. I should 
 like to quote one or two sentences from Colonel 
 Harrison, because he is a particularly valuable 
 witness. I understand that Colonel Harrison is 
 one of the guiding spirits of the National Council 
 for Combating Venereal Diseases, who are not pre- 
 pared to go nearly as far as we are in advocating 
 self-disinfection. Colonel Harrison has also had 
 a great deal of experience in the Army, and he was a 
 member of the Department Committee which had 
 issued the Report I have ventured to criticise. I 
 am rather disappointed that Colonel Harrison is 
 not a member of the Society for the Prevention of 
 Venereal Disease, because if he were it would 
 accord exactly with a certain lecture he gave not 
 very long ago at the Royal Institute of Public 
 Health. Colonel Harrison says that he looks to the 
 breaking of the chain of infection before it has 
 become well established ; that the reason was not 
 far to seek, because the micro-organisms of the 
 disease were the most delicate organisms in exist- 
 ence, they were planted on an exposed situation and 
 easily liable to removal by urination or ordinary 
 ablution. When natural agencies were assisted by 
 prompt application of antiseptics, it can easily be 
 proved that the chances of infection were reduced 
 to an infinitesimal amount. 
 
 "He then gives some powerful statistics in 
 support of this view, with which I will not trouble 
 your Lordships ; but later in this very interesting 
 jecturc which is a perfect justification of every <
 
 240 PREVENTION OF VENEREAL DISEASE 
 
 thing that this new Society is advocating he 
 says : 
 
 ' The ideal method is undoubtedly that in which 
 the man submits himself to treatment by a skilled 
 attendant within an hour of exposure ; but promp- 
 titude is vitally necessary to success, and if the 
 man is situated where he cannot obtain skilled 
 assistance he should have the means of self-disin- 
 fection with him.' 
 
 I have quoted this passage before, but I have taken 
 the liberty of reading it again. I do not think 
 anything could be clearer than that. I quote 
 Colonel Harrison at some length, as he is now claimed 
 as the principal opponent of the view I wish to 
 put before your Lordships. 
 
 " No one has contributed more to the cause of 
 self-disinfection with greater success than Sir 
 Archdall Reid, and it will be necessary, for those 
 of your Lordships who have not read his letters in 
 the New Statesman and elsewhere, to trouble you 
 to listen to what he says, because this is absolutely 
 first-class testimony by one who has deliberately 
 tried it and has seen the results. He says : 
 
 ' In a large area ' 
 
 I think this refers to the Portsmouth area, about 
 which I am asking for Papers 
 
 * served by a single venereal diseases hospital both 
 quick and slow disinfection have been extensively 
 practised. For quick disinfection nothing more was 
 found necessary than to tell the men to swab them-
 
 SOCIETY FOR THE PREVENTION 241 
 
 selves with permanganate of potash (or any other 
 active antiseptic) immediately after exposure. 
 No "packets" were necessary, but the men were 
 given the antiseptic if they asked for it. At the 
 time of my last inquiry, of all the hundreds who 
 had passed through the hospital, nearly every man 
 had practised slow disinfection and not one had 
 practised quick disinfection. At a later period the 
 method of quick disinfection was more extensively 
 applied in this area ; thereafter almost the only 
 cases of disease that occurred within it arrived with 
 men joining station from outside and bringing 
 their infections with them.' 
 
 In the remarks I was allowed to address to your 
 Lordships last April I gave you the results which 
 were fairly well published and studied, and which 
 were well known to all who took an interest in this 
 subject with regard to Sir Archdall Reid's and 
 Surgeon-Commander Boyden's great and marked 
 success with regard to teaching their men in the 
 Army and in the Navy to use immediate self- 
 disinfection. As these statements of what Sir 
 Archdall Reid and Surgeon-Commander Boyden 
 actually achieved have become so much a part of 
 the public controversy on this subject, I need not 
 weary your Lordships with repeating them ; but 
 they are telling in the extreme. 
 
 " I will now give an extract from them as quickly 
 as possible. Sir Archdall Reid was in charge of a 
 rapidly changing body of men in a large seaport 
 I am quoting from the British Medical Journal of 
 February 8, 1919 where the average number of 
 16
 
 242 PREVENTION OF VENEREAL DISEASE 
 
 men was about 2000, and he estimates that 40,000 
 must have passed through his hands during the 
 war. Venereal disease was common amongst them 
 in spite of moral lectures and early treatment. In 
 1917 he instructed immediate personal prophylaxis. 
 Each man who applied was given an ounce of 
 potassium permanganate solution (1 in 1000), a 
 swab of wool, and careful directions. During 1917 
 and 1918 about 20,000 men passed through the 
 station, and only seven cases of venereal disease 
 occurred. The man who acquired syphilis carried 
 no disinfectant with him, and used it only two hours 
 afterwards. Of the six cases of gonorrhoea, two 
 were contracted from the men's wives, two others 
 were drunk, one took no precautions, and the sixth 
 only after an hour's interval. Surgeon-Commander 
 Boyden tells practically the same story. 1 
 
 " I am aware that in producing this testimony, 
 powerful as it is, I shall be told that statistics 
 equally powerful can be produced in support of a 
 contrary view. The point which I wish to put to 
 your Lordships is that although statistics may be 
 produced to prove that self-disinfection has not 
 always had the same success as when it was re- 
 commended by Sir Archdall Reid, the reason it has 
 been unsuccessful is that it has not been system- 
 atically, regularly, and properly applied ; and 
 however many statistics you produce on the oppo- 
 site side with regard to the failure or the alleged 
 failure of self-disinfection, you will never be able 
 to produce statistics to prove that disinfectants do 
 not disinfect if they are properly applied. 
 
 1 See Appendix IV. pp. 406-7.
 
 " In support of this view I should like to quote a 
 word or two from the very remarkable testimony 
 of Miss Ettie Rout, who is an authority on this 
 subject whom it is permissible to quote. She is 
 the honorary secretary of the New Zealand Volun- 
 teer Sisters, and has made a special study of this 
 subject ever since the war began ; she has been to 
 practically every area occupied by troops. The 
 whole of her testimony goes to prove what they all 
 have experienced. She says it has been proved 
 time and time again that whenever disinfectants 
 are supplied adequately in proper form to soldiers, 
 and confidently recommended, venereal infection 
 practically ceases. In this regard it is a rather pet 
 phrase in Lord Astor's White Paper. He alludes 
 to a carefully organised packet system in the Army. 
 It is exceedingly doubtful whether, except in cer- 
 tain areas presided over by certain commanding 
 officers and by those who took the same point of 
 view as Sir Archdall Reid, there was ever any 
 carefully organised packet system. Just listen to 
 this report from a lady, who says : 
 
 ' In June and July, this year ' 
 
 That is, 1919 
 
 4 1 visited most of the Australian and New Zealand 
 camps in England and lectured to some 25,000 or 
 30,000 soldiers who voluntarily attended at my 
 personal invitation. I put the test question to 
 several audiences as to whether they had ever gone 
 on leave without instructions and packets being 
 given to them. On the average not more than 10 
 per cent, of the men had received packets. The
 
 244 PREVENTION OF VENEREAL DISEASE 
 
 vast majority of the audience held up their hands as 
 having gone on leave without packets during the 
 previous few weeks. When I asked how many 
 men had ever gone on leave without packets, 
 practically the whole audience held up their hands.' 
 
 I have here one or two very interesting and im- 
 portant figures taken from Paris, and then I shall 
 have very nearly done with these quotations. 
 From June to November 1918, in a period of five 
 months, when abundant disinfectants were given 
 individually to the Anzacs for the purpose of im- 
 mediate self-disinfection, the number of infections 
 recorded at the Paris Medical Report Centre was 
 only twenty, whereas in November and December 
 1918, during a period of five weeks, when the 
 supply of disinfectants was temporarily cut off, the 
 number of Anzac infections recorded at the Paris 
 Medical Report Centre was twenty-four. That is 
 very remarkable, and these figures can be fortified 
 over and over again by other quotations of the 
 same character, with which I will not now trouble 
 your Lordships, though I can assure you they are 
 very telling. 
 
 "The fact that self -disinfection, if properly ap- 
 plied, is effective, has not been impugned. Nobody 
 in authority has attempted to contradict, or can 
 contradict, the fact that, scientifically, the case for 
 immediate self-disinfection is proved up to the 
 hilt. It is perfectly easy to urge that the improper 
 use of it is unsuccessful. That applies to all 
 remedies. If anybody brushes his teeth, for 
 instance, in a perfunctory manner, and so suffers
 
 SOCIETY FOR THE PREVENTION 245 
 
 as the result of not brushing them properly, that 
 is not an argument in favour of abandoning the 
 brushing of teeth altogether ; and I say that, 
 having got a scientific fact upon which everybody 
 agrees, it is the duty of the Government to give 
 this fact every chance and to try to make it a 
 success. I believe that so far those who do not 
 care perhaps to go so far as I should like to go in 
 the instruction of the public, will have agreed in 
 the main with what I have said up to the present 
 moment. 
 
 " What is the issue between the National Council 
 for Combating Venereal Disease and those who 
 support them and the Society for the Prevention of 
 Venereal Diseases ? I do not believe there is really 
 any very important medical issue at all, because 
 the medical men on the National Council must 
 know what are the properties of calomel ointment 
 and permanganate of potash. At the same time 
 there is a rather important difference between us, 
 and I think that difference may best be described 
 as being a difference in frame of mind. Different 
 frames of mind will give a different answer to this 
 question How far is it ethically or morally justi- 
 fiable to withhold or to promulgate the teachings 
 of science ? That is where I believe we may part 
 company. The most rev. Primate in the courteous 
 reply which he gave to the remarks I offered to 
 your Lordships last April, said that I skated 
 rather lightly over the moral issue. 
 
 " I will put two questions to the school of thought 
 which perhaps the most rev. Primate represents. 
 I should like to ask whether they admit that ex-
 
 246 PREVENTION OF VENEREAL DISEASE 
 
 posure to risk of catching venereal disease is likely, 
 before universal continence prevails, to control the 
 sexual instinct in such a way that there is no pro- 
 miscuous intercourse between the sexes, or that, 
 while all this is going on, the consequences of ven- 
 ereal disease are still likely to proceed ? The second 
 is this If you answer this question in the affirma- 
 tive, are you prepared to let your fellow-country- 
 men share in the latest teachings of science so as to 
 protect them and their innocent and unborn de- 
 scendants from these results ? 
 
 " Some people would seem to go only part of the 
 way, and some would seem to say that there is 
 nothing really very immoral in going round to what 
 is called an early treatment centre an hour or two 
 after the connection has taken place ; but that 
 there is a difference between the morality of doing 
 that and using certain disinfectants at the time of 
 exposure to risk. I myself cannot see any great 
 difference between these two processes. If im- 
 mediate self-disinfection is really a success, is it 
 that people are afraid of the consequences of making 
 the intercourse between the sexes too frequent ? 
 I submit to your Lordships, with great respect, that 
 real true morality ought to be free from, and 
 independent of, the fear of catching venereal 
 disease. At best those who say that the fear of 
 catching the disease prevents promiscuous inter- 
 course are really using an argument which could 
 be used the other way. 
 
 " If you say to people that you are going to run 
 the very grave risk of catching this disease unless 
 you disinfect yourself properly, then I can imagine
 
 a state of things where, if there is indeed a fear of 
 catching it, those who are afraid of so doing would 
 refrain from intercourse supposing they had not 
 got the necessary disinfectants with them. If it 
 comes to a question of morality, I submit to your 
 Lordships that it is a very doubtful remedy to try 
 to suppress the truth. Not only that, you cannot 
 suppress it. The truth with regard to immediate 
 self-disinfection at the time of exposure to risk is 
 out. It is here. Disinfectants and instructions 
 how to disinfect have been supplied to thousands 
 of men on demobilisation, and at this moment, in 
 spite of the law, packets are being sold. They 
 may or may not be of the right strength. If they 
 are not of the right strength it is because they are 
 not properly supervised by the Government and 
 not made up in the proper way, and nothing in the 
 world can be more dangerous than the sale of un- 
 authorised packets by ignorant people to ignorant 
 people. The Society of which I am a member 
 intends to publish the fullest and latest scientific 
 information by every means in its power. The 
 Society for the Prevention of Venereal Disease 
 contains on its list medical men, scientists, and 
 venerealogists whose authority and opinion cannot 
 possibly be ignored. Those gentlemen intend to 
 press forward with the campaign for enlightening 
 their fellow-countrymen. 
 
 " I appeal to your Lordships, and to the National 
 Council for Combating Venereal Disease, that as 
 this knowledge is getting out it would be much 
 better, instead of trying to suppress it, to direct 
 it scientifically in such a way as to be valuable to
 
 248 PREVENTION OF VENEREAL DISEASE 
 
 the public. I call for this information because I 
 believe we shall get some valuable facts which the 
 public is not in possession of in regard to the 
 Portsmouth area. I ask the other questions 
 because I believe the health of the race is the very 
 best guarantee for its moral tone. I intend to 
 press the Motion for a Division. I have sufficient 
 confidence in my fellow-countrymen to believe that 
 we shall do no harm by telling them the truth. 
 Let us place them in the possession of the latest 
 teachings of science, and leave it to them to choose 
 for themselves." 
 
 " Moved for Papers giving information as to the 
 yearly incidence of venereal disease in the Ports- 
 mouth area as compared to the rest of England ; 
 and for Colonel Keble's reports and for the Hilsea 
 Hospital records giving information as to the 
 relative frequency in hospital of men who have used 
 immediate and delayed disinfection respectively. 
 (Lord Willoughby de Broke.} 
 
 " LORD SYDENHAM : My Lords, every one who 
 has listened to the speech of the noble Lord must 
 be well aware of the earnest care he has devoted 
 to this subject, and his sincere anxiety to combat 
 venereal disease in every way possible. If I differ 
 from him in his methods, I am sure he will credit me 
 with the same sincerity and earnestness. I regret 
 that his Committee would not accept the invitation 
 to a round-table conference which I offered, be- 
 cause I believe it would have cleared away a good 
 many misunderstandings and have led to the
 
 SOCIETY FOR THE PREVENTION 249 
 
 avoidance of this very distasteful debate. It is 
 very natural that he should criticise the Report 
 which has been made public, because it really is 
 very damaging to his case. It is not, I think, quite 
 as clear as it might have been, and it is a great pity 
 that the names of the ten experienced medical 
 officers who formed the Committee were not given. 
 I am not myself at liberty to give their names, 
 but although they do not hail from Harley Street 
 I think the public would respect them and feel that 
 they speak with great authority. 
 
 " I do not think the Note is quite as clear as it 
 should be. It does not make sufficient distinction 
 between the prophylactic packet to be used before 
 risk and the disinfecting packet to be used after- 
 wards. As regards the first, I pointed out in the 
 debate of April last that it had been tried and given 
 up in the American Army, and now Sir Archdall 
 Reid says that the prophylactic packet is useless. 1 
 
 1 Lord Sydenham gives his words unusual meanings always 
 a dangerous procedure unless antecedent warning be given also. 
 " Prophylactic " means " preventive " ; and prevention is 
 prevention whether applied before or after the arrival of the 
 microbes. Presently some one who uses his words with their 
 ordinary connotations, is sure to announce, on Lord Sydenham's 
 authority, that I consider prophylactic packets useless. I have 
 said nothing like that. I have said that the supply of packets to 
 soldiers in England was unnecessary, because the disinfectants 
 present in every medical inspection room were sufficient. The 
 men needed only clear and insistent instruction. I have said 
 that the supply of packets to civilians is unnecessary. Civilians, 
 also, need only instruction. I have said that permanganate is 
 a better antiseptic for immediate disinfection than calomel. I 
 have said that disinfectants in packets or otherwise without 
 instruction are relatively useless. I have said, on purely theoret- 
 ical grounds, that disinfection before the arrival of the microbes is
 
 250 PREVENTION OF VENEREAL DISEASE 
 
 We have this then that this method, which was 
 widely advertised and advocated, is now practically 
 dead. Now I come to post-risk disinfection. The 
 Inter-Departmental Committee, very unfortunately 
 as I think, did not make this one of the main sub- 
 jects of their consideration, but they have provided 
 us with a large amount of valuable evidence which 
 in my opinion goes very far to destroy the theories 
 of the noble Lord. Post-risk disinfection may be 
 of two kinds. It may be carried out by skilled 
 attendants or under skilled supervision, or it may 
 be left to the care of the individual. It is in the 
 latter case that the packet containing permanganate 
 and the tube of calomel ointment is recommended 
 to be used. According to Sir A. Reid, the materials 
 for disinfection should be ' ready in the man's 
 pocket,' not on the shelf of the ' Early Prevention 
 Treatment Hut.' 
 
 ' ' I believe medical opinion is quite unanimous that 
 disinfection skilfully and vigorously applied within 
 one or two hours will in all probability remove the 
 risk of the disease. Medical opinion is also agreed 
 that such disinfection may be carried out success- 
 fully when applied by exceptional people in ex- 
 ceptional circumstances. But the question really 
 is whether an ordinary individual in special cir- 
 cumstances would be likely or not to disinfect 
 himself effectively. That is not a medical question ; 
 
 unlikely to be effective ; for you cannot guarantee the adherence 
 of the disinfectant to the skin. But all that is very different 
 from saying that packets are useless. Why should I, who have 
 advocated the use of disinfectants, suppose that disinfectants 
 done up in packets should be less efficacious than the same 
 disinfectants not so wrapped up ?
 
 SOCIETY FOR THE PREVENTION 251 
 
 it is a question which any layman is competent to 
 judge on such evidence as is available. Happily, 
 we have some evidence in the White Paper which 
 was not available when our debate took place last 
 year. We were told that the American authori- 
 ties tried self-disinfection on a large scale and 
 abandoned it entirely in favour of disinfection by 
 skilled attendants. They were so convinced that 
 self-disinfection amongst their soldiers was a 
 failure that in some units they declined to give 
 all-night passes and issued disinfectants only to 
 men who were going on leave to a distance. They 
 have abandoned permanganate of potash, which 
 we have been told is a specific disinfectant. The 
 American evidence is very valuable, and I commend 
 it strongly to the study of the noble Lord. The 
 American Army figures of incidence among men at 
 home before the war were considerably higher than 
 our own. When America entered the war energetic 
 measures were taken by the authorities to enforce 
 supervised disinfection, and those measures brought 
 down the figures of infection in their troops in this 
 country close to our own ; but the rate among 
 troops in the United States was still distinctly high 
 in the last half of 1918. 
 
 " The Australian evidence seems to be even more 
 destructive of the views of the noble Lord. My 
 information is that no man left camp or barracks 
 without having a packet offered to him, and the 
 result was a distinct increase of disease among the 
 Australian troops. This deplorable failure is attri- 
 buted to the lack of sufficient stations where dis- 
 infection could be applied under skilled supervision,
 
 252 PREVENTION OF VENEREAL DISEASE 
 
 In other words, it was a complete breakdown of 
 purely self-disinfection. In the last three months 
 ended December 31, 1918, the rate among the 
 Australian troops at home was 147 per thousand 
 per annum ; and if cases where abortive treatment 
 are considered we get an incidence more than five 
 times greater than among our own troops in this 
 country during the same period. 
 
 " The point that I wish to make is this, that it 
 is quite impossible to carry out self -disinfection 
 among the civil population as vigorously as it was 
 carried out among the Australian troops, and that 
 among them it was an undoubted failure. The 
 reason is given by Colonel Raffen, who says : 
 
 * Unfortunately for various reasons due to 
 carelessness, excitement, and mainly excess of 
 alcohol, there are a large number of men who fail 
 to use the outfit correctly, if at all.' 1 
 
 Therefore we have practical experience showing 
 that the sovereign remedy proposed by the noble 
 Lord failed in circumstances in which one would 
 most expect to find it successful. 2 
 
 1 Colonel Raffen does not give the most important reason 
 the neglect to furnish the men with proper teaching. Since Sir 
 James Barrett and Colonel Elgood were magnificently successful, 
 it follows that Colonel Raffen should have been equally successful. 
 The blame lay not with the men, but with those who were in 
 medical charge of them. The point does not bear discussion. 
 What would be said if one officer or foreman of works achieved 
 good results with his men, and another, under similar conditions, 
 failed to do so ? 
 
 2 On the other hand, it succeeded in circumstances in which one 
 would most expect it to fail in great Asiatic and English cities. 
 What, then, is the explanation of the failure a bad system, or 
 bad administration ? Lord Sydenham thinks the system is bad !
 
 SOCIETY FOR THE PREVENTION 253 
 
 " On the other hand, there was a marked success 
 amongst the Canadian troops at Havre, where of 
 5153 treatments not one infection occurred, due 
 entirely to the work of skilled attendants. In the 
 British Army since the middle of last year, extensive 
 measures were undertaken for disinfection purposes, 
 careful instructions were given, inspectors were 
 appointed, and as much as possible was done to 
 make self-disinfection a success. In some cases 
 there was success, no doubt for exceptional reasons. 
 That will always occur. But all the efforts made 
 failed to bring down the incidence of disease in 
 our army to any marked degree. The rate per 
 1000 per annum in the United Kingdom was forty- 
 three in the first half of 1918, thirty-eight for the 
 last half of 1918, and it rose to thirty-nine for the 
 first half of 1919, when the system was in full 
 operation. It is impossible to claim success on 
 such figures, though, of course, there may be reasons 
 why the arrangements were not so effective as was 
 wished. Sir Archdall Reid has asserted that our 
 military authorities failed because they told men 
 to apply for disinfectants after exposure, implying 
 that they were to wait until they got back to 
 barracks. This is not quite accurate. The War 
 Office, most rightly in my opinion, declined to 
 press packets upon our soldiers, but every man 
 knew perfectly well that he could get a packet, and 
 as a matter of fact large numbers were taken, and 
 in some cases, I believe, were sold. One man was 
 found with thirty-five tubes of calomel in his pocket. 1 
 
 1 Here Lord Sydenham " gives away " the whole case. It Is 
 admitted by his own party that self-disinfection is successful
 
 " Sir Archdall Reid gave to the Committee the 
 figures which have been quoted, and very striking 
 figures they were, but when questioned he said he 
 did not know the percentage of men who used 
 permanganate and were infected or not infected, 
 and he did not know the percentage of men who 
 did not use permanganate, nor did he know the 
 percentage or numbers of men who were diseased 
 on arrival in camp or on leaving. Without these 
 important details it is impossible to form a satis- 
 factory and scientific opinion as to the results 
 claimed. 1 We all know how easily statistics may 
 mislead. I do repeat that self-disinfection may 
 
 only among men who have been instructed in the method and 
 the necessity of it. As stated in the Report of the Inter- 
 Departmental Committee, " a reduction is effected only when the 
 medical officer takes a very special interest in the subject, and 
 neglects no opportunity of impressing the importance of prompt 
 disinfection on the men under his charge. It is clear from 
 Table E that this effort must be exceptionally energetic and 
 personal, since the rate has not been reduced in spite of the 
 careful instructions issued by the War Office, and the provision 
 of District Inspectors to see that those instructions were carried 
 out." Lord Sydenham enables us to estimate the value of those 
 careful instructions and of those District Inspectors. As a fact, 
 the soldiers were instructed not to use the packets as packets. 
 There are the altered words in my lecture to witness, for instance. 
 See p. 349. 
 
 1 See pp. 369-70. What more information could Lord 
 Sydenham want ? He is now taking his cue from the questions 
 asked me by Colonel Harrison when I gave evidence before the 
 Inter- Departmental Committee (see pp. 202-211). The fact 
 remains that Surgeon-Commander Boyden had no cases out of 
 496, and that I reduced the venereal rate among my men to i 5 
 per 1000 per annum. Not one of our men who obeyed instruc- 
 tions was infected, and very few failed to obey. Our claims may 
 be checked from independent hospital records. What more, I 
 say, does Lord Sydenham want ?
 
 SOCIETY FOR THE PREVENTION 255 
 
 succeed if all necessary conditions are com- 
 plied with we none of us deny that or if all 
 the circumstances are satisfactory and all the 
 instructions are carried out in detail ; 1 but all 
 the experience which we have is derived from 
 forces under discipline, and it is certainly not 
 encouraging. An immense advantage is possessed 
 by the military and naval authorities in dealing 
 with this disease. Among the civil population 
 none of these advantages exist. You cannot en- 
 force attendance on lectures, and you cannot 
 possibly have the very severe disciplinary arrange- 
 ments which were applied to the American Army. 
 
 "Therefore, does it not follow that even if the 
 evidence derived from the military and naval 
 experience were hopeful, which it certainly is not, 
 we could not expect nearly so good results to apply 
 to the civil population? I was at one time un- 
 certain of the policy of the noble Lord's Society, 
 but it has been made quite clear. On the 22nd of 
 last month the Society published its programme, 
 and the public was informed that ' immediate 
 self-disinfection, requiring no special skill or 
 training,' is ' the only way which offers any real 
 hope of efficiently combating this terrible scourge.' 
 Accordingly the Society asked every one to send a 
 stamped envelope, and then promised that ' the 
 necessary instructions ' will be sent free of charge. 
 
 1 The reader should bear in mind what the " necessary con- 
 ditions," the " satisfactory circumstances," and " all the in- 
 structions " are that, as soon as possible after exposure, the 
 man shall take a little bottle from his pocket, wet a little swab 
 of cotton-wool with its contents, and therewith damp for a little 
 space (say one minute) a few inches of skin.
 
 256 PREVENTION OF VENEREAL DISEASE 
 
 I think I have proved that this statement is not 
 quite in accordance with the facts, and that as it 
 stands it really may do very great harm. Super- 
 vised disinfection has proved to be a success, but 
 self-disinfection has not proved to be trustworthy, 
 even when conditions are favourable, and the effect 
 of such an announcement as I have read out must 
 be to create a false sense of security and possibly 
 to increase infection. 
 
 " The Society of the noble Lord is nothing if not 
 belligerent. Sir Archdall Reid has permitted 
 himself to attack the National Council in very 
 strong language. He declared in the New States- 
 man of September last that we were a ' fake ' 
 society. He went on to say that our ' object is 
 not to prevent venereal disease, but by pretending 
 to prevent it to prevent other people from pre- 
 venting it.' I decline to characterise a statement 
 of that kind, which must do harm, and I leave it 
 to the judgment of your Lordships' House. This 
 * fake society ' was started by the members of the 
 Royal Commission who wrestled with this most 
 unpleasant subject for two years, and took a great 
 mass of expert evidence. Surely I have the right 
 to defend the Council. We were the first to 
 publish widely some striking figures obtained from 
 the American Naval Station at Norfolk, Virginia, 
 where disinfection under skilled supervision was 
 employed. We have used these figures to drive 
 home the lesson of the necessity of treatment at 
 the earliest moment, and we are now accused of 
 keeping back a wonderful discovery of the dis- 
 infectant power of permanganate and calomel.
 
 SOCIETY FOR THE PREVENTION 257 
 
 " What are the facts ? The National Council took 
 up the question of disinfection in the autumn of 
 1916, as a result of the experience gained in France. 
 We were then greatly concerned with the large 
 number of troops on leave in London, and in a 
 pamphlet which we published the uses of calomel, 
 protargol, and permanganate were explained. 
 With the approval of the Director-General of 
 Medical Services and with the co-operation of the 
 National Guard, Sir Thomas Barlow took great 
 pains to secure the establishment of irrigation 
 statistics in camp and barracks. The result of this 
 was a most striking success in many cases, especi- 
 ally in Chelsea Barracks. 1 We also issued many 
 thousands of cards to soldiers on leave, urging them 
 to take early preventive treatment, and telling them 
 where it could be obtained. That system could 
 not be applied throughout the country for the use 
 of the whole civil population. It was gradually 
 superseded by the military authorities in favour of 
 self-disinfection packets. 
 
 "As regards the civil population, the National 
 Council has strongly urged the immediate use of 
 
 1 See p. 364. Heaven only knows what Lord Sydenham means. 
 The irrigation or ablution rooms were left open day and night, and 
 no record or estimate was ever made of the number of men using 
 them. Consequently no statistics, except perhaps of the kind 
 published by the Inter-Departmental Committee, were possible. 
 How could statistics result in a most striking success, especially 
 in the Chelsea Barracks ? I am informed that Sir Thomas 
 Barlow was mainly instrumental in procuring that alteration in 
 the " Specimen Lecture " (see p. 143) which directed the men to 
 disinfect themselves not immediately, but after return to quarters. 
 Probably some hundreds of thousands of infections resulted 
 from this change of policy. 
 
 17
 
 258 PREVENTION OF VENEREAL DISEASE 
 
 soap and water, which even Sir Archdall Reid 
 admits may be effective. Soap has been known to 
 be a germicide, and if vigorously used is probably 
 quite as effective as permanganate. 1 We do not 
 deny, and we do not suppress the fact, that disin- 
 fectants recommended by a medical man if skil- 
 fully and quickly applied will reduce the risk of 
 disease, but they do not afford and cannot afford 
 certain security, and if any symptoms supervene 
 medical advice must be taken at once. But we 
 decline to make soap and water or anything of that 
 kind the only or even main plank of our plat- 
 form, and for the reasons I have given. We are 
 deeply impressed with the danger of making any 
 announcement which may be misunderstood by 
 the public. 
 
 " Now we have evidence that already in the case 
 of women harm has been done by the letters which 
 the noble Lord's Society have sent to the Press. 
 Some women thought, not unnaturally, that dis- 
 infection was a cure for the disease, and used the 
 
 1 Soap may be a germicide. I do not know. At best, it must 
 be very feeble. Surgeons do not commonly use it as such. I 
 use it for its solvent action on grease. But, if it be a germicide, 
 why does the National Council make such a virtue of recom- 
 mending it instead of permanganate of potash ? The main 
 objection to soap and water is that, being bulky, they cannot be 
 carried, and that most infections are acquired after dark in the 
 open air. Most of the remainder are acquired in filthy back 
 bedrooms where the light of pure water never shines, and in 
 dwellings the inhabitants of which wash rarely and promiscuously 
 in the scullery. Soap and water are recommended by the 
 National Council for precisely the same reason that it recom- 
 mended Municipal Early Treatment Centres by way of 
 window-dressing.
 
 SOCIETY FOR THE PREVENTION 259 
 
 disinfectant with the result of delaying proper treat- 
 ment and jeopardising their ultimate cure. Colonel 
 Harrison, whom I agree in thinking is one of our 
 greatest authorities, and who may perhaps have 
 changed his opinion lately in consequence of larger 
 information obtained of late, has said publicly 
 that he has seen numbers of cases where soldiers 
 have treated themselves with these prophylactics, 
 allowing the disease to get a deeper and deeper hold 
 on them. 1 Sometimes the result was truly dis- 
 astrous, as when a man who suffered from syphilis 
 treated the sore with ointment, and his next event 
 was hopeless paraphlegia. I do beg my noble 
 friend and his colleagues to consider the grave 
 warning conveyed in those lines. Self-disinfection 
 is practically useless for women, and, further, it is 
 a well-known fact that syphilis can be conveyed 
 by other means, which the measures advocated by 
 the noble Lord's Society do not meet. 
 
 "I will not dwell on the moral aspects of this 
 matter, which are very difficult, and on which my 
 Council feels strongly, but I regret the tone of some 
 of the letters of the secretary of the noble Lord's 
 Society. He has accused us of being influenced by 
 ecclesiastical opinion because we say that the only 
 complete safeguard against disease is to lead a 
 moral life. 2 But that does not prevent us in the 
 least from recognising the many imperfections of 
 
 1 But surely this proves no more than that the soldiers were 
 extraordinarily badly instructed ? 
 
 2 Complete ! It is calculated that there are in any year about 
 1,000,000 innocent women and children suffering from venereal 
 disease in the United Kingdom.
 
 260 PREVENTION OF VENEREAL DISEASE 
 
 human nature, or from combating disease by all 
 the means which medical science has placed at our 
 disposal ; but we do consider that it is not only 
 contrary to moral law but positively dangerous to 
 hold out a promise of certain immunity for men only 
 by the use of these disinfecting packets. I hope 
 that I have succeeded in showing that this promise 
 is illusory, even when self -disinfection is practised 
 under most favourable circumstances. The more 
 sexual irregularity exists the more, most certainly, 
 must venereal disease increase, and the false idea 
 that men only can be made safe by these means 
 must lead to an increase of sexual immorality from 
 which in the long run women may suffer most, 
 morally and physically. 
 
 " There was a time, not very long ago, when many 
 people thought that the Contagious Diseases Act 
 was an absolute specific against the spread of 
 diseases. Where are those people now ? Between 
 1883, when the Contagious Diseases Acts were sus- 
 pended, and 1918, the incidence of disease of our 
 troops in the United Kingdom fell from 260 per 
 thousand to 50'9. That reduction of less than 
 one-fifth of the former incidence was brought 
 about by many causes, of which probably healthy 
 recreation, temperance, and good counsel were 
 amongst the most important. Now medical science 
 has given us more weapons in our hands, and we 
 must use them not always, but use them with 
 wise judgment. I hope that we shall never ignore 
 the moral aspect of this matter, or be induced to 
 place complete reliance on methods which experi- 
 ence shows may be failures, and it is for that
 
 SOCIETY FOR THE PREVENTION 261 
 
 reason that I regret the far too confident announce- 
 ments, as I think them, in the publications of the 
 noble Lord's Society. But I do cordially agree 
 with him in asking for any statistics which can be 
 given that are relevant to this matter, provided 
 that those statistics are very carefully examined, 
 because otherwise they would certainly lead to 
 misunderstandings . l 
 
 " I will only say one word in conclusion. Some 
 legislation is very much needed, and I think that 
 it is a great pity that the Joint Select Committee 
 over which my noble and learned friend Lord Muir 
 Mackenzie presided was stopped when the last 
 Parliament ended, and I hope that the noble 
 Viscount may say that the Government will con- 
 sider whether that Committee might not be set 
 up again, because there are certain questions in- 
 volving legislation which are very important and 
 very urgent. I believe that it was a thoroughly 
 competent body, and that it would have been able 
 to pronounce a decided opinion upon this matter. 
 
 " The LORD ARCHBISHOP OF CANTERBURY : My 
 Lords, I am very grateful to Lord Willoughby for 
 having called attention to-night to the Report in the 
 White Paper, on the existence of which his speech 
 was to some extent based. The noble Lord has 
 now, as on former occasions when he raised this 
 subject, handled what is admittedly a most un- 
 pleasant matter in its details, and one which is 
 controversial in more ways than one, with lucidity, 
 
 1 The reader and Lord Sydenham will find them examined 
 in the next chapter of the present book.
 
 262 PREVENTION OF VENEREAL DISEASE 
 
 with knowledge, and with force. He has neces- 
 sarily gone over the ground which he covered some 
 eight months ago, and he will not be surprised if I 
 propose for the same reason to repeat somewhat 
 what passed on that occasion. The arguments 
 which were then used do not seem to have changed 
 in their character, or to have had much force 
 added to them by what has passed since then. 
 Undoubtedly, however, fresh light has been thrown 
 upon the subject by what is known as Lord Astor's 
 Report. 
 
 " I note that the noble Lord did not say to-night 
 and I do not think on a former occasion that he 
 said anything himself to that effect that this 
 subject is a purely physical one, a purely medical 
 or surgical one, and that it has nothing practically, 
 as regards policy, to do with morals or ethics. 
 But the noble Lord has rested his arguments in 
 no small degree upon the statements of people who 
 have said that. One of them has said that it is 
 time the moralists and ethical people were treated 
 with scorn, and put on one side. He went on to 
 say that they should be allowed a free hand, and 
 that it should be recognised that the two things are 
 entirely different. I will quote these words : 
 
 * You will remember that the principles which 
 underlie the whole question of the suppression of 
 venereal disease are, first, the complete and ab- 
 solute separation of the moral from the medical 
 problem.' 
 
 I need not multiply quotations to that effect from 
 the lady upon whom the noble Lord relied con-
 
 SOCIETY FOR THE PREVENTION 263 
 
 siderably, or from some of the medical authorities 
 whom he quoted and who hold that opinion. But 
 he himself has not said that. Allegations of that 
 kind, however, continue to be made, and I have 
 tried more than once here, and constantly else- 
 where, to meet them. It seems to me that we are 
 in the same position on that matter as were those 
 who were discussing political economy questions 
 in the days of our boyhood. We were then con- 
 stantly told that whatever we did we must keep 
 out of political economy all questions except those 
 relating purely to the statistical side, and that 
 political economy had nothing to do with morals 
 or ethics. In short, you had to discuss it as some- 
 thing entirely apart from its practical application 
 to human conduct. I do not say for a moment 
 that the great masters of political economy, like 
 Adam Smith, said that the science had no practical 
 application to human conduct, but it was said by 
 political economists in that day. I do not think 
 there is any political economist who will take up 
 that standpoint to-day. Even those who dwell 
 most upon its scientific and statistical aspect 
 acknowledge now that the human nature side does 
 come into and affect the whole question. 
 
 " That is equally true indeed much more true 
 with regard to this particular question. The 
 purpose which we all have in view is the prevention 
 or the eradication of a horrid evil which is flagrant 
 in the midst of us, and it is when the methods come 
 to be discussed that the moral side has to come in. 
 I ventured to say on the former occasion, and I 
 apologise for repeating it, that the moral side cannot
 
 264 PREVENTION OF VENEREAL DISEASE 
 
 be kept out because you are dealing with human 
 beings. You have to behave in a totally different 
 way from the way in which you would behave if 
 you were dealing with animals. If you were dealing 
 with the cattle plague or with the dog plague of 
 rabies you might do so by killing the animal, but 
 in this you are dealing with human beings, and you 
 cannot deal with it in that way. It is not a purely 
 physical or medical matter. 
 
 " Lord Willoughby has to-night, as on former oc- 
 casions, urged, and with my complete concurrence, 
 that it is desirable that people should know and 
 realise the gravity of the evil and the necessity and, 
 if so be, the possibility of combating it effectively. 
 His eloquence on that point is not needed now. I 
 think that I am entirely in agreement with him on 
 that point. The cry has been raised that we want 
 concealment. I do not want concealment. I want 
 people to know everything that is to be known, 
 provided it is told in a proper way and told without 
 panic. I believe it is desirable that the fullest 
 possible knowledge should be extended on the 
 whole subject. Whatever may have been said or 
 thought a few years ago, it is quite certain that 
 since the publication of the Report of the Royal 
 Commission over which the noble Lord who has 
 just spoken presided, the policy which to some 
 extent perhaps existed before of complete silence 
 on the subject or of suppression, not exactly of the 
 facts but suppression of discussion respecting them, 
 is dead. Everybody must know that this subject 
 is before the world. We have to discuss it, whether 
 we like it or not, and we cannot from the daily
 
 SOCIETY FOR THE PREVENTION 265 
 
 Press or anywhere else fail to find that it is con- 
 stantly forward. 
 
 " But what I am anxious to make clear is that 
 those on whose behalf I speak if I am allowed to 
 speak on behalf of any group are quite as anxious 
 as those whom the noble Lord represents that the 
 whole facts should be known, and that no kind of 
 concealment of the deliberate sort, or of any other 
 kind that we can avoid, shall take place in the 
 matter. The noble Lord went so far as to say that 
 it was doubtful morality to suppress the truth. I 
 quite agree with him. I do not want to suppress 
 the truth, and I do not know who does. Nowa- 
 days I do not say it was ever so nobody does, 
 and I agree with him that it would be unwise, 
 possibly doubtful morality, to suppress it. More 
 than that, we are all in agreement in our desire to 
 prevent and combat this disease. They are really 
 unworthy taunts which are brought against those 
 who are represented by the noble Lord, Lord 
 Sydenham, by some of those upon whom the noble 
 Lord (Lord Willoughby de Broke) relied. Two of 
 them I can quote. An article by Sir Archdall 
 Reid said : 
 
 ' Doctors as well as the general public are divided 
 in opinion both as to whether it is right to prevent 
 venereal diseases, and also as to the best means of 
 doing so.' l 
 
 1 It is a pity the Archbishop did not quote the whole of the 
 passage. Here it is : " Recently a statement appeared in the 
 Press that ' it is the doctors themselves who have been too much 
 afraid of public opinion to expose themselves to censure ' by 
 describing in popular journals proper prophylactic methods
 
 266 PREVENTION OF VENEREAL DISEASE 
 
 Are doctors divided as to whether it is wise to pre- 
 vent venereal diseases ? Can we find a member of 
 the public that would take that view ? I do pro- 
 test against that kind of statement being made 
 by such high authorities. And it is made in even 
 blunter forms by some others to whom the noble 
 Lord refers. The lady whose name he gave, and 
 who has written voluminously on the subject, said : 
 
 ' A section of the so-called ' religious ' public 
 is so benighted ethically that they actually desire 
 to maintain venereal disease as a material hell into 
 which to drop all offenders against their moral 
 code.' 
 
 This kind of argument might be treated with abso- 
 lute contempt, if its author had not been quoted 
 to-night by the noble Lord as one upon whom 
 he desires to rely as a guide in what we are to do 
 
 against venereal disease. That statement is not correct. Many 
 doctors are anxious to discuss prophylaxis openly. They believe 
 that venereal disease may be greatly reduced, if not quite 
 abolished, by sanitary measures, and that it is so certainly right 
 to take these measures that public approval is sure to follow open 
 discussion. But it has never yet been possible to secure open 
 discussion. Editors, even editors of medical journals, are timid. 
 Among their readers are many who I think mainly because 
 there has been no adequate discussion are opposed not only to 
 prevention, but also to the indecency of people knowing the 
 truth. Consequently, doctors, as well as the general public, have 
 defective information, and are divided in opinion both as to 
 whether it is right to prevent venereal diseases, and also as to the 
 best means of doing so. Some would do nothing, some would 
 licence approved prostitutes, some would punish even private 
 immorality, some would inflict penalties for conveying infection, 
 some advise prophylactic packets, some have faith as a rule it 
 is a mere faith in this chemical, some in that, some in another.'
 
 SOCIETY FOR THE PREVENTION 267 
 
 in a subject of this kind. Nothing of the kind is 
 said now by anybody who is worthy of being lis- 
 tened to, and I hope we shall not hear any more 
 said as to its being necessary to meet an argument 
 like that as if it existed now the argument that 
 it is desirable to maintain diseases in order that 
 punishment should follow from an offence. There, 
 I think, we are all in agreement. 1 
 
 " The difficulty arises when the question comes as 
 to the reliance or non-reliance on the self -disinfec- 
 tion about which the noble Lord has spoken so well 
 and so clearly to-night. One school of thought in 
 this matter relies not infallibly but mainly on 
 personal disinfection, and desires to make universal 
 provision for it. The other distrusts self-disin- 
 fection, and urges that the proper course is to 
 advocate everywhere in addition to advocating 
 morality cleanliness on the part of any one, man 
 or woman, who has subjected himself or herself to 
 the possibility of infection, and then to obtain as 
 early as possible treatment by those who can really 
 give that treatment effectively. That is the 
 difference which divides people. And in the dis- 
 
 1 Oae day, I think late in 1918, I was summoned to an official 
 conference, which was called, I understood, at the instance of the 
 Archbishop of Canterbury. The subject of it was the " Specimen 
 Lecture " (see p. 346). A clergyman, who was his chaplain (or 
 some such official), produced a copy and said the Archbishop 
 considered that it had immoral tendencies and wished it with- 
 drawn. " I know that lecture," said I. " It appears to me 
 merely to deal with sanitation. How has it immoral tendencies ? ' ' 
 The clergyman answered : " The Archbishop thinks that in a 
 lecture on such a subject it ought, at least, to be plainly stated 
 that venereal disease is God's punishment for sin " " Vide 
 num h<xc sit restis filii tut."
 
 268 PREVENTION OF VENEREAL DISEASE 
 
 tinction thus drawn you can find on either side of 
 the line medical men of high authority. There is 
 no doubt whatever that there are medical men of 
 high authority who give support to the whole 
 contention which the noble Lord has brought 
 forward. We have testimony to that effect not by 
 Sir Archdall Reid only, but by many others as 
 well. 
 
 " What I want to point out, and to put your Lord- 
 ships on your guard against in studying this 
 subject, is that those who are giving you statistics 
 about what happened in regimental or barrack 
 treatment in this matter skate lightly over this as 
 if it were true with regard to the general public, and 
 by a kind of sleight of hand I do not think it was 
 intentional on the part of the noble Lord, but, if 
 it was intentional, it was exceedingly adroit 
 suddenly slip, as he did, from arguments and 
 statistics which he was bringing out as regards 
 barrack treatment under the careful supervision 
 of Sir Archdall Reid to the application of that to 
 the general public, of whom he speaks in the Notice 
 which he has given, and to the steps given to in- 
 struct the general public in the matter. That is 
 fraught with the greatest possible danger. Things 
 which may be true with regard to men under 
 discipline in barracks and elsewhere though I 
 distrust them there may be absolutely untrue 
 when you apply the same rule, or anything like the 
 same rule, with regard to the general public. I 
 distrust this system which is advocated. I distrust 
 it for the disciplined forces, for the men in barracks 
 or under military or naval discipline, but as regards
 
 SOCIETY FOR THE PREVENTION 269 
 
 the general public I not only distrust it but detest 
 and abhor it. I believe it to be something pre- 
 judicial in the highest possible degree to public 
 welfare and the public good. 
 
 "The noble Lord and those who act with him 
 used, as you would expect, careful, well chosen, and 
 guarded language, and the blunt and brutal form 
 in which the matter can express itself is not there, 
 or is covered up by statements which are not 
 susceptible of attack, because of the careful way 
 in which they are formulated. But while the noble 
 Lord and those who act with him avoided the 
 blunter statement, they do not, as far as I can see, 
 avoid what it ultimately conies to in fact. We 
 have the statements perfectly clearly, in plain 
 facts. The lady whom the noble Lord referred to 
 to-night says quite plainly (and this is a lady whom 
 he has relied upon to-night for evidence) that every 
 boy and girl in our parishes must be provided free 
 with the outfit which will make them secure, and 
 when you have done that all will be right " Go 
 with clean people and you will be clean." That is 
 the kind of treatment of this subject, and I did not 
 expect to hear the author quoted to us to-night. 
 But if she is to be quoted, let us understand what it 
 means when it comes down to the plain English 
 in which it will be used and understood up and 
 down the country. The words which the noble 
 Lord quoted the kind of general words about early 
 disinfection and self-disinfection couched in that 
 kind of language may not mean very much to very 
 many of the public, but when you have it all in 
 the form in which I have put it, quoted from this
 
 270 PREVENTION OF VENEREAL DISEASE 
 
 lady, we see what it means that we are being led to 
 support, if we follow the line along which the noble 
 Lord desires us to go. 
 
 " The noble Lord has quoted the authority of the 
 Medical Officer of Health for one of our great 
 boroughs as showing what is to be said in favour 
 of the self-disinfecting process which he described. 
 There are others not less entitled to weight, one 
 or two of whom, after what he has said, I think 
 I may be entitled to quote. The Medical Officer 
 of Health for Birmingham says : 
 
 ' In the first place, I am convinced that the only 
 true prevention for civilians is sexual morality. 
 The alternative which is suggested, of teaching 
 the use of and supplying prophylactic outfits, will 
 more surely destroy the family life of this nation 
 than any other method you could advocate. To 
 destroy the family is to destroy the nation. It 
 was to similar methods that the glory of ancient 
 Rome owed its eclipse.' 1 
 
 I do not like repeating what was said on a former 
 occasion, but the noble Lord rather tempts me 
 that way as he has gone over again ground that he 
 
 1 1 seem to remember a historian named Gibbon who concluded 
 " that the glory of ancient Rome owed its eclipse " to the 
 stupidity resulting from a mental training which was exclu- 
 sively founded on bias. Here is another quotation from the 
 same medical officer made at a meeting of the local branch of the 
 National Council, "the adoption of prophylaxis would mean the 
 disruption of the family life of the country." It appears that in 
 Birmingham they or some of them believe that the families 
 of the country are held together by fear of venereal disease. I 
 am sure this cannot be true of all the husbands and wives of 
 Birmingham.
 
 SOCIETY FOR THE PREVENTION 271 
 
 traversed before ; therefore I do not think it is 
 inappropriate to read what was said, which has 
 never been withdrawn, by the high medical and 
 military and naval authorities who dealt with this 
 whole question with regard to the American troops 
 when they were in this country. Colonel Snow, 
 of the United States Army, said : 
 
 * In considering this matter in relation to the 
 civil population, it seems to me, both from my 
 experience in the army and as a public health 
 officer, that any measure which produces self- 
 diagnosis and self -treatment, such as the * pro- 
 phylactic packet,' will militate against the early 
 discovery and treatment of infected persons. In 
 so far as the ' packet ' has a bearing on the moral 
 question, its official promulgation seems to me 
 to favour increased sexual promiscuity.' * 
 
 I bring that forward because the noble Lord has, 
 fairly and rightly, brought forward at any rate 
 medical evidence of a weighty kind. There is a 
 well-known passage, that I almost shrink from 
 quoting again, which the American Navy Secretary 
 continued to circulate during the war as regards 
 his views of the suggestions which have been put 
 forward to-night. He said : 
 
 ' The use of the packet I believe to be immoral ; 
 it savours of the panderer ; and it is wicked to 
 
 1 A fitting comment on Colonel Snow's statement is another 
 statement by a distinguished American Army medical officer 
 that since the arrival of the American Army in France the 
 vaginae of the French women have become test-tubes for the cul- 
 tivation of American germs. Wives and children in the United 
 States are now reaping that harvest.
 
 272 PREVENTION OF VENEREAL DISEASE 
 
 seem to encourage and approve placing in the hands 
 of the men an appliance which will lead them to 
 think they may indulge in practices which are not 
 sanctioned by morality, military or civil law, with 
 impunity, and the use of which would tend to 
 subvert and destroy the very foundations of our 
 moral and Christian beliefs and teachings with 
 regard to these sexual matters.' l 
 
 These are strong words, and I do not necessarily 
 want to adopt them in their entirety, because I 
 can imagine that something might be brought 
 forward to qualify some of the evidence. 
 
 " It would be sheer impertinence on my part to 
 try and express a personal opinion on the medical 
 and surgical aspect of this question, but at the 
 same time I do not profess to be entirely ignorant 
 about it. I have not only read about it, but I 
 have spent trying hours in the hospitals seeing the 
 actual processes so that I might be thoroughly 
 conversant with what is happening. I am glad 
 that such emphasis was laid by my noble friend on 
 the weight attaching to what is said and done in 
 this matter by the man to whom I believe we owe 
 more in this respect than to any one else Colonel 
 
 1 A fitting comment on the moral outburst of the American 
 Navy Secretary the weighty critic of the British Navy 
 is that, in the six months ending 2jth December 1918, the 
 venereal rate of all troops in the United States was 150-62 
 per 1000 per annum, and 189-89 for troops in cantonments. 
 When American troops first landed in France some of the units 
 developed a venereal rate of 104 per 100 per annum ; which 
 means that practically all the men acquired disease, and some 
 acquired it twice. Since the introduction of prophylaxis, the 
 rate has fallen to 40 per 1000 per annum.
 
 SOCIETY FOR THE PREVENTION 273 
 
 Harrison. He has been to the fore in the whole 
 of this matter ; he has worked at it, he has written 
 and spoken about it, he has taught people on the 
 subject, and to him, and to the careful and pains- 
 taking effort he has made to grapple with this 
 subject, we owe more than words can say. Colonel 
 Harrison is a prominent member of the Executive 
 Committee of the Society for Combating Venereal 
 Disease, the Society which the noble Lord is 
 opposing to-night. Colonel Harrison, with in- 
 creasing certainty I think, is expressing himself in 
 regard to this matter. 
 
 " I do not know the date of the quotations used 
 by the noble Lord, but a few months ago Colonel 
 Harrison was a prominent member of the great 
 Congress held at Newcastle where this, among 
 other subjects, was discussed. There he said that 
 he was opposed to the methods of prophylaxis by 
 means of disinfectants for the use of the individual 
 so far as they applied to the civil community. His 
 reason was that the results would not justify the 
 price to be paid. As for the results, it would be 
 conceded by every one that such methods would 
 have a better chance of success in the Army, where 
 men would be taught almost individually, and 
 supervision generally must be closer than amongst 
 civilians. Yet so far no general diminution of 
 venereal incidence had occurred in the Army. The 
 admission rate for all troops in the United Kingdom 
 during the war had been approximately 38 per 
 thousand per annum. It was the same to-day as 
 it was before the introduction of prophylactic 
 packets. The rate for English, Scottish, and Irish 
 18
 
 274 PREVENTION OF VENEREAL DISEASE 
 
 troops was considerably lower than for Colonial 
 troops, in spite of the fact that the prophylactic 
 methods under discussion had been far less energeti- 
 cally pursued in the Imperial troops than among the 
 Colonial. Probably the most energetic in this 
 respect had been the Australians, but their infection 
 rate for troops in the United Kingdom was consider- 
 ably higher at the end than at the beginning, when 
 it had been 130 per 1000 per annum. Those are 
 the words of the Medical and Military authority to 
 whom the noble Lord has specially referred and on 
 whose authority he laid such stress. I think they 
 are of first-rate importance when we are discussing 
 the question of the difference between the two 
 schools. 1 
 
 1 The lowest rate for British troops (in 1913) was 50-9 per 1000 
 per annum. The reduction from 275-4^1885 was due to the use 
 of prophylactics and increasing cleanliness (see pp. 199-200). There 
 is every reason to believe that there was a considerable rise in the 
 rate in the first years of the war (1914-1 5). Hence, presumably, 
 the suppression of the statistics for those years by the Inter- 
 Departmental Committee ; hence the introduction of the venereal 
 ablution rooms ; hence the Army Council's praise of the doctor 
 who reduced the rate among his men to 58-38 ; hence the fall of 
 the rate to 36 in 1916. This fall was not due to preaching, but to 
 the introduction of self -disinfection even if delayed disinfection. 
 The rate for the Dominion troops was higher merely because 
 the men were on the average much younger, because they were 
 to a far greater extent unmarried, and because they had no 
 homes to go to when on leave. So far from being " most ener- 
 getic " in applying prophylaxis, the Australians were shamefully 
 slack. For instance, the instruction of the men, when given at 
 all, was left to orderlies. There was constant opposition from 
 the preachers and their followers. " Nevertheless, the Canadians 
 pressed on with prophylaxis, and reduced their rate of infection 
 in the United Kingdom from 222 per 1000 in 1915 to 81 per 1000 
 in 1918 ; the Australians reduced theirs from 167 per 1000 in 
 September 1917 to 132 per 1000 in September 1918 for the United
 
 SOCIETY FOR THE PREVENTION 275 
 
 " In that same speech Colonel Harrison points 
 out the peril which would arise, from the use of 
 the procedure which has been recommended to- 
 
 Kingdom, although here the Australian system was inadequately 
 applied ; and the Australian figures for France for the same 
 months were reduced from 101 down to 55 per 1000, Paris in- 
 fections being almost completely eliminated. But as a New 
 Zealander, it is the figures for the New Zealand Division which 
 I wish particularly to emphasise this afternoon. At the end of 
 1917, without prophylaxis, we had always about 1000 men out 
 of action with venereal infection, approximately 2 per cent., 
 and no matter what we did we could not reduce this number. 
 Then in desperation we adopted the system of a free issue of 
 prophylactic packets, which system was fairly well applied in 
 France, but poorly applied in the United Kingdom. Neverthe- 
 less, our combined rate for France and the United Kingdom was 
 reduced from 2 per cent, constantly sick in 1917, down to less 
 than i per cent, in 1918. At the end of 1918, instead of having 
 over looo New Zealand soldiers out of action with venereal 
 disease, the number was approximately only 400, and this at 
 a time when we were short of prophylactic supplies, and even 
 temporarily without them, and when among all the Allied 
 troops venereal disease had to be classified as a self-inflicted 
 disease. Men, driven insane by the ordeal of battle, bought 
 and sold tubercle sputum and gonorrhoeal discharge, and de- 
 liberately infected themselves for the purpose of securing evacua- 
 tion from the firing-line to the Base Hospitals, and when such 
 men became diseased, they were quoted as evidence of the failure 
 of prophylaxis. Similarly, when men were threatened with being 
 sent home to New Zealand if they contracted venereal disease, 
 they simply said, ' That'll do me. I'll be out of the trenches 
 anyhow for a while.' On the London streets women who were 
 diseased charged a higher price for sexual relationship with 
 soldiers than did women who were not diseased. . . . Now 
 note the difference in 1919. At the end of 1918 venereal disease 
 was lower in the New Zealand Division than it had ever been 
 before, but we had a virulent outbreak of political and ecclesi- 
 astical opposition, largely engineered by English people. Our 
 Prophylactic Lecturer was demobilised ; outfits were not given 
 to many men going on leave ; the Prime Minister of New Zealand 
 pledged himself to abolish the outfit altogether ; and the result
 
 276 PREVENTION OF VENEREAL DISEASE 
 
 night, as to the evasion of the Venereal Diseases 
 Acts. Those Acts are intended to prevent the 
 provision by quacks, or unskilled, or otherwise 
 inappropriate people, of rough and ready remedies 
 for venereal disease. Infinite mischief has come 
 from that which these Acts try to prevent. 
 Colonel Harrison points out in the next place that 
 it is undoubtedly true that the public will use for 
 curative purposes in that case what were not 
 meant for curative purposes, but what were issued 
 for preventive purposes. It would be impossible 
 to get people to distinguish between the two. 1 He 
 further says : 
 
 of this combined attack by the forces of ignorance and pre- 
 judice was that our venereal diseases rate steadily rose until it 
 was well over 2 per cent., and it went on rising till the venereal 
 diseases hospital was crowded out ; we had nearly 1000 sufferers 
 from these dreadful maladies at the very time we were most 
 anxious to get our men home clean, and when the actual number 
 of New Zealand men abroad was some 20,000 less than it had been 
 in 1918. These are the real facts, but they have, in London, 
 been wilfully distorted in an attempt to prove that the issue and 
 recommendation of prophylactics increases disease. I ask you 
 to listen to the words of the New Zealand Y.M.C.A. in a circular 
 issued to New Zealand soldiers going on leave : ' It would appear 
 that by issuing these things (prophylactic packets) the military 
 authorities advise illicit sexual relationship as necessary to the 
 health and the retention of manhood's functions. Such is not 
 the case. On the contrary, the military authorities used and 
 still use every moral force in advocating continence. The ex- 
 treme step of issuing preventives has been taken because of the 
 alarming spread of venereal disease.' " (Miss Rout Speech at 
 the Mansion House, 5th February 1920.) 
 
 1 There is not an iota of evidence as to all this. Colonel 
 Harrison was merely imagining bogeys. There is no more 
 likelihood of instructed people using antiseptics as curative agents 
 than there is danger of patients swallowing the lotions and oint- 
 ments which doctors prescribe for other diseases. If men can 
 be taught that the boiling of water is a preventive, not a cute
 
 SOCIETY FOR THE PREVENTION 277 
 
 ' The greatest factor in the reduction of venereal 
 disease in the Army had been improvements in 
 social conditions and encouragement of games ; 
 and the reduction was effected without recourse 
 to any direct means of prophylaxis. The best 
 hope of salvation now lies in the promptest possible 
 treatment of venereal disease after its commence- 
 ment.' l 
 
 I have troubled your Lordships with those quota- 
 tions because Colonel Harrison is the gentleman on 
 whom the noble Lord to a large extent relies, and 
 it is most important that the words of one who is 
 such an expert, and to whom we all look for guid- 
 ance, should be brought forward and dwelt upon 
 on such an occasion as this. 
 
 for typhoid, surely they can be taught that sponging with an 
 antiseptic is a preventive not a cure for venereal disease ? Even 
 in the Army, where the instruction was so much neglected, it 
 must have been extraordinarily rare for men to try to cure them- 
 selves with the materials from the ablution rooms. In plain 
 words, I do not believe it ever happened. I never heard of a 
 case ; but, if any did occur, they furnish evidence only of bad 
 teaching. It must be borne in mind that the Army authorities, 
 in deference to the National Council, committed the insincerity 
 of calling these measures for prevention " early treatment " just 
 as the National Council called its proposed municipal establish- 
 ments for disinfection " Early Treatment Centres." If men, 
 deceived by this misuse of language, use disinfectants for the 
 treatment of actual disease, the authorities, not the men, are to 
 blame. 
 
 1 Colonel Harrison, having left the Army and gone to the 
 Ministry of Health, has every opportunity of proving his words. 
 On the other hand, the Town Councils of Portsmouth and several 
 other boroughs have rejected the National Council's scheme of 
 Early Treatment Centres, and adopted the plan of advising 
 civilians to disinfect quickly. The lists are set. We shall soon 
 see which is the better method.
 
 278 PREVENTION OF VENEREAL DISEASE 
 
 "The whole of that is summed up in Lord Astor's 
 Report, which is given as the basis of the noble 
 Lord's discussion and Motion to-night. I entirely 
 agree with the desire that found expression that 
 we should be furnished with the names of those who 
 were Lord Astor's colleagues, and I hope that the 
 noble Viscount when he speaks will be able to fur- 
 nish us with the names of the medical authorities 
 who, with Lord Astor, agreed in putting forward 
 that Report. What the Report says is of the 
 greatest possible importance, and I do not apologise 
 for quoting a few sentences from it because the 
 whole point of to-night's debate is involved. The 
 Report says : 
 
 4 The Committee desire me to point out that in 
 their view many of those who wish the Government 
 to utilise in peace time for the civil population 
 methods which have been tried among the Forces 
 in war have not sufficiently appreciated the funda- 
 mental differences between the two groups, or 
 between the conditions of war and peace ; nor 
 have they been aware of the comparative failure 
 of packets even in a disciplined force.' * 
 
 That is after taking all this evidence. Again : 
 
 ' The civil authorities cannot command or 
 control the general population, men and women, 
 as officers can properly and legitimately control 
 enlisted men.' 2 
 
 Then a little later : 
 
 * That the issue of prophylactic packets tends to 
 1 See p. 371. 2 See p. 371.
 
 SOCIETY FOR THE PREVENTION 279 
 
 give rise to a false sense of security, and thus to 
 encourage the taking of risks which would not be 
 otherwise incurred, and the neglect of facilities for 
 early treatment when available ; and, in certain 
 circumstances, might even increase the spread of 
 disease.' 1 
 
 Then: 
 
 ' That the most carefully organised packet 
 system, such as exists now in the Army (a system 
 which would be unattainable in the civil community) 
 has not produced such a general reduction in the 
 incidence of venereal disease as to counteract the 
 disadvantages mentioned in these conclusions. 2 . . . 
 The Committee set out to examine the evidence 
 placed before them from the scientific and the 
 medical point of view, and it is strictly in this 
 spirit that they desire to record it as their opinion 
 that the irreplaceable effect of the moral factor 
 has been too frequently neglected or forgotten.' 3 
 
 That is the result of the Committee's deliberations 
 on the evidence taken before them. The Com- 
 mittee was appointed by His Majesty's Govern- 
 ment to look into this matter, and these quotations 
 really conclude what I have to say. But the gen- 
 eral issue is one of very great importance. I am 
 quite sure that we underrate the danger of arming 
 men with supposed securities of course, no one 
 says absolute against venereal disease, and arming 
 them beforehand ; and, still greater is the danger, 
 if you make the same applicable, as has been sug- 
 1 See p. 372 2 See p. 373. See p. 374.
 
 280 PREVENTION OF VENEREAL DISEASE 
 
 gested by the noble Lord, to young women. It is 
 a quasi-encouragement of the gravest kind. 
 
 " I do not want to rest that assertion upon opinions 
 which come perhaps from a source which would be 
 distrusted as coming from those whose special 
 business it is to deal with ethical and moral ques- 
 tions. I much prefer to rest it on those whose 
 primary duty is medical and surgical. Therefore 
 I should like to quote from one of the foremost 
 doctors dealing with this matter, Sir Malcolm 
 Morris : 
 
 ' If you provide a man with an outfit and assure 
 him that it is a reliable safeguard against infection, 
 do you not so far encourage him to the indulgence 
 in which the outfit will come into play ? You may 
 accompany the outfit with an exhortation to 
 practise continence. That is well. But which is 
 the more likely to influence him, your words or 
 your act ? Do you not, by providing him with this 
 safeguard, release him from the prudential restraint 
 which might otherwise be effective ? ... It is a 
 question of ethics. But it is much besides. It is a 
 question of the effect that will be produced upon 
 the mind of the man whom you prevail upon to 
 accept the outfit and carry it about in his pocket 
 ready for use at any moment. I submit that the 
 mere possession of that outfit will tend to lessen 
 his powers of resistance. He will not have had it 
 in his pocket long before he will come to feel that 
 he is a fool unless he indulges himself and brings 
 it into use. No difference between prophylactics 
 and early preventive treatment ! There is the
 
 SOCIETY FOR THE PREVENTION 281 
 
 difference between making it easy and not making 
 it easy for a man to yield to temptation.' 
 
 These are the words of a great medical authority 
 who has given peculiar attention to the subject. 
 He is an authority not only on the technical side, 
 but also upon its bearings with regard to the general 
 conduct and character of a man's life. 1 I think the 
 more closely this is looked into, and the more it is 
 studied in the writings of those who have dealt 
 with the matter in the largest way, the more will 
 the conviction come to those who study it that we 
 are liable to underrate the moral effect of action 
 which is supposed to make less the risk which at 
 present exists. I do not admit that you do 
 make them much less, but if you have to con- 
 sider against that the greater number of persons 
 whom you will induce to run the risk it is obvious 
 that while a limited number of people are led to 
 imagine that they are protected against the evil, 
 at the same time a larger number of people are en- 
 couraged to subject themselves to the danger 
 you are defeating the very object you have in view. 
 " If any one will refer to what has been said in 
 the admirable work of Abraham Flexner in his 
 History of Prostitution, and look at the statistics 
 
 1 1 dare say that Sir Malcolm Morris is all that the Archbishop 
 of Canterbury describes. I know nothing about him ; and there- 
 fore shall not be misunderstood if here I utter a protest. No 
 sooner does a medical man Medical Officer of Health, veneri- 
 ologist, or preacher declare himself " on the side of the angels," 
 than he becomes a great authority even when his professional 
 brethren consider him so biased by antecedent prejudice or 
 self-interest that they would not accept an uncorroborated 
 word from him.
 
 from Copenhagen, Vienna, and Berlin, and see how 
 he works them out and shows by actual charts 
 and diagrams the way in which the extent of the 
 moral wrong-doing varied with the increase of 
 supposed facilities for the protection of the wrong- 
 doer, he will be struck by finding how the man who 
 produced this book with no other object than that 
 of science, is led to the conclusion which I believe 
 to be the right and true conclusion. 
 
 " We have before us two different groups, to 
 which the noble Lord has referred several times 
 the Society for Preventing Venereal Disease and the 
 National Council for Combating Venereal Disease. 
 Quotations have been made as if the medical 
 authorities were chiefly on one side, but remember 
 that the Society which argues against the personal 
 disinfection process and against the issue of packets, 
 and in favour of the other process I am speaking 
 of the civil population and not of the technically 
 military question, on which I have expressed my 
 opinion before, but which concerns me less than that 
 with regard to the general population remember 
 that the medical men on that side include the 
 President of the Royal College of Physicians and 
 the President of the Royal College of Surgeons, 
 and such leading medical men as Sir Thomas 
 Barlow, a former President, Col. Harrison, Sir 
 Arthur Pearce Gould, and many more who could 
 be named. 
 
 "It is trifling to say that medical opinion is on one 
 side. It is not for me to try to balance the long 
 list on one side against the list on the other, but I 
 have given the names of great medical authorities
 
 SOCIETY FOR THE PREVENTION 283 
 
 to show that we do not speak lightly when we say 
 that we quote medical authority on the side I 
 recommend. I very earnestly hope that no coun- 
 tenance will be given by any action on the part of 
 this House to the recommendations to which I 
 have referred, given in guarded terms by the noble 
 Lord and in less guarded and perhaps therefore 
 a more useful form by those who advocate them in 
 a blunt and full way that free access should be 
 given to everybody to obtain for nothing that 
 which is supposed to protect them from the evil 
 which is there. There is a right and a wrong way 
 of dealing with the matter. The National Council 
 seeks for the support of His Majesty's Government 
 and hopes to hear to-night that that support is 
 being more strongly given. I hope that we are 
 going to adopt the right and not the wrong way. 
 
 " The EARL OF CLAN WILLIAM : My Lords, my only 
 excuse for intervening in this debate is the fact 
 that during the war I had a certain amount of 
 practical experience in preventing the spread of 
 this disease. Before I say more, I would say to 
 the noble Lord, Lord Willoughby de Broke, that I 
 should like to support him in his request for Papers. 
 I believe that anything that can be either said or 
 done to prevent the spread of this appalling disease 
 is worthy of the very serious consideration of the 
 Government, and anything that can be done to 
 secure that end should be done. 
 
 " During the war I was attached to a Division, 
 and it was one of my duties to collect evidence of 
 cases of this disease and take what steps I could to
 
 284 PREVENTION OF VENEREAL DISEASE 
 
 prevent the disease spreading. As soon as a man 
 was infected he was sent to me for interrogation, 
 and afterwards, accompanied by my French and 
 English representatives, was sent to identify the 
 woman. He then returned to me, was handed over 
 to the medical authorities, and went to hospital 
 to be treated and cured. The same thing happened 
 to the woman. She was taken in charge by the 
 French authorities and sent to hospital. In a 
 very short time this reduced the number of cases 
 of disease in that Division. As I was there for a 
 considerable period, I was able to take stock of the 
 measures taken to prevent a spread of the disease, 
 and I found there was no question but what this 
 method was extremely effective. We found con- 
 siderable difficulty in the cases of houses licensed 
 by the Government, and there, although the women 
 were supposed to be medically examined at frequent 
 intervals, owing to certain reasons identification 
 was not practicable. For that reason I would 
 never advocate the existence of such houses in this 
 country. 
 
 " One other matter is worthy of note in this debate. 
 The greatest difficulty I, or any one in my position, 
 had to contend with was the case of a man who had 
 been at home on leave. The man went home, and 
 some of them, not all of them, came back infected, 
 and it was absolutely impossible to carry out any 
 identification. They returned to France or Bel- 
 gium on leave, and it was some time before the 
 medical authorities knew that they were infected. 
 During all that time they were going about spread- 
 ing the disease. I do not wish to say anything
 
 SOCIETY FOR THE PREVENTION 285 
 
 more about that. Your Lordships will see the 
 moral of it. It was our greatest difficulty and one 
 we could not contend against. I have seen such a 
 lot of this appalling disease that anything which 
 can be done to prevent it will receive my hearty 
 support. I shall support the Motion of the noble 
 Lord. 
 
 "EARL RUSSELL : My Lords, the noble Lord who 
 introduced this discussion deserves the thanks of 
 the House for the manner in which he dealt with it. 
 We all recognise his most earnest desire to deal 
 with this subject and to do what is possible to 
 combat it. I am in great sympathy with him, and 
 perhaps he will therefore forgive me if I criticise 
 just a little some of the things he said. The noble 
 Lord advocated as the measure beyond all measures, 
 superior to all, the one which should be made known 
 to the public generally as the thing for dealing with 
 venereal disease early self -disinfection. In his 
 Question on the Paper he asks the Ministry of 
 Health what steps they are taking to instruct the 
 public in the proper application of immediate self- 
 disinfection at the time of exposure to infection. 
 It seemed to me his enthusiasm was a little like 
 that of people who think they have suddenly dis- 
 covered a specific which has never been heard of 
 before and which can be relied upon to remove 
 all the evils if it is adopted. 
 
 " In a matter of this kind considerable caution is 
 required before you can be sure you really have a 
 specific and certain remedy. I gathered from the 
 criticisms of Lord Sydenham that, although medi-
 
 286 PREVENTION OF VENEREAL DISEASE 
 
 cal opinion admits apparently that immediate self- 
 disinfection, properly applied, is almost practically 
 a certain preventive, there is still a very great 
 difference of opinion as to whether in the case of 
 the ordinary public there is a reasonable chance 
 that it will be properly applied so as to be effec- 
 tive. It is obvious these are medical questions 
 which must be settled by experience, statistics, and 
 doctors, and upon which your Lordships cannot 
 express an opinion. 1 
 
 "If these questions are still in dispute, as is per- 
 fectly obvious they are, and if there is a great deal 
 of doubt about it, is it wise and safe to recommend 
 to the public this method as being perfectly certain 
 and perfectly safe ? Are you not really running 
 very considerable risk ? Lord Sydenham uttered 
 a word of caution which I should like to endorse. 
 The noble Lord read one of the advertisements and 
 notices to the public which said : " This is the only 
 way to safety." That does seem to me to be 
 rather a dangerous statement to put forward to the 
 
 1 With all deference, I think Earl Russell is mistaken. Ven- 
 ereal diseases are microbic and contagious ; as a rule the 
 microbes attack only a particular part of the body, and only at 
 a particular time ; delicate, and at first all on the surface of the 
 body, they are especially susceptible to the action of antiseptics ; 
 venereal diseases have been easily prevented under what should 
 be difficult circumstances big cities, prolonged periods, and 
 large bodies of men by various doctors, who used very simple 
 means. These are the medical facts. They are not disputed. 
 The rest is all a matter of common sense. The things in dispute 
 are whether it is right or wrong to teach immediate disinfection, 
 and whether Englishmen are, or are not, too stupid to learn to 
 disinfect a few inches of skin. Medical men have no monopoly 
 of common sense and knowledge of human nature.
 
 SOCIETY FOR THE PREVENTION 287 
 
 ordinary ignorant layman, and one which is likely 
 to lead him into a sense of false security. It is 
 probable that that which is merely a disinfectant 
 may also be used as a curative treatment. I 
 think caution is perhaps a little required in a matter 
 of this sort, and a more considerable measure of 
 medical agreement than we have at the moment 
 before you give official advice to the whole com- 
 munity. 
 
 "The most rev. Primate dealt with a question 
 which is of obvious importance ; the effect of this 
 sort of thing on the morals of the community, and 
 he read a sentence, which rather surprised me, 
 from the report of a lady doctor which in terms 
 said that these things were to be taught to every 
 boy and girl. You would have in effect a licence 
 for prostitution, almost an invitation to promis- 
 cuous intercourse. That of course from the moral 
 point of view is not in the least desirable, and you 
 are faced there, and the most rev. Primate himself 
 is, I am sure, prepared to face the position fairly, 
 with the difficulty which is always apt to arise in 
 matters of this sort. You have a widespread 
 scourge which you know is enormously widespread ; 
 you know that the populace as a whole is not con- 
 tinent, and that this disease is rampant, and you 
 always have the difficulty of drawing the line as 
 between telling as many people as is necessary and 
 telling too many. If you are really to be effective 
 you must tell the innocent. If you tell those who 
 are already infected, you are rather too late. 
 
 "On the whole I think we have come to the con- 
 clusion, and the most rev. Primate seems to support
 
 288 PREVENTION OF VENEREAL DISEASE 
 
 the view, that perfect frankness and openness and 
 instruction in these matters is better than conceal- 
 ment, but that instruction ought to be under some 
 safeguard, and certainly ought not to be given unless 
 you are sure it is the right instruction, and that you 
 are making no mistake in giving it. Less indeed 
 than the most rev. Primate himself can I profess 
 to know of the medical questions involved, but it 
 seems to me a matter which is for experts to decide. 
 It has undoubtedly two branches. One, purely 
 scientific and medical, and the other a question of 
 morals. The question of what is the proper or 
 best treatment does not enter into the question of 
 morals. You must first ascertain what is the proper 
 treatment, and the application of that knowledge 
 is not involved in questions of morals, on which we 
 can all have different opinions. I am entirely 
 inclined to support the noble Lord's campaign, but 
 I think it wants caution in its administration. 
 
 " Lord MUIR MACKENZIE : My Lords, I rise only 
 because, as has been already mentioned, I was 
 Chairman of the Joint Committee of both Houses 
 which dealt, now a year ago, with the Sexual 
 Offences Bill and the Criminal Law Amendment 
 Bill introduced into this House. I do not desire to 
 give any opinion upon the merits or otherwise of 
 the prophylaxis which is recommended by the 
 noble Lord who opened this debate. I am not 
 competent to give any opinion upon the subject, 
 and it did not come before the Joint Committee in 
 any way, and therefore I have had no opportunity 
 of dealing with that side of the subject. I only
 
 SOCIETY FOR THE PREVENTION 289 
 
 wish to say this. I cannot at present get over my 
 own feeling of repugnance towards the sort of 
 presumption that fornication is to take place, 
 which seems to be involved in presenting people 
 with these packets ; nor can I get over the repug- 
 nance which I feel towards the idea that everybody, 
 even the youngest, is to have instruction and sug- 
 gestion in this direction. It was not to deal with 
 that subject that I got up. It was that I think 
 this is a fair opportunity for asking the Govern- 
 ment, or the representative of the Ministry of Health 
 in this House, whether all the labours of that Joint 
 Committee, which worked for a long time and with 
 great assiduity, at the end of last session, are to be 
 thrown away or whether the Ministry of Health 
 propose to take any action upon this subject. 
 
 "Viscount SANDHURST: My Lords, with regard to 
 the last sentence which fell from my noble and 
 learned friend, of course he will readily understand 
 that I am not in a position to give information one 
 way or the other as to the future course in regard to 
 that Committee, which was set up in reference to 
 two particular Bills. I will, however, mention the 
 matter to the Minister of Health, and probably 
 take an opportunity of informing my noble and 
 learned friend privately. 
 
 "I should like to join with others who have once 
 again remarked in what a fitting manner my noble 
 friend Lord Willoughby de Broke introduced this 
 subject. We all recognise my noble friend's single- 
 ness of purpose, and his enthusiasm in pressing 
 the cause which he thinks may be so useful to 
 19
 
 290 PREVENTION OF VENEREAL DISEASE 
 
 his fellow-countrymen. It makes me regret all the 
 more that I do not see eye to eye with him. I was 
 also very glad to hear of the experience of the noble 
 and gallant Lord who has served his country so well 
 in France. This debate, of course, bears a very 
 close family resemblance to the debate which we 
 had in April, and I shall, you will be glad to hear, 
 not have to detain you very long at this hour, be- 
 cause really the speech of the most rev. Primate 
 was of such a character that I think I might almost 
 have left the question in his hands although, of 
 course, my noble friend will expect me to say some- 
 thing on behalf of the Government. 
 
 " It was suggested by my noble friend on the cross 
 benches, and also by the most rev. Primate, that 
 it might be for the convenience of the House and 
 of the public if they knew the names of the Com- 
 mittee who sat under the Chairmanship of Lord 
 Astor. Noble Lords will understand that there is 
 no mystery about it. I shall be very glad to give 
 the names, and to give them at once, to the most 
 rev. Primate and to the House. I may remind 
 your Lordships that this Committee, as I think 
 has already been stated in this House and in the 
 Commons, was a Departmental Committee ap- 
 pointed by the Minister of Health to inquire at the 
 time of demobilisation into a number of parasitical 
 and infectious diseases, such as malaria and ven- 
 ereal disease, and to take evidence from expert 
 and other witnesses and to report. The case of 
 both sides in this controversy was fully represented 
 before the Committee, and perhaps noble Lords 
 would like to hear tfre reference to. the Committee.
 
 SOCIETY FOR THE PREVENTION 291 
 
 It was ' To consider the possible risks of introduc- 
 tion of infectious and parasitical conditions into the 
 country in the course of demobilisation from the 
 various fronts, and to make recommendations for 
 the purpose of securing close and effective co- 
 operation in administrative measures for dealing 
 with these conditions on the naval and military 
 (including the Air Service) and the civil side.' 
 
 The members of the Committee were Viscount 
 Astor, Chairman ; Major W. C. Smales, D.S.O., 
 M.R.C.S. (War Office) ; Colonel L. W. Harrison, 
 D.S.O., K.P.H., M.B. (War Office); Surgeon- 
 Captain D. J. M'Nabb, C.B., R.N., M.R.C.S. 
 (Admiralty) ; Lieut.-Colonel H. F. Home, R.A.F., 
 M.D. (Air Force); Dr. G. S. Buchanan, C.B., 
 M.D. (Ministry of Health) ; Dr. F. J. H. Coutts, 
 M.D. (Ministry of Health) ; Colonel A. L. A. Webb, 
 C.M.G., C.B., M.R.C.S. (Ministry of Pensions); 
 Mr. J. Smith Whitaker, M.R.C.S. (Insurance) ; and 
 Sir Leslie Mackenzie, M.D., LL.D. (Local Govern- 
 ment Board for Scotland). 
 
 "I should like to mention once more the name of 
 Colonel Harrison, who has been referred to in the 
 course of this debate. The noble Lord quoted 
 from a lecture which was given by him, and which 
 was also referred to by the most rev. Primate. 
 Colonel Harrison advised in favour of the self- 
 disinfection system in October 1918, 1 judging from 
 
 1 If Colonel Harrison advised in favour of self -disinfection in 
 October 1918, he was much belated, for the venereal ablution 
 rooms had already been established for two and a half years. 
 I think Lord Sandhurst refers to the packets which were forced 
 on the Army in 1918. The sequence of events was as follows : 
 1916, venereal ablution rooms j 1917, quick disinfection secretly
 
 292 PREVENTION OF VENEREAL DISEASE 
 
 the figures which he had then been given of the 
 results of skilled disinfection in the American 
 Navy, and from some Australian statements, but 
 at a later date he had an opportunity of seeing and 
 watching the figures of our Army, showing the rates 
 of the disease after the disinfection policy had been 
 for some time disseminated and to an increasing 
 degree in operation. It was his discovery that such 
 large numbers of soldiers still caught the disease, 
 in spite of the prevalence of the new system, 
 which caused Colonel Harrison to realise that the 
 efficacy of self-disinfection was much lower than 
 he had expected in October 1918 it would be, and 
 made him realise that for the civil population it 
 would be still less efficacious, and that such good 
 as might be gained would involve other things 
 whose disadvantage would far outweigh the good. 
 " In dealing with this subject so soon after it was 
 
 practised ; 1918 (winter), quick disinfection accepted by auth- 
 orities ; 1918 (spring), Government resolve to supply packets; 
 1918 (summer), distribution of packets with instructions that 
 they were to be used not as packets, but with delay ; 1918 
 (later), appointment of sanitary inspectors who saw to the care 
 of the packets, but not to the instruction of the men ; 1919, 
 selected evidence tendered to the Inter-Departmental Committee 
 from an army which had not used packets as packets, by way of 
 proof that packets used as packets were useless ; 1919 (later), 
 perpetual citation of this evidence by the National Council, the 
 Archbishop of Canterbury, and the like ; 1919 (still later), 
 Colonel Harrison, .whose opinions had undergone a singular 
 change (in the sense that no one else, I believe, has changed in 
 the same direction), leaves the Army and joins the National 
 Council and the Ministry of Health, in which he has an important 
 post; 1919 (December), the Lords debate and the production 
 by Lord Sandhurst, speaking for the Ministry of Health, of figures 
 relating to the Portsmouth Area like in kind and quality to 
 those supplied to the Inter-Departmental Committee.
 
 SOCIETY FOR THE PREVENTION 293 
 
 dealt with in April, it seems almost impossible to 
 avoid appearing to repeat one or two of the things 
 which I said on that occasion, but I shall do so as 
 little as possible. I would, however, point out 
 that this cleansing is, of course, only one item in a 
 propaganda which has been put forward by a 
 society which has been subsidised for that purpose. 
 The other items in the propaganda have already 
 been referred to, and I do not think that I need 
 refer to them again. In regard to some of the figures 
 to which my noble friend refers and I hope to 
 be able to meet him by giving the Papers and 
 figures he requires it has been frankly asserted 
 by such gentlemen as Sir Archdall Reid that if 
 only the civil population were instructed to use 
 proper disinfecting drugs such as permanganate of 
 potassium immediately after exposure to infection, 
 and if outfits for this purpose were made generally 
 available, the risk of venereal disease would be 
 avoided, and that if this policy were made general 
 by the Government the disease would before long 
 disappear. But careful investigation has con- 
 clusively shown that even amongst the military, 
 where disciplinary arrangements can be resorted 
 to and instruction can definitely be given, there 
 are found amongst soldiers in venereal disease 
 hospitals substantial numbers of men who state 
 categorically that they used permanganate of 
 potassium within a few minutes after exposure. 
 It is thus clear that even in circumstances specially 
 favourable to instruction and to the method pro- 
 posed, the risk of venereal disease is by no means 
 certainly avoided ; for even in those conditions a
 
 certain number of cases occur. How much more 
 then would this be the case, and how far removed 
 should we still be from secured immunity, with the 
 civil population, in respect of whom the arrange- 
 ments as to instruction and discipline adopted for 
 the military would obviously be quite impossible ? 
 
 "As to the Portsmouth position, which was, I 
 think, specially mentioned by my noble friend, the 
 information received as to the number of soldiers 
 admitted to hospital for venereal disease per 
 thousand of the total military strength in the 
 United Kingdom and in the Portsmouth military 
 area, respectively, shows that the incidence of 
 venereal disease amongst the military in the Ports- 
 mouth area from 1912 to 1914 was approximately 
 one and a half times greater than that amongst the 
 military throughout the United Kingdom. In the 
 years from 1916 to 1918, the rates for the Ports- 
 mouth area were approximately twice those of the 
 United Kingdom ; and in the current year, 1919, 
 the rate in the Portsmouth area has been two and 
 a half times that of the United Kingdom. I 
 believe that I am right in saying that in the years 
 1918 and 1919 the policy advocated by Sir Archdall 
 Reid was at its height in that area. 
 
 "In regard to the statements by Colonel Harrison, 
 it is admitted that skilled disinfection very shortly 
 after intercourse will usually prevent venereal 
 disease, but inquiries at military hospitals show 
 that is by no means the case when the disinfectant 
 is applied by the man himself, and this even 
 when he has been in a military unit under military 
 discipline, and has been furnished with the usual
 
 SOCIETY FOR THE PREVENTION 295 
 
 lectures and posters together with personal in- 
 struction. Thus in the venereal hospitals where 
 this matter had been carefully investigated 7-3 
 per cent, of the patients stated that they had 
 swabbed themselves with permanganate of potas- 
 sium solution within ten minutes after exposure. 
 A further 36 per cent, had similarly, that is within 
 ten minutes, used calomel ointment, and a further 
 1-5 per cent, had used both calomel and perman- 
 ganate. Thus, in these two hospitals there were 
 12-4 per cent, of the venereal patients who stated 
 that they had disinfected themselves with the 
 drugs advised within ten minutes after exposure. 
 In another military hospital 11-2 per cent, of the 
 patients stated that they had themselves used 
 permanganate, or calomel, or both, within five 
 minutes after exposure. 1 
 
 " It may be noted that these inquiries show a 
 further and different point namely, that the clear 
 instructions of the medical officers on early treat- 
 ment had in a large proportion of the cases either 
 not been observed at all or had been followed in the 
 most diverse ways. From this it is seen that, to 
 be effective, instruction must be given much more 
 clearly and insistently than has yet been accom- 
 plished in the Army, even by thelectures, posters, and 
 personal instructions given freely in many units. 
 
 " It has been suggested that instruction in that 
 degree of detail and thoroughness should be given 
 to the civil population. I venture to say that in- 
 struction in that degree of detail in regard to the 
 civil population is a practical impossibility. As to 
 1 See pp. 214-19, 317-20, 424-36.
 
 296 PREVENTION OF VENEREAL DISEASE 
 
 what can be recommended by the Minister of Health 
 I may say this. Bearing in mind that if the 
 Ministry recommended any specific disinfectant, 
 it would be necessary to issue formal advice as to 
 its use, and that this advice, and also a regular 
 supply of the particular drug, would have to be 
 made available through the usual channels with 
 all the risk of misuse and of creating a false sense 
 of security the Minister is not prepared in the 
 present position of the evidence to authorise a re- 
 commendation of any drug for these purposes. 
 He would, however, be prepared to sanction the 
 issue of advice in some such form as the follow- 
 ing : * Those who have exposed themselves to infec- 
 tion are hereby advised that they have incurred 
 grave risk of venereal disease. Persons who have 
 incurred such risk of infection will certainly dim- 
 inish that risk, to some extent at least, by effec- 
 tively cleansing themselves immediately. They are 
 further advised to watch carefully for several weeks 
 for the first signs of disease, and to seek medical 
 advice at a clinic or elsewhere immediately such 
 signs appear.' 
 
 " I believe that what I am about to say has been 
 referred to already, but perhaps your Lordships 
 will pardon me if I repeat what has been well said. 
 It has been said that there is this danger, that the 
 preventive might be used in place of a curative, and 
 that if a preventive is used it might tend, as I think 
 was pointed out from the cross benches, to drive 
 the disease deeper and deeper into the system. 
 The use of these things by self-application might 
 tend to prevent men from seeking proper treatment,
 
 and by the use of them the impression would 
 prevail, as the right reverend Primate pointed out, 
 that risks might be taken with impunity, thereby 
 increasing promiscuity. On these grounds the 
 Minister, seeing the doubtful results in the case of 
 men under discipline, did not think it right to go 
 further than I stated a moment ago, and I am 
 bound to say that, having read a great deal about 
 this matter officially and otherwise, especially in 
 regard to the use and misuse of disinfectants owing 
 to carelessness and want of knowledge on the part 
 of individuals, the Minister has put himself in an im- 
 pregnable position in not going further than he has. 
 "My noble friend moved for certain Papers. The 
 Papers he moves for are those giving information 
 as to the early incidence of venereal disease in the 
 Portsmouth area as compared with the rest of 
 England, Colonel Keble's Report, and the Hilsea 
 Hospital records. I understand that the War 
 Office has no official reports from Colonel Keble, 
 but in regard to the figures, and the Hospital 
 records that my noble friend desires, I shall be 
 able to place on the Table the Memorandum with 
 those figures, and they will also have side by side 
 with them the necessary statistical explanations, 
 without which in either direction such figures might 
 be misleading. I hope I have been able to give the 
 information desired, though the debate developed 
 in such a way that speeches were made which 
 really answered the questions on my behalf. 
 
 " Lord RANKSBOROUGH : My Lords, I am much 
 disappointed that there has been nothing in this
 
 298 PREVENTION OF VENEREAL DISEASE 
 
 important debate on the subject of notification. 
 It has all been prophylactics and things of that 
 sort, and it seems to me that we are at the wrong 
 end of the problem. I was three years at Cam- 
 bridge, and I have spent my life among soldiers, 
 and my experience is that the chief agent for keep- 
 ing a man clean has been the fear of consequences. 
 Of course, there are many men who rise above that 
 level, but it has been the athlete's and the sports- 
 man's fear of the consequences that has been the 
 chief motive. We should not diminish that fear. 
 I think we should endeavour to increase it and if 
 possible to make it into a terror. The only way to 
 do that is by publicity, that is, the notification to 
 some public body, in the same way as is done with 
 other contagious diseases. 
 
 " I am aware of the arguments against it the 
 stigma, and the difficulty with doctors, and the 
 danger of driving it underground. But it has been 
 underground ever since I can remember, and the 
 question is Do we intend to kill this invisible 
 demon ? If we do we shall not succeed by stroking 
 its back in the dark. By all means have the best 
 advice as to precautions for those who may require 
 it, but let them be under no delusion as to what 
 will happen if these gruesome safeguards fail. I 
 am convinced that if we are going to tackle this 
 scourge and destroy it we can only do it by the 
 daylight of notification. 
 
 " Lord WILLOUGHBY DE BROKE : My Lords, my 
 friends and I have thought a great deal about this 
 question of notification, and I have given some
 
 SOCIETY FOR THE PREVENTION 299 
 
 attention to it myself. It is too late to go into the 
 whole subject of notification to-night. There are 
 very serious pitfalls about notification, and I should 
 say that you are much more likely to be able to 
 insist on notification of venereal disease after you 
 have provided the means of preventing it. When 
 you have found out whether somebody has or has 
 not used the means of prevention, then I should 
 think that the State would be in a much stronger 
 position with regard to notification. But in the 
 present state of public opinion my view is that 
 anything like public notification would not stand 
 a chance of being carried in this country, and the 
 most we could hope for at present would be some 
 form of anonymous notification. But it is, 
 nevertheless, a very important aspect of the pre- 
 vention of venereal disease, and we are not losing 
 sight of it. I shall take what the noble Viscount 
 said as equivalent to accepting my Motion for 
 Papers. 
 
 " Viscount SANDHURST : I said I would give my 
 noble friend the Papers and figures, except Colonel 
 Keble's Report, which we have not got. 
 
 "Lord WILLOUGHBY DE BROKE: Therefore I shall 
 not put the House to the trouble of a Division. 
 But I think it is unfortunate that we have not 
 proceeded further in combating venereal disease 
 than a promise from the Minister of Health of a 
 certain amount of soap and water. We do not 
 seem to have made very great strides in any direc- 
 tion, and the noble Viscount in his courteous and
 
 300 PREVENTION OF VENEREAL DISEASE 
 
 well -considered reply did not say much about these 
 early treatment centres. Has that been abandoned 
 as part of the policy of disinfection, or what has 
 happened to it ? Some stress during this debate 
 has been laid on ablution rooms where it is properly 
 carried out by a skilful attendant. Are we to 
 understand that the policy of the Government now 
 with regard to disinfection of any kind before the 
 symptoms have declared themselves is merely soap 
 and water ? I do not quite follow the Govern- 
 ment policy about this. The most rev. Primate, 
 who was extremely kind to me in his reply, as he 
 always is, was rather annoyed at me for quoting 
 Miss Ettie Rout, and he gave me to understand 
 that she was not the kind of witness that I ought 
 to bring forward on my side. In answer to that I 
 should like to remind him that I have only quoted 
 facts, and did not quote anybody's opinion except 
 Colonel Harrison's. I regret that since April last 
 when we brought forward this matter the Govern- 
 ment have taken no further steps to deal with this 
 question. Still, this is going to occupy a consider- 
 able portion of public controversy, and I dare say 
 we shall hear a good deal more about it. 
 Motion, by leave, withdrawn." 
 
 The Times, IGth December 1919. 
 
 VENEREAL DISEASE. 
 
 To the Editor of The Times 
 
 SIR, In the discussion on venereal disease which 
 occurred in the House of Lords on the 10th instant,
 
 SOCIETY FOR THE PREVENTION 301 
 
 Lord Sandhurst, replying to Lord Willoughby de 
 Broke, declared that " with regard to the prevalence 
 of the disease among the military in the Portsmouth 
 area, statistics showed that in 1914 the cases were 
 one and a half times as many as in any other military 
 district in the United Kingdom. From 1916 to 
 1918 the number of cases were approximately twice 
 as many, and this year they were two and a half 
 times as many in the Portsmouth area as in any 
 other district in the country." Owing, doubt- 
 less, to a misunderstanding, Lord Sandhurst's state- 
 ment is enormously inaccurate ; for, fortunately, 
 full materials for a more accurate statement are 
 available. 
 
 Lord Willoughby de Broke, I understand, 
 desired to ascertain in what proportion troops 
 dwelling in a certain definite area, under the medi- 
 cal care of a certain medical authority, acquired 
 venereal disease, as compared to troops in other 
 areas. The troops in another area were infected, 
 I believe, at the rate of something approaching 
 100 per 1000 per annum. It follows that Lord 
 Sandhurst, if he understood Lord Willoughby de 
 Broke, maintained that the troops resident in the 
 Portsmouth area and in charge of the authority 
 I have mentioned, were infected at the rate of at 
 least 250 per 1000 per annum. This estimate is 
 wildly wrong. It will be found on investigation 
 that, for 1919 at any rate, it is at least ten times 
 too large. Probably Lord Sandhurst has included 
 in his estimate not only the disease contracted by 
 the men dwelling in the area under the charge of 
 the authority I have mentioned, but also disease
 
 302 PREVENTION OF VENEREAL DISEASE 
 
 occurring among men not under that authority 
 (e.g. Colonial troops) as well as imported disease 
 that is, disease occurring among men arriving on 
 draft from other areas and contracted in those other 
 areas, and also disease brought by troops from 
 overseas. I am, Sir, yours faithfully, 
 
 G. ARCHDALL REID. 
 SOUTHSEA, 13th December. 
 
 17th December 1919. 
 To the Editor of The Times 
 
 SIR, In the interests of accuracy, may I ask you 
 to find space for the following in your columns ? 
 Sir Archdall Reid, in a letter in your issue of to-day, 
 purports to quote verbatim (for he uses inverted 
 commas) from a speech of mine in the House of 
 Lords last Thursday, a passage on which he founds 
 an assertion that my " statement is enormously 
 inaccurate." The whole of his argument is based 
 on words quite different from anything that I 
 said, and wholly falls to the ground when my 
 actual words are read. The relevant words in 
 my speech were, as you will see from the Hansard 
 of 10th December, page 877: 
 
 " The incidence of V.D. amongst the military 
 in the Portsmouth area from 1912 to 1914 was 
 approximately one and a half times greater than 
 that amongst the military throughout the United 
 Kingdom." 
 
 Sir Archdall Reid quotes me with inverted 
 commas as having said : " One and a half times as 
 many as in any other military district in the United 
 Kingdom."
 
 SOCIETY FOR THE PREVENTION 303 
 
 Similarly, I said in my next sentence : " In the 
 current year 1919 the rate in the Portsmouth area 
 has been two and a half times that of the United 
 Kingdom." Sir Archdall Reid quotes me, in in- 
 verted commas, as having said : " Two and a half 
 times as many in the Portsmouth area as in any 
 other district in the country." 
 
 It will thus be seen that the whole of the rest of 
 Sir ArchdalPs letter, his whole accusation of in- 
 accuracy, falls to the ground, when what I actually 
 said is taken, instead of what he erroneously 
 attributes to me, I may perhaps add that I took 
 no steps to see any proof of the Hansard Report 
 before it was printed. I am, yours faithfully, 
 
 SANDHURST. 
 
 LORD CHAMBERLAIN'S OFFICE, 
 16th December. 
 
 19th December 1919. 
 
 To the Editor of The Times 
 
 SIR, I am sorry if I misquoted Lord Sandhurst. 
 I copied from the fullest newspaper report available. 
 Nevertheless, I cannot conceive how my argument 
 " falls wholly to the ground." Lord Sandhurst 
 was reported to have said that the incidence of 
 venereal disease was two and a half times greater 
 among the military in the Portsmouth area than 
 in any other area in the United Kingdom. It 
 appears he said it was two and a half times greater 
 than throughout the kingdom. Actually, I be- 
 lieve, the Portsmouth district is the model area for 
 the wfyple country j J think I know the SQUrce of
 
 304 PREVENTION OF VENEREAL DISEASE 
 
 the figures on which he relied. They are the off- 
 spring of immoral statistics just such statistics as 
 those published in that " Note on Prophylaxis 
 against Venereal Disease," which was recently 
 presented to the Minister of Health as a testimonial 
 to the National Council for Combating Venereal 
 Disease, but which have since raised such heavy 
 trouble for that unhappy body. If Lord Sandhurst 
 still thinks his reply to Lord Willoughby de Broke 
 was correct, it is easy for him to establish his 
 position. As I said, full materials are available. 
 I am, Sir, yours faithfully, 
 
 G. ARCHDALL REID. 
 
 SOUTHSEA, 17th December. 
 
 Srd January 1920. 
 
 To the Editor of The Times- 
 Sin, In view of Lord Sandhurst's recent state- 
 ment in the House of Lords, and subsequent cor- 
 respondence in your columns, I think it only fair 
 to the borough of Portsmouth to send you the 
 following statistics : (a) of the number of men who 
 served under my command at Portsmouth during 
 the first nine months of 1917 ; (6) of the number who 
 contracted venereal disease in Portsmouth during 
 that period : 
 
 (a) Number of men, 8750 (approximate). 
 
 (b) Number contracting disease, 5. 
 
 I quote the statistics from memory. I held the 
 command until 27th September 1917. I am, Sir, 
 yours truly, GEORGE ASTON. 
 
 SALISBURY.
 
 SOCIETY FOR THE PREVENTION 305 
 
 Sir George Aston's letter ended the correspond- 
 ence in The Times. The following, which is an 
 extract from a letter from me which appeared in 
 The British Medical Journal of 24th January 1920, 
 also elicited no reply. 
 
 *' Lord Willoughby de Broke, desiring to ascer- 
 tain the effects of quick disinfection, asked for in- 
 formation concerning the Portsmouth area, where 
 it had been widely practised. Of course, he re- 
 ferred only to troops resident in the area, and in 
 charge of the Assistant-Director of Medical Services 
 at Portsmouth. His question was plain enough, 
 and was thoroughly understood, if not by Lord 
 Sandhurst, yet by the person who supplied his 
 figures. In 1919 there came into the area from 
 elsewhere in the United Kingdom drafts who, 
 relatively few in number, brought about twice as 
 much disease as that contracted by the resident 
 soldiers that is, disease which developed in a few 
 days after, and was admittedly contracted before 
 arrival. Into it, also, came tremendously infected 
 units from abroad. In it, also, were large numbers 
 of Colonial, American, and R.A.F. troops with 
 which the A.D.M.S. had nothing to do, and who 
 were suffering severely. Lord Sandhurst ingeni- 
 ously combining all this infection, announced that 
 the disease in the Portsmouth area was two and 
 a half times greater than that for the rest of the 
 kingdom. The average army rate is about 40 
 per 1000 per annum. Therefore the rate for the 
 Portsmouth area should have been 100. But 
 consider the weakness and incompetency of the 
 army administration which permitted without 
 
 20
 
 306 PREVENTION OF VENEREAL DISEASE 
 
 protest and without remedy this shocking state 
 of affairs. Suppose the disease had been typhoid. 
 Lord Sandhurst has been taxed with the mani- 
 pulation of the figures I have indicated, and 
 has not denied the soft impeachment. But Mr. 
 Turner and Dr. May quote him, and talk of an 
 actuary. After all, I think the actuary is really 
 necessary. 
 
 " But consider the case if Lord Sandhurst's 
 figures were true. They would then be even more 
 deadly. Portsmouth is the only large town in 
 the area. The venereal rate, therefore, should be 
 about 150 per 1000 per annum. Yet a little 
 careful instruction given to some six or seven 
 thousand men has reduced this huge figure to 
 next to nothing among them."
 
 CHAPTER XVII 
 
 LORD SANDHURST'S APOLOGETICS 
 
 WHILE this book is passing through the Press 
 there has appeared a " Statement made by 
 the Ministry of Health, with concurrence of the 
 War Office, relative to the Incidence of Venereal 
 Disease amongst Soldiers in the Portsmouth Area 
 and the Rest of the Country." 1 This "White 
 Paper," like its predecessor, the Report of the 
 Inter-Departmental Committee, deserves careful 
 study. It is compiled as a reply to my letters to 
 The Times and The British Medical Journal, and 
 admits that Lord Sandhurst was very wrong. " On 
 this revised basis the figure of 163 ... is found 
 certainly to be too high, as the measurement of the 
 incidence amongst the troops normally within the 
 stations named or the Portsmouth area as a whole ; 
 very much too high. On this changed basis the 
 figure [should be 54-4." . . . An explanation of 
 the origin of the differences between this and the 
 figure arrived at last December will be found in 
 the Addendum below." * 
 
 Probably no more remarkable " explanation " 
 than that found in this Statement was ever offered. 
 Portsmouth, which with Gosport forms a compact 
 
 1 See Appendix VI. pp. 413-36. * See p. 430. 
 
 307
 
 urban whole, is one thing ; the Portsmouth 
 military " Area " is another thing. I believe there 
 are alterations now, but in my time the military 
 Area included all Dorsetshire, and Hampshire, with 
 the exception of Southampton, Netley, and that 
 portion of Hampshire which was under the Alder- 
 shot Command. So also the " City " is one thing, 
 and the Area which we call " London," and which 
 we so describe on our letters, is quite another thing. 
 Lord Willoughby de Broke asked for information 
 concerning the " Area." It is as if he had asked 
 for information concerning " London," as dis- 
 tinguished from the " City." The former includes 
 the latter. 
 
 Now, when I wrote my letters, I knew certain 
 things about the Portsmouth Area : (a) that quick 
 disinfection had been widely practised throughout 
 it ; (b) that since this practice had begun venereal 
 disease had fallen very low among the resident 
 and instructed military population, but that much 
 disease had been imported with drafts joining the 
 resident troops, and by men (often whole units) 
 coming from overseas ; (c) that within the area a 
 careful count had been kept distinguishing disease 
 occurring among the resident military population 
 from that imported by military immigrants and 
 contracted elsewhere ; and (d) that within the area 
 were large bodies of R.F.C., Colonial, and American 
 troops, none of whom were under the officer in 
 medical charge of the Portsmouth Area, or had been 
 properly instructed to disinfect themselves, and 
 all of whom had a very high incidence of disease. 
 I knew also that during a time when men were
 
 LORD SANDHURST'S APOLOGETICS 309 
 
 perfunctorily questioned at the Hilsea Venereal 
 Diseases Hospital, which serves the area, many of 
 them declared that they had disinfected themselves 
 at once, but that afterwards, when they were care- 
 fully questioned by responsible medical officers, 
 not one sufferer during five months was found to 
 have so disinfected, though in order to avoid blame 
 they often began their answers by declaring that 
 they had disinfected themselves immediately. 
 
 The foregoing was the extent of the " local 
 knowledge " which the Statement mentions as pos- 
 sessed by me. When I read Lord Sandhurst's reply 
 to Lord Willoughby de Broke I knew that he was 
 preposterously wrong ; but I did not know how he 
 had gone wrong. After some puzzling, I guessed 
 that he must have included in his estimate the 
 disease brought in by drafts and troops from 
 overseas, and probably also that occurring among 
 the R.F.C., Colonial, and American troops. As 
 may be seen from the Statement issued by the 
 Ministry of Health, I was right. 1 But the official 
 who supplied Lord Sandhurst with his figures did 
 more. He took the military population of the 
 urban area of Portsmouth, and related to it not 
 only the disease occurring in that town, but also a 
 good deal of the disease occurring elsewhere in the 
 military Area. z It was exactly as if he had been 
 asked to give the incidence of disease in " London," 
 and had replied by relating to the population of 
 the " City," not only the disease in all London, but 
 also the disease brought into the Port of London 
 from infected countries abroad. Thus he reached 
 1 See pp. 419-21. See pp. 421-22.
 
 the conclusion that the incidence of venereal dis- 
 ease in the Portsmouth Area was 163 per thousand 
 per annum, and therefore two and a half times 
 larger than that in the rest of the United Kingdom. 
 Thus did Lord Sandhurst seek (doubtless himself 
 deceived) to lead his audience to believe that I was 
 a most unreliable person. 
 
 The Statement, " on this changed basis of 
 calculation," reduces the figures for Portsmouth 
 town from 163 to 54-4, and for the Portsmouth 
 Area from 163 to 47-3 a very material difference. 1 
 The changed basis means that the disease occurring 
 in Portsmouth town is now related to the military 
 population in Portsmouth town, and the disease 
 occurring in the Portsmouth Area is now related to 
 the military population of that Area. That is to 
 say, we now get a true account, as far as it goes. 
 Moreover, the disease occurring among the R.F.C., 
 Colonials, and Americans in the Area, none of whom 
 were in Portsmouth town, is now excluded. But 
 the disease imported with drafts and units from 
 abroad is not excluded. Were it excluded the 
 figures would be far lower than 54-4 and 47-3. But 
 more of this anon. 
 
 It is only right to say that when the Statement 
 was compiled, it is probable that the writer was 
 unaware that records had been kept which dis- 
 tinguished between the disease occurring among 
 the military population resident in the Portsmouth 
 Area from the disease brought in by drafts and units 
 from overseas. These records were not ordered by 
 the War Office, and therefore were not sent to it. 
 1 See p. 423.
 
 LORD SANDHURST'S APOLOGETICS 311 
 
 They were compiled for the information of the 
 local military authorities, who desired to ascertain 
 the effect of instructing men to disinfect themselves 
 quickly. But, about the time the Statement was 
 issued, I wrote to the authorities in London telling 
 them that the information was available. They 
 know all about it now. 
 
 Examine now Table I. in the Statement. 1 " The 
 rates per thousand for the United Kingdom in 
 the left-hand column include, of course, the cases 
 counted in the right-hand column." Had the 
 cases counted in the right-hand column not been 
 included in the left-hand column, the difference 
 between the two columns would have been greater 
 (though not perhaps much greater) ; for, as it is, 
 the inclusion of the Portsmouth cases has raised 
 the general rate (as expressed in the left-hand 
 column) somewhat. As may be seen from this 
 Table, Portsmouth was disgraced before the war by 
 a very high incidence of venereal disease nearly 
 twice as high as that for the rest of the kingdom. 
 At that time British troops were not protected any- 
 where by disinfection, except such as the men may 
 have employed on their own initiative. There 
 can be no doubt that Portsmouth has always been 
 a very bad station for venereal disease. The Navy 
 has always so reckoned it. For some mysterious 
 reason the returns for 1915 are " not complete." 
 War has always been found to increase the incidence 
 of venereal disease, and therefore we find by refer- 
 ence to the right-hand column that the venereal 
 rate for 1914 (during which war began) rose to 
 1 See p. 419.
 
 312 PREVENTION OF VENEREAL DISEASE 
 
 51-3. In Portsmouth, where it had been 92, 
 it fell, however, to 80, the probable explanation 
 being that a large proportion of the military 
 population was now composed of men locally 
 recruited who spent their leisure, when off duty, 
 in their own homes. The general rate for 1916 
 was 37, and that for 1917 was 38. These low rates 
 mark the establishment of venereal ablution rooms, 
 and constitute a new record for both war and peace. 
 The considerable rise in the general rate to 43 
 in 1918 marks the beginning of the return of in- 
 fected troops from the war, the influence of which 
 is still more clearly shown by the rise in the rate 
 to 64 in 1919. It does not, however, mark the 
 full rise, for beyond doubt many men when de- 
 mobilised were suffering from undetected disease. 
 In 1916 the venereal rate in the town of Ports- 
 mouth was 91, and in 1917 it was 92, being now 
 almost thrice as high as for the rest of the country, 
 It coincides with the departure of the local troops 
 and the incoming of strangers. It would have 
 been higher, but for the establishment of the 
 venereal ablution rooms. In 1918 there is a drop 
 to 78, which marks the beginnings of quick disin- 
 fection. Up to now the figures are probably 
 accurate. In 1919 the huge rate of 163 is reached. 
 But this only indicates the ingenuity of Lord Sand- 
 hurst's statistician. The real figure, as may be seen 
 from Table II., 1 should be 54-4. So now, for the 
 first time in its long history, the great garrison, sea- 
 port, and dockyard town of Portsmouth has a rate 
 lower, much lower, than the rest of the kingdom. 
 1 See p. 423^
 
 LORD SANDHURST'S APOLOGETICS 313 
 
 Judged by its history, and by that of the rest of the 
 country, its rate ought to have been at least the 
 163 which Lord Sandhurst wished us to accept. 
 How shall we account for this tremendous fall, 
 which occurs just when the rates for the whole 
 kingdom are nearly doubled ? Is any explanation 
 conceivable other than that it marks the spread of 
 quick disinfection, the employment of which became 
 general during this year among the troops in the 
 town ? How shall we account for the fall of the 
 rate to 47'3 in the Portsmouth Area, where just 
 precisely at the same time instruction in quick 
 disinfection became general ? Is any explanation 
 conceivable other than that here we have the 
 effects of quick disinfection ? 
 
 Lord Sandhurst's ingenious statistician attempts 
 another explanation. 1 He supposes that the figure 
 64 for the whole country is higher than the figure 
 54-4 for Portsmouth town, and 47-3 for the Ports- 
 mouth Area for two reasons : (a) because the 
 figure 64 is unduly raised by the inclusion of disease 
 among Colonial troops ; and (b) because it is unduly 
 raised by disease brought in by troops from over- 
 seas, " amongst whom the incidence rate of V.D. 
 was very high in 1919." a 
 
 (a) The Colonial troops cannot have greatly 
 
 1 See pp. 420-21. 
 
 * In 1919, shocked by the immense prevalence of disease among 
 the troops returning from the Continent, I communicated with 
 Sir Thomas Bramsdon, M.P. In answer to him, the Minister 
 for War stated in the House of Commons that there was no 
 unusual prevalence of venereal disease among the troops on the 
 Continent. I presume we have here again the work of the in- 
 genious statistician.
 
 314 PREVENTION OF VENEREAL DISEASE 
 
 contributed to raise the venereal rate for all troops 
 to 64 per thousand per annum. Compared with 
 the immense British Army, they were present in 
 inconsiderable numbers within the United King- 
 dom. Certainly they cannot have been the cause 
 of the rise of the venereal rate from 37 in 1916 and 
 38 in 1917 to 64 in 1919 ; for they were present in 
 all three years. That rise, which began in 1918 
 with the figure 43, and which reached 64 in 1919, 
 was due to a new factor, the return of troops, who, 
 having passed, on the conclusion of the armistice, 
 from the trenches into villages and towns in France, 
 Belgium, and Germany, had become immensely 
 infected. 
 
 (b) It is difficult to characterise in adequate terms 
 the statement : " A further reduction must also be 
 made in the figure 64 in respect of V.D. cases 
 imported by troops returning to England from 
 Flanders, Germany, and the East, amongst whom 
 the incidence of V.D. was very high in 1919 ; these 
 troops entered the country through ports other 
 than those in the Portsmouth Area, and cases of 
 V.D. detected amongst them, after arrival, must 
 have swelled the United Kingdom rate consider- 
 ably without materially affecting the Portsmouth 
 rate." * The troops from overseas were landed, 
 mainly, in the South of England. Almost 
 the whole weight of the introduced disease fell, 
 therefore, on the southern counties. It is true 
 that there is no port in the Portsmouth Area 
 at which the overseas troops landed in any num- 
 bers. But Southampton, the principal port of all, 
 
 1 See p. 421,
 
 LORD SANDHURST'S APOLOGETICS 315 
 
 is a mere enclave in that area. It was congested. 
 Troops landed in it were hurried away as soon as 
 possible ; all of them passed through the Area ; 
 and very many of them stayed in it for days, 
 or weeks, or months. Only when the great camps 
 and barracks in the Area overflowed, did the troops 
 pass elsewhere. All this must have been known to 
 the writer of the Statement, who, quite as in the 
 Report of the Inter-Departmental Committee and 
 in Lord Sandhurst's speech, argues not from the 
 facts within his own knowledge, but from the 
 ignorance which he supposes exists within the minds 
 of his readers. Portsmouth town, a railway ter- 
 minus situated in an island, is away from the main 
 stream of traffic ; yet during the period of 1919 
 under consideration the overseas troops flowed 
 in a continuous stream into its barracks, where 
 much of the disease contracted by them shortly 
 before leaving the Continent developed. I have 
 already told how I found in one day among a 
 party of 200 of them thrice as many cases as I 
 had found during twenty-eight months among 
 instructed troops whose numbers averaged 2000. 1 
 I received many similar parties, though none 
 quite so much infected ; and it was the experi- 
 ence of Portsmouth which caused Sir Thomas 
 Bramsdon to ask his question in the House of 
 Commons. I myself wrote to the authorities 
 insisting that all this mass of disease was easily 
 preventable, and offering, if given adequate powers, 
 to go to the Continent and return an almost clean 
 bill of health within three months. My offer to go 
 
 1 See p. 133.
 
 was accepted, but adequate powers were refused, 
 on the ground that authority to grant them was 
 lacking. After my past experience, it would have 
 been folly to go under such conditions. 
 
 Probably the Portsmouth Area intercepted as 
 much, or more, disease introduced from overseas 
 than any other area in the kingdom. Yet its 
 venereal disease rate during 1919 was only 47-3, 
 while that of the rest of the country, including 
 Ireland, Scotland, and the northern counties of 
 England which the troops from overseas can have 
 reached only after much of their disease had been 
 eliminated, was 64. 
 
 The Statement continues : " Taking these various 
 considerations together, the outcome of these further 
 investigations would seem certainly to show that 
 whilst, on the one hand, Sir Archdall Reid is right 
 in asserting that the incidence rate of the Ports- 
 mouth Area certainly was not two and a half, nor 
 one and a half, times that of the United Kingdom (as 
 the uncorrected basis of the December figures had 
 caused it to appear on 10th December), on the other 
 hand, there is no foundation for Sir Archdall Reid's 
 statement, quoted in paragraph 2 above, * that the 
 Portsmouth district is a model area for the whole 
 country,' or that its incidence rate was anything 
 like so low as 25 per thousand, which he asserted 
 in his other letter." J I was far too moderate. 
 When the disease brought in by immigrants is 
 separated from that acquired by the residents, 
 I am sure the Portsmouth Area rate will be found 
 below 15. As I have already stated, the records 
 1 See pp: 303-4.
 
 LORD SANDHURST'S APOLOGETICS 317 
 
 exist, and should by now be in the hands of the 
 War Office. I am very confident that Portsmouth 
 is now actually the model district not only for the 
 United Kingdom, but for the whole world, except 
 perhaps here and there a military post isolated 
 in mountains, or in deserts, or on remote islands. 
 
 The writer next seeks to discredit my statement 
 that immediate self -disinfection is an effective pre- 
 ventive of venereal disease. 1 He produces evidence 
 from Hilsea, No. 7 General Hospital, Rochester 
 Row, and Warlingham. The three last are repre- 
 sented as furnishing evidence as to whether the 
 patients did, or did not, disinfect soon after ex- 
 posure to danger. On the other hand, Hilsea is 
 represented as furnishing evidence only as to 
 whether its patients disinfected the same day, 
 next day, later, or not at all. 
 
 The Army regulations require from hospitals 
 only such records as those which Hilsea furnished. 
 They indicate the value attached by Headquarters 
 to the time-element in disinfection. Venereal 
 diseases, like the surgical fevers, are contagious ; 
 suppose hospitals recorded in their statistics of 
 operations whether patients were disinfected the 
 same day, next day, later, or not at all I If more 
 precise information is wanted, it must be collected 
 specially in response to a request from Head- 
 quarters, or through the private initiative of the 
 hospital staff. As already described, the most 
 precise and carefully compiled information of all 
 was collected at Hilsea. It proved that venereal 
 patients, while they often declared at first that 
 1 See pp. 424-36.
 
 318 PREVENTION OF VENEREAL DISEASE 
 
 they had disinfected immediately, always, if closely 
 questioned, ended by admitting that they had not 
 done so. But these Hilsea records, compiled for 
 the information of the staff, were unofficial. They 
 were not secret, of course. On the contrary, they 
 were freely discussed, and I understood that 
 London knew of them informally ; but being un- 
 official, apparently they have not been preserved. 
 They passed with the passing of the staff that 
 collected them. Doubtless, however, plenty of 
 officers can be found to testify to them. The 
 important point is not that Hilsea demonstrated 
 that the information furnished by venereal hos- 
 pital patients is untrustworthy. The worthless- 
 ness of this information is admitted, and notorious, 
 and is dwelt upon in the very White Paper we 
 have under consideration. 1 The really important 
 point is that, given reasonable care, correct in- 
 formation can be elicited from the hospital patients. 
 The truth that quick disinfection prevents 
 venereal disease rests on other grounds than hos- 
 pital reports. Except as checks, these reports 
 are unimportant in this connection. At any 
 rate they are superfluous. They themselves 
 cannot be checked, for it is impossible to 
 learn what amount of care has been exercised 
 in their compilation. It is only human for 
 authorities to believe that they have taken every 
 care ; and it is not only natural, but customary 
 also, for them to depute to subordinates routine 
 and apparently unimportant duties. That is what 
 subordinates are for. On the other hand, the 
 
 1 See p. 428.
 
 reports from medical officers in charge of troops 
 are vitally important. Their reports may be 
 checked to the last item from the hospital books, 
 which record each patient's name and unit, and 
 also when, and where, and by whom (prostitute 
 or amateur) he was infected. They may be checked 
 also, in great measure, from the daily reports 
 furnished by the Medical Officers to the Officers 
 Commanding units. The hospital authorities, ex- 
 cept by accident, know nothing about the doctor 
 who sends the case, or how many troops he has 
 in charge, or what method of prevention he is 
 using, or what success he is achieving. But, if 
 he makes a claim, they can always, by going over 
 their books, ascertain how many men he has sent 
 in, and the details of each infection. Obviously, 
 the degree of success achieved by a doctor in 
 preventing disease is indicated by the percentage 
 of infections acquired by the men under his charge. 
 If, then, various doctors, naval and military, 
 report that they have employed a certain method 
 of sanitation, and that, out of many thousands of 
 men in their charge, very few have failed to obey 
 instructions ; and, moreover, that not one of those 
 who obeyed has been infected, this statement can 
 be exactly checked from the records of the regiments 
 and naval stations, and from those of the various 
 hospitals ; for each doctor must send all his men 
 infected with a particular disease to a particular 
 hospital. If it be found from the records of the 
 various hospitals that the claims of the various 
 medical officers are correct, the conclusion is 
 irresistible that a right method of sanitation has
 
 820 PREVENTION OF VENEREAL DISEASE 
 
 been successfully employed. If, now, men coming 
 from a hundred or a thousand other doctors declare 
 that they have employed the same method, and yet 
 have become infected, it is at least highly probable 
 that they are lying, or that their doctors have 
 instructed them badly. When it is further ascer- 
 tained that these doctors themselves have been 
 instructed, as far as they have been instructed at 
 all, to teach their men wrongly, the probability 
 becomes greater. When the men invariably con- 
 fess on close questioning that they have not really 
 disinfected quickly, the probability becomes cer- 
 tainty. And lastly, when it is ascertained that 
 people who have full access to the records, and who 
 dislike the method, can only give an appearance of 
 inutility to the latter by making great mistakes 
 with the former, certainty becomes, if possible, 
 more sure. 
 
 This White Paper, issued by the Ministry of 
 Health, is important for the vivid light it sheds on 
 the methods adopted in the Inter-Departmental 
 Committee and elsewhere to discredit quick dis- 
 infection. The writer of it did not know that 
 records, which differentiated local from imported 
 disease, had been kept in the Portsmouth Area. 
 He may be excused, therefore, for having set 
 down the disease in the Area at 47*3, while that of 
 the rest of the country was 64. But what excuse 
 can be found for the admitted fact that he attri- 
 buted the diseases of the whole Area (imported or 
 other, in the British Army or other) to the re- 
 latively small garrison of Portsmouth town, and so 
 reached the figures for the Area which he published
 
 LORD SANDHURST'S APOLOGETICS 321 
 
 through the mouth of the unfortunate Lord 
 Sandhurst ? Again, what excuse can be found 
 for the fact that he explains the low figures in the 
 Area by stating that it was exempt from disease 
 imported from overseas, when, notoriously, its 
 barracks and camps were filled with overseas 
 troops, and its hospitals swamped by their 
 diseases ? Yet again, what shall we say of 
 the attempts to set against the verifiable and 
 quite indisputable reports of the medical officers 
 in charge of troops and naval units, the admittedly 
 unreliable and quite unverifiable statistics of the 
 venereal diseases hospitals ? 
 
 21
 
 CHAPTER XVIII 
 
 SUMMARY 
 
 r I ^HE human mind reaches its convictions as to 
 J. truth and right in two ways through bias, 
 and through evidence. Bias, which, as a rule, can 
 be acquired only by the very young, or by those 
 who already have the habit of founding judgments 
 on bias, is an imitation instinct, a mental attitude, 
 learned almost always from familiar associates. 
 Once acquired, and the individual grown, it 
 tends to persist even in the teeth of conflicting 
 evidence. Not only is there then a tendency 
 to dislike and ignore unfavourable facts, but 
 there is also a tendency to suppress them for 
 fear of their effect on less robust minds. On 
 the other hand, beliefs founded on evidence 
 may be learned by people of all ages (except 
 in so far as they are prevented by bias), and 
 are very changeable on the production of fresh 
 evidence. Fresh evidence is then, as a rule, 
 eagerly welcomed, and is regarded with all the 
 more interest and curiosity when it tends to over- 
 throw antecedent convictions. Compare religious 
 and moral convictions with scientific and business 
 beliefs. 
 
 When there is much bias, the power of utilising 
 
 322
 
 SUMMARY 323 
 
 evidence is greatly restricted. Hence, apart from 
 that natural incapacity to learn which is found 
 most conspicuously in idiots, the stupidity of in- 
 dividuals and the stagnation of peoples. Intelli- 
 gence is nothing other than a power of profiting by 
 experience ; that is, of learning from experience. 
 There are, however, many desirable traits of mind, 
 necessary for the preservation of society, which 
 can be acquired only through bias. Among them 
 are nearly all morals, and more especially sexual 
 morals. If, therefore, we wish people to be chaste, 
 we must inspire them with a bias for chastity, and 
 against unchastity, when they are very young. 
 Later the task will be almost impossible ; for the 
 adult is not plastic. Hence the futility of moral 
 lectures given to adults. They excite, as a rule, 
 in people already biased in an opposite direction, 
 nothing but irritation and contempt. A child can 
 be taught a bias, an adult can be only preached at. 
 Among Christians, and especially among English- 
 speaking peoples, there exists a convention or 
 taboo, which forbids the familiar discussion of 
 sexual matters by peoples of different sexes and 
 ages. In England, therefore, adults give no 
 lessons either by intimate discourse or by example 
 to children. Sometimes, though rarely, they lec- 
 ture them ; but mere lecturing, even when the 
 subjects of it are very young, is more akin to 
 preaching than to teaching. Children are con- 
 ventionally supposed to grow up ignorant or 
 " innocent." Actually, a knowledge of the function 
 of sex is traditional among boys, and I suppose to 
 some extent girls, of the school age. Children,
 
 324 PREVENTION OF VENEREAL DISEASE 
 
 therefore, are the real teachers of sexual morality, 
 or immorality, in England. The discussions of 
 boys are often obscene. The result is that very 
 many, I think the great majority, of young men 
 grow up quite prepared to be unchaste if opportun- 
 ity offers. It usually does offer. It is remarkable 
 that the people who most condemn immorality are 
 precisely those who most object to the free dis- 
 cussion before children of sexual matters that is, 
 who most object to the teaching of morality in the 
 only way in which it can be taught. However, 
 the teaching of children is not at present a question 
 of practical politics. The convention is too strong. 
 Venereal diseases are contagious microbic dis- 
 eases ; that is, they are caused by living organisms 
 which pass from victim to victim by direct contact. 
 Of all microbic diseases the contagious diseases 
 (except venereal disease in the female) are the 
 easiest to prevent ; and of all contagious diseases 
 the venereal diseases are (in the male at least) the 
 most preventable. The microbes are exceptionally 
 delicate, the place and time of infection may usually 
 be anticipated, and the male organ is so shaped 
 and situated that disinfection is a particularly 
 simple matter. It is, in fact, not so difficult as 
 washing the hands, and not more dangerous. Time 
 is the essential element. It is altogether wrong to 
 teach that disinfection for venereal diseases should 
 be performed within an hour. It ought to be per- 
 formed at the earliest possible moment. At first 
 the microbes are all on the surface, but every 
 moment of delay increases the danger that they 
 may pass beyond the reach of the disinfectant.
 
 SUMMARY 325 
 
 It is true that disinfection within an hour is 
 usually successful, but it is folly to take un- 
 necessary risks. The surgical fevers are also 
 contagious diseases ; but no surgeon would be so 
 crazy as to delay a moment if he feared infection. 
 
 Any of the ordinary disinfectants used in solu- 
 tions of quite moderate strength are effective. I 
 employed permanganate of potash (Condy's fluid) 
 for my soldiers, not because it is an especially good 
 disinfectant, but merely because it was at hand in 
 the barracks, and could be procured from any 
 chemist by a man on leave. Five grains of per- 
 manganate of potash to half a pint of water (one 
 part of the chemical to 1000 parts of water) is 
 effective. About eight grains can be taken up on 
 a threepenny bit. If this quantity is dropped into 
 three-quarters of a pint of clean water, the solution 
 will be about right, and may be used at once, or kept 
 for any length of time. Many chemists sell five- 
 grain tablets. The solution when made should have 
 much the appearance of claret. A small quantity 
 of it a tablespoonful or so is sufficient for one 
 application. People who insist on incurring danger 
 should carry it in a small bottle, and, when danger 
 does occur, should wet a dottle of cotton-wool 
 the size of a walnut or so with the solution, and 
 thoroughly swab the endangered parts and their 
 neighbourhood, taking care to squeeze the solution 
 into every cranny. 
 
 In my experience, and in that of other doctors 
 who have had large experience with properly 
 instructed men men instructed just as the reader 
 now is this procedure has never failed. But, of
 
 326 PREVENTION OF VENEREAL DISEASE 
 
 course, failure is possible. Not even the most 
 skilful surgeon is always successful, even under 
 apparently the best conditions. Yet surgeons do 
 not hesitate, after having rendered success highly 
 probable, to undertake operations in which failure 
 to disinfect results in almost certain death. We 
 cannot guarantee safety during a sea voyage, or a 
 railway journey, or even a quiet stroll in the 
 street. No one advises non-intercourse between 
 husband and wife, yet, having regard to the millions 
 of innocent sufferers, marital intercourse without 
 disinfection is far more dangerous than irregular 
 intercourse with disinfection. I conceive that 
 failure is most likely to occur in men with long 
 non-retractable foreskins. In such cases special care 
 should be exercised ; and it would be prudent to 
 inject the solution, diluted to half strength, by 
 means of a syringe under the foreskin, not only 
 immediately, but two or three times and for days 
 subsequently. Late injection of the pipe with a 
 solution of one-quarter strength would also be 
 prudent. In ordinary cases, judging from the ex- 
 perience of well-instructed men, who act promptly, 
 injection of the pipe is quite unnecessary. It is 
 necessary only when there has been delay. 
 
 " Two methods of preventing contagious disease 
 are in vogue disinfection with all possible speed 
 after exposure to infection, and disinfection delayed 
 for one, two, or more hours. As far as I am aware, 
 delayed disinfection is practised only in the case of 
 the venereal diseases, and then only by doctors who 
 are ignorant of how to apply quick disinfection, 
 or by those who have " moral " objections to its
 
 SUMMARY 327 
 
 employment, or by those who are compelled by 
 superior authority not to employ it. It is remark- 
 able that the people who object to quick disinfec- 
 tion on moral grounds are precisely those who are 
 convinced that it is useless on medical grounds. 
 It is equally remarkable that whenever (any time 
 within the last ten years) and wherever (Japan, 
 India, South Africa, England) quick disinfection 
 has been practised, and the active disinfectants 
 ordinarily used in surgical practice have been 
 employed, the result has always been almost per- 
 fect better far than those achieved by surgeons 
 who prepare patients for operation. It is even 
 more remarkable that these results, the majority 
 of which may be verified to the last detail from 
 official records, are never quoted by people (even 
 by people who have official access to records) who, 
 on moral grounds, are convinced that quick dis- 
 infection is wicked." 1 
 
 Owing to physical conformation, the disinfection 
 of women is exceedingly difficult, and must, I think, 
 always be uncertain. Fortunately, venereal dis- 
 ease passes alternatively from sex to sex, just as, in 
 insect-born diseases, the microbes pass to and from 
 man to insect. Each sex is the carrier for the 
 other. If we eliminate it from one sex, we auto- 
 matically eliminate it from the other. It is suffi- 
 cient, therefore, when we have public sanitary ends 
 in view, to deal with only one-half of the population. 
 
 We possess no reliable evidence indeed, no 
 evidence at all as to whether venereal disease is, 
 on the balance, a deterrent from, or a cause of, 
 
 1 Letter by Sir Archdall Reid, Lancet, 22nd November 1919.
 
 328 PREVENTION OF VENEREAL DISEASE 
 
 sexual immorality. Men who know much about 
 these disorders, are less chaste than women who 
 know less. Medical students, who of all young 
 men know most, are perhaps the least famed for 
 austerity. Three out of four soldiers, and I 
 suppose a greater proportion of civilians, acquire 
 their diseases from amateurs. Venereal disease 
 is, of course, far more prevalent among prosti- 
 tutes than among other women. It follows that 
 irregular intercourse with prostitutes is a still 
 smaller fraction of the total amount of current 
 unchastity. Doubtless, fear of disease ^frequently 
 deters men from intercourse with professional 
 women. But few men suspect disease in non- 
 professionals. To what extent, then, are men, 
 who have never received moral teaching, who 
 have been trained from early boyhood to regard 
 unchastity as a peccadillo, and sexual intercourse 
 as a principal aim in life, turned by the fear of 
 disease to the pursuit of " decent " girls ? The 
 reader must judge from his own experience of life. 
 Myself, I think that the great mass of what may 
 be called " deliberate " unchastity is with non- 
 professionals ; whereas most of what may be 
 termed " impulsive " unchastity is with profes- 
 sionals. A man who has an intrigue with a " de- 
 cent " woman usually contemplates intercourse 
 long before it is committed. Usually he thinks he 
 is seducing the woman. Often she is trying to 
 seduce him. But the convention is that he shall 
 have the appearance of being the seducer. There 
 are diseased men who are utterly callous of the 
 suffering they may inflict. There are others, who
 
 SUMMARY 320 
 
 in the hope of cure try to " pass on their disease." 
 Many diseased women are unaware of their condi- 
 tion. Many men, and more women, think them- 
 selves cured when they are still infective. In my 
 experience drunkenness is by no means a usual 
 accompaniment of illicit sexual intercourse, es- 
 pecially when the partner is a non-professional. 
 Evidence that this surmise is correct is afforded 
 by the fact that, whenever men have been properly 
 instructed to disinfect themselves, the venereal 
 rate has been reduced to 1-5 per 1000 per annum, 
 which, of course, would not have been possible had 
 drunkenness at the time of danger been common. 
 Like sexual immorality, venereal disease is no 
 new thing. It is clearly indicated in the Old 
 Testament and other ancient literature, but beyond 
 doubt it is enormously older than written history. 
 Christians have suffered its ravages as much or 
 more than any other people, and the British as 
 much or more than other Christians. Certainly 
 the British, more than others, have spread it to 
 the remotest quarters of the world. It has fol- 
 lowed their footsteps much more certainly than the 
 Bible or trade. Among foreigners, England is the 
 recognised cesspool of the world. At the present 
 moment something like every other person in the 
 United Kingdom has suffered, or is suffering, from 
 venereal disease. Our asylums, workhouses, hos- 
 pitals, and homes for the broken and blind, are 
 full of its victims. The loss to the nation by it in 
 health, in happiness, in efficiency, in treasure, far 
 transcends the loss from any other cause, even 
 consumption. Though not deadly in proportion
 
 330 PREVENTION OF VENEREAL DISEASE 
 
 to the number of cases, syphilis alone has been 
 reckoned as the fourth killing disease probably an 
 under-estimate, for it is responsible for a quite un- 
 known, but certainly vast, number of miscarriages, 
 still-births, and deaths, which unsuspicious or 
 charitable doctors ascribe to other causes. 
 
 Similar ideas of right and wrong, and, therefore, 
 similar rules of conduct, enable men to " play the 
 game," and so live together. Laws, morals, con- 
 ventions are all guides to conduct ; and Nature, 
 by making men imitative and prone to acquire 
 bias in early youth, fits them to accept these guides. 
 Men, therefore, are social beings by habit, not, as 
 lower animals are, by instinct. The habits of 
 educable, and therefore rational beings, are equiv- 
 alent to the instincts of lower types. But they 
 are, in the mass, far superior to instincts ; for they 
 fit men and races to their special niches ; they 
 make them adaptable ; they are if not in the 
 individual, yet in the race changeable, and, there- 
 fore, improvable ; most of them, from speaking 
 and walking to religious and patriotic devotion, 
 are traditional, the outcome of generations of ex- 
 perience, whereby each man's ancestors are made 
 his present allies. Consider how language has been 
 perfected during innumerable generations. 
 
 Every one breaks the rules of his community 
 to some extent ; for training is never perfect, 
 and habit, which is often opposed to inclina- 
 tion, is never so sure as instinct, which is always 
 in accord with inclination ; but whoever, when 
 responsible for his actions, breaks the communal 
 rules to a great extent, becomes an outlaw or
 
 SUMMARY 331 
 
 an outcast. Doubtless there are in every com- 
 munity numberless taboos, restrictions, and con- 
 ventions, which are foolish and unnecessary ; but 
 it is proper that men should observe them, for 
 otherwise the game would not be played fairly. 
 In well-ordered societies (which are usually pros- 
 perous and progressive) men may think certain 
 rules wrong, but nevertheless they obey till they 
 are able to obtain an alteration. In ill-ordered 
 societies (which are usually poor and stagnant) 
 men less often question the rules, but more often 
 break them. 
 
 But, as we have seen, societies, excessively 
 burdened with bias, are commonly inferior to those 
 less burdened. Whence it would appear that the 
 greater the provision for maintaining order, the 
 less is the order maintained. The explanation of 
 this apparent contradiction is found when we 
 consider the different kinds of bias which men 
 acquire. There are two sorts. The one kind 
 binds the body, limits action, supplies rules of 
 conduct, impels men to " play the game." The 
 other kind binds the mind, limits thought, impels 
 men never to question the rules. When the rules 
 binding the mind are many and strait, men tend 
 to regard lightly the rules that bind to conduct 
 All this may seem far-fetched, but consider uni- 
 versal history. Is it not the fact that races have 
 been stagnant and turbulent in proportion as their 
 minds have been bound ? I may be afflicted with 
 racial prejudice, but to , me it seems that the men 
 of English speech owe their predominant position 
 in the world to the fact that they, more than others,
 
 332 PREVENTION OF VENEREAL DISEASE 
 
 " play the game " scrupulously, and yet have been 
 freest of all in their thoughts, and so, while obeying 
 their existing rules, have most readily and con- 
 tinuously altered the rules both of conduct and of 
 thought. We English may have only one sauce, 
 but fortunately we have a hundred heresies. 
 
 An illustration will make my meaning clearer. 
 Once I stole a pencil from another boy at school ; 
 on several occasions I robbed orchards ; and once, 
 as a little chap in India, unwisely entrusted with 
 a small gun, I shot and stole no less than nine fowls 
 belonging to a neighbour. Seven of them I hid, 
 and two I persuaded our native cook, a thorough 
 rascal, to prepare for dinner. Doubtless he charged 
 my innocent mother for them. To this day the 
 theft of the pencil is an odious and shameful 
 memory to me, but I still regard the rape of the 
 fruit and the fowls with a certain satisfaction. 
 Whence this difference in feeling ; theft is theft in 
 any case ? The difference arises from the fact that 
 when I stole the pencil I broke the rules of conduct 
 which govern the world of boys far more seriously 
 than when I stole the edibles. Indeed, in the 
 latter case, I hardly broke the rules at all. There 
 is little hope for a boy who habitually steals pencils 
 from his companions ; he is a sneak ; he does not 
 play the game ; he is not likely to play it when 
 grown. But for a boy who steals edibles under 
 such conditions there is hope. He plays the game 
 according to his lights. Presently, when grown, 
 it is probable that he will not steal anything. 
 Just so, the young man may be unchaste before 
 marriage, and perfectly chaste afterwards.
 
 SUMMARY 333 
 
 When one English boy or man says of another, 
 " He plays the game," he bestows the highest 
 praise in his power. He of whom that is true may 
 be trusted under all circumstances ; he is honour- 
 able ; he fulfils his obligations, whether explicit or 
 implicit, to the last item ; he is not a sneak ; he 
 has that character which the English say is devel- 
 oped in their playing-fields, and which they esteem 
 so valuable that they think it excuses even the 
 intellectual deficiencies of their public schools. 
 Now, the Royal Commission of 1913 was ap- 
 pointed " to inquire into the prevalence of Venereal 
 Diseases in the United Kingdom, their effects upon 
 the health of the community, and the means by 
 which those effects can be alleviated or prevented." 
 Prevented, be it noted. Acceptance of office in the 
 Commission placed all the members on their 
 honour to tell the truth, the whole truth, and 
 nothing but the truth. They were supposed to 
 serve not as partisans, but as inquirers, judges, 
 and expositors. 
 
 When the Commission began its sittings, Metch- 
 nikoff's discovery was the best part of a decade 
 old. When it prepared its Report some 20,000,000 
 of fighting men were being protected by the dis- 
 covery. Only the British Army had no protection. 
 Yet, both in its proceedings and in its Report, the 
 Commission ignored Metchnikoff 's discovery. Cer- 
 tain medical members of it did wish to consider 
 and report on it fully, but after consultation they 
 abandoned the idea, feeling, in view of the pre- 
 judices of the clerical and women members, that 
 the attempt was hopeless, and that persistence in
 
 334 PREVENTION OF VENEREAL DISEASE 
 
 it would wreck the Commission. At that time 
 greater hopes were built on treatment by salvarsan 
 than the event has justified, and the doctors thought 
 it better to secure half a loaf than no bread at all. 
 Suppose the Royal Commission on Coal, in its desire 
 to influence the public in favour of a certain opinion, 
 had suppressed important facts, what would we 
 think of it ? Just that should we think of the 
 Royal Commission on Venereal Diseases. It broke 
 its obligation of honour. It did not play the game. 
 It committed the offence that Englishmen hold 
 unpardonable. The Empire was then straining in 
 its greatest war. Its fate hung in the balance. 
 Colonial Governments were threatening to with- 
 draw their forces ; in each Dominion a disloyal 
 faction was appealing to the public not to send 
 clean lads to the English cesspool ; the infec- 
 tions of soldiers were mounting towards millions ; 
 innocent women and children, and men whose moral 
 training had been totally neglected, were being 
 poisoned by the many millions ; and into the 
 scales against all this, and against their own per- 
 sonal honour, the little members of this miserable 
 little Commission put their most miserable little 
 prejudices, and found their prejudices the heavier. 
 Doubtless they were honest in a way. Or, if 
 " honest " be not the right word, doubtless they 
 thought they were acting virtuously. But, surely, 
 this indicates how hopelessly unfitted they were 
 intellectually for the task they undertook. 
 They belonged to that category of foolish people, 
 found in Holy Russian Synods and the like, who 
 try to suppress the truth for fear of its effect
 
 SUMMARY 335 
 
 on weaker brethren. Remember we are not at 
 the moment discussing whether self-disinfection is 
 practical. We are discussing only Metchnikoff's 
 discovery, which was then playing a great part 
 in the world, and the evidence concerning which 
 the Royal Commission suppressed. 
 
 The Royal Commission, having concluded its 
 labours, presented its Report, in which it dwelt on 
 the necessity of treating disease which had been 
 already contracted, and advocated preaching to 
 people who had already received their bias ; but 
 made no suggestions about real teaching, and none 
 about sanitation. It was exactly as if, being com- 
 missioned to write a history of the late war, it 
 had described the campaigns against Austria, 
 Bulgaria, and Turkey, but had omitted all men- 
 tion of Germany, in the hope of creating an 
 impression that no Protestant country had done 
 wrong. Ostensibly, it was appointed for sanitary 
 purposes ; actually, its authors intended it to 
 advocate certain preconceived opinions. I dare 
 say when the country awakens to the enormity of 
 the offence, some of the Commissioners will declare 
 that they regarded themselves as precluded by 
 the terms of the Commission from dealing with 
 prevention, " it being understood that no return to 
 the policy or provisions of the Contagious Diseases 
 Acts of 1864, 1866, or 1869 is to be regarded as 
 falling within the scope of the inquiry." But you 
 are none the less guilty if you are the willing instru- 
 ment of a superior malefactor ; your offence loses 
 none of its iniquity when it gains in meanness. 
 The Contagious Diseases Acts of the last century
 
 336 PREVENTION OF VENEREAL DISEASE 
 
 provided, or attempted to provide, means of 
 restraining infected women. 1 These Acts were 
 not concerned with sanitation by means of disin- 
 fection. It follows that the Royal Commission of 
 1913 was not precluded from considering preven- 
 tion. If any of its members were privately told 
 that prevention was not to be discussed, that would 
 only mean that some of the partners to the fraud 
 lurked in the background. I suppose, really, that 
 the Commission started its labours with vague ideas. 
 Some of its members desired to discuss sanitation, 
 the clerics, the women, and some of the others 
 were determined that it should not be discussed, 
 and the rest, indifferent, regarding membership of 
 the Commission as a "duty " or as an " honour," 
 were content to leave the decision to the experts 
 in medicine or morals. 
 
 The Royal Commission bequeathed its mission 
 to its adopted child the National Council for Com- 
 bating Venereal Disease. The Chairman of the 
 former became the President of the latter, and 
 about half the members of the Commission joined 
 the Executive Committee of the Council. Orig- 
 inally it was proposed to call the new body the 
 National Council for the Prevention of Venereal 
 
 1 In my opinion, these Acts were hopelessly wrong. They 
 were clumsy, inefficient, offensive ; they carried the seeds of 
 failure. It is one thing to hold this opinion ; I believe it is 
 founded on facts, and would be confirmed by the consideration 
 of more facts. It is quite another thing to say to an inquirer : 
 " You must exclude this or that relevant, or possibly relevant, 
 thing from your mind." The latter shows bias ; it indicates 
 a fear of facts. The inquirer ought not to accept so impudent 
 a limitation. It should awaken his suspicions and make him 
 doubly curious.
 
 SUMMARY 337 
 
 Disease, but the word " Prevention " suggested the 
 accursed thing, and " Combating " was adopted 
 instead. The Council is a self-elected body, 
 subsidised by the Government, and in receipt of 
 considerable funds from people who suppose that 
 its objects are sanitary. In effect, it is an appanage 
 of the Church, and more especially of the See of 
 Canterbury. I do not know on what authority 
 public money is granted to this little knot of in- 
 tensely prejudiced and incapable private people, to 
 which is now opposed a mass of scientific and in- 
 structed opinion immensely more weighty than its 
 own, as may be judged by comparing the list of its 
 supporters with that of the Society for the Preven- 
 tion of Venereal Disease, which its own tortuous 
 procedure has called into being. It possesses all the 
 faults usual to societies and teaching bodies which 
 are professedly scientific, but are under ecclesias- 
 tical control for instance, an almost insect-like 
 incapacity to learn or change, a tendency to 
 suppress, minimise, or misinterpret inconvenient 
 evidence, and to work by the back stairs in the 
 promotion both of measures and of men. It has 
 established clinics for the treatment of venereal 
 diseases, and keeps them busy by employing lec- 
 turers who expound the horrors of these maladies, 
 but are forbidden to explain how they may be 
 prevented. Its severest condemnation may be 
 found in its own statement of "Aims and Objects," 
 " Policy," and " Literature." * 
 
 When the National Council began its career of 
 preaching to adults, lecturing on the horrors of 
 
 1 See pp. 116-17. 
 22
 
 338 PREVENTION OF VENEREAL DISEASE 
 
 venereal disease, and treating people already 
 infected, both immorality and disease were im- 
 mensely prevalent. They are even more prevalent 
 now. If one adopted the post hoc, ergo propter hoc 
 style of argument, which is so greatly favoured by 
 biased people, and which, for instance, the Inter- 
 Departmental Committee used when it attributed 
 the fall of the Army venereal rate after 1887 to 
 improved facilities for recreation, one might 
 attribute the increased prevalence of disease to the 
 activities of the Council, which, doubtless, has driven 
 a certain number of men from the welcoming 
 arms of the prostitute to the pursuit of the shy 
 amateur ; but the increase is too great to be thus 
 explained. It is such as follows every war. Prob- 
 ably the National Council has had little influence 
 one way or the other, except in so far as it has 
 succeeded in preventing the adoption of proper 
 sanitary measures. 
 
 During the career of the Council a method of 
 prevention that reduced venereal disease almost 
 to the vanishing point was published. The Govern- 
 ment, which could thoroughly test the evidence as 
 to the success and general feasibility of this method, 
 was satisfied, and made arrangements to introduce 
 it throughout the Army. Nothing was required 
 beyond a stringent order to medical officers to give 
 certain very simple instructions to the men in their 
 charge. Of course, the nature of these instructions 
 should have been clearly and insistently explained 
 to the medical officers, and they should have been 
 made to understand that since some army doctors 
 had .found it easy to prevent venereal disease, all
 
 SUMMARY 339 
 
 army doctors must in future prevent it. It was 
 a time for swift and decisive action, for the Ger- 
 man offensive was impending ; many thousands 
 of young unmarried men, fully-trained soldiers, 
 efficient in every way save for venereal disease, 
 inhabited the hospitals and depots ; and the 
 dearth of troops in the fighting-line was acute. 
 Unfortunately, the Council got wind of the plan, 
 and, either directly through its officials, or indirectly 
 through " influential people," proceeded to wreck 
 it. I do not know what threats or promises were 
 made, but I learned enough to know what influences 
 were at work. The situation was such that only 
 extreme incapacity or deliberate disregard of the 
 public weal was to be dreaded. At the time I 
 hoped that the officials concerned would be wise 
 and patriotic enough to ignore the influences of 
 the backstairs. I wrote to say that I felt sure that, 
 if public agitation were attempted, a simple revela- 
 tion of the truth would make short work of the 
 fanatics. I offered, if necessary, to make the 
 revelation on my own responsibility. I had not 
 the smallest fear of the result, and was not so 
 presumptuous as appears on the surface. On the 
 one hand, I knew that my suggestions would reach 
 only a few " experts," minor officials, who would 
 consult with more exalted personages if they 
 thought fit. On the other hand, English people, 
 in an ever-increasing degree, are guided by common 
 sense ; that is, they are relatively free from bias 
 and open to the influence of facts. Hence the 
 national progressiveness and tendency towards 
 evolution rather than revolution. I had talked
 
 340 PREVENTION OF VENEREAL DISEASE 
 
 with and written to some hundreds of men and 
 women, among whom the feeling seemed universal 
 that, since the prevalence of unchastity was 
 plainly traceable to lack of effective teaching, it 
 was abominable that even sinners should be poisoned 
 and sanitation delayed at the instance of the very 
 people who were responsible for the teaching, 
 but not for the sanitation ; and that in any 
 case every endeavour ought to be made to pro- 
 tect the army, the community generally, and 
 above all the innocent. It seemed clear, there- 
 fore, that the opposition to sanitation was not 
 in accord with the will of the majority, but was 
 the work of a small knot of people, who were 
 influential merely because some of them had social 
 and ecclesiastical position by means of which they 
 had intimidated the Government, because they 
 were organised, and because they had hitherto 
 managed to control publication. 
 
 These people had fought on wrong grounds. 
 They had put themselves in a false position, and 
 were tangled in a net of their own weaving. 
 Had they declared openly that, in the face of the 
 convention as to reticence, they were unable to 
 teach sexual morality, but were determined never- 
 theless to impose it by every means in their 
 power, and, therefore, that they desired the pres- 
 ence of venereal disease as an aid to chastity and as 
 a punishment for sin, they would have been entitled 
 to the respect which we must accord to honest 
 conviction even when we think it terribly mistaken. 
 But, actually, while professing to teach morals, 
 they had committed the immorality of suppressing
 
 SUMMARY 341 
 
 the truth, and had based their opposition on a 
 pretence that prevention was impossible. Nothing 
 more was necessary, therefore, than to prove that 
 prevention was possible ; and the ground would 
 be cut from under their feet. 
 
 I proved to be mistaken not as to my faith 
 in the public, of which this book is evidence 
 but as to my faith in the staunchness of the officials. 
 Unnecessary packets were issued ; but the wicked- 
 ness of teaching men how to use them was avoided. 
 Then followed the Inter-Departmental Committee, 
 the debate in the House of Lords, and the recent 
 White Paper from the Ministry of Health. It 
 seems, therefore, that in this matter of the pre- 
 vention of venereal disease we must have revolu- 
 tion, not evolution. The public, having learned, 
 will act in scorn of authority. 
 
 But the chicanery and the humbug, the un- 
 courageous fanaticism, the treachery to the Army 
 and the nation, the flood of useless misery and 
 disease, the slaughter of the innocents these, I 
 think, will not be forgotten, but will stink in the 
 nostrils of the nation for evermore.
 
 APPENDICES 
 
 APPENDIX I 
 
 THE PREVENTION OF VENEREAL DISEASE 
 
 VENEREAL DISEASE can be prevented with almost 
 complete certainty if the right precautions be taken 
 in time. At first the microbes which cause the disease 
 are all on the surface, and can be destroyed if immediate 
 action be taken. 
 
 In this room there are three sets of articles to which 
 every soldier has access night and day. He may possess 
 himself of one specimen of each kind, and should carry it 
 about with him if he thinks he is liable to incur danger. 
 
 (1) Bottles containing disinfectant. 
 
 (2) Swabs of cotton-wool, done up in reels of paper. 
 
 (3) Capsules of calomel ointment. 
 
 Immediately after danger of infection has been incurred, 
 he should retire to some convenient place (for instance, a 
 water-closet), wet the swab of wool with the disinfectant, 
 and carefully and thoroughly swab the penis, especially 
 round the head (with the foreskin drawn back), at the lips 
 of the pipe, and in the crannies underneath. As an addi- 
 tional precaution, he should prick the cap of the capsule 
 with a pin. Squeeze out the ointment and rub it over the 
 penis, especially over the head. 
 
 Note the nature of the disinfectant in the bottle. It is 
 a solution of permanganate of potash (Condy's Fluid) in the 
 strength of one to one thousand parts of water. If by 
 chance he has not a bottle of it with him (as may happen , 
 
 343
 
 344 PREVENTION OF VENEREAL DISEASE 
 
 for instance, when on leave), he can always obtain it at a 
 chemist's for a few pence. 
 
 NOTE. Please return the bottles. 
 
 G. ARCHDALL REID, M.O. 
 
 APPENDIX II 
 
 PROPHYLAXIS IN VENEREAL DISEASE 
 
 To the Editor of The Lancet 
 
 SIR, At one time I had medical charge of an establish- 
 ment employing 2000 men, mostly young and away from 
 home. Venereal diseases were very prevalent among them. 
 I gave the usual moral lectures, with the usual result. I could 
 not prevent immorality. However, my duty, that for which I 
 was employed and paid, concerned rather the health and 
 efficiency of my charges. At length I delivered a lecture, 
 often repeated, which produced results. I explained in 
 simple language the nature of the several venereal diseases, 
 pointing out that the microbes, when accessible, were easily 
 killed by antiseptics, and that immediately after infection 
 they were present, not in the urethra (a closed pipe) or under 
 the surface of the skin, but on the surface itself. I insisted 
 that if the men exposed themselves to infection they must 
 disinfect without delay. My dispensary attendant had 
 orders to give any man who asked for it an ounce of solu- 
 tion of permanganate of potash (i to 2000) and a little 
 cotton-wool. The men were instructed to sponge the penis 
 carefully, especially about the fraenum and the meatus, 
 the lips of which were to be a little everted, with the cotton- 
 wool wetted with the antiseptic. Any other antiseptic 
 will do equally well. Within a few days I ceased to see 
 fresh cases. Thereafter not one originated in the establish- 
 ment for more than six months. Then one occurred in a 
 man who had taken no precautions. Then no more. I 
 dare say I had some good fortune, but there can be no doubt 
 that the very simple procedure adopted was extraordinarily 
 
 1 The Lancet, jrd November 1917.
 
 APPENDIX II 345 
 
 successful. After all, it was only such as any surgeon 
 would use did he fear infection of any sort. It was a form 
 of very early treatment. 
 
 More elaborate methods are cumbersome and unneces- 
 sary. Owing to the delay involved they are less effective. 
 They are not required if disinfection be carried out imme- 
 diately. For instance, injections into the urethra and 
 calomel cream are quite unnecessary. The latter is a 
 feeble antiseptic, and is useful only when, much later, the 
 micro-organisms have penetrated the tissues. I take it 
 no surgeon would dream of disinfecting his hands with 
 calomel. 
 
 I offer no excuse or apology. I was right, and every normal 
 person will think I was right. Indeed, I have never met 
 any one who thought otherwise. I can be blamed only by 
 foolish fanatics, now I think few in number, who may be 
 ignored. The fear of disease does not prevent immorality. 
 Young men who know much about venereal diseases are 
 on the average much less continent than young girls who 
 know nothing. I am told, I do not know with what measure 
 of truth, that since the present war began from one-third 
 to one-quarter of the British Army has contracted venereal 
 disease. It is certain, at least, that an enormous proportion 
 of the Colonial Forces have suffered, and that abroad, at 
 any moment, tens of thousands of men of all ranks are in 
 detention camps. What will happen when the soldiers 
 who have suffered in hospital, but not in the field, return 
 to their homes ? Must we expect such another epidemic as 
 that which swept Europe in Tudor times, and was then 
 known as the Great Pox, in contradistinction to that lesser 
 evil, the small-pox ? It is surely a bitter reflection that 
 there lay, and lies, at hand in every medical military 
 inspection room the means to prevent all this suffering, 
 loss of efficiency, and future danger to the public. 
 
 We must bear in mind the helplessness of all classes under 
 our current laws, and the protection afforded by these laws 
 to the criminal. In England at the present day if one 
 person wilfully kills another with arsenic he is hanged by 
 the neck till he is dead. If he tries to poison with arsenic 
 but faik, he is condemned to a long term of penal servitude.
 
 346 PREVENTION OF VENEREAL DISEASE 
 
 But if he wilfully poisons with venereal disease, even to 
 death, the law holds him guiltless, providing the poisoning 
 is done in a particularly cruel and treacherous way. Even 
 when the sufferer is a perfectly innocent person (e.g. a 
 wife), the law punishes not for the poisoning, but for the 
 infidelity. I am, Sir, yours faithfully, 
 
 G. ARCHDALL REID. 
 SOUTHSEA, 2jth October 1917. 
 
 APPENDIX III 
 
 SPECIMEN LECTURE TO TROOPS ON THE 
 PREVENTION OF DISEASE 
 
 Almost every disease from which we suffer especially 
 in the young is caused by microbes. Pimples and boils, 
 skin diseases, and almost all forms of blood-poisoning are 
 due to microbes, and so is toothache. Different kinds of 
 microbes cause colds in the head, measles, malaria, diph- 
 theria, influenza, typhoid, plague, cholera, and the venereal 
 diseases. There is no doubt that the trench fever from 
 which many of you have suffered is caused by microbes. 
 
 The way to prevent illness is to prevent microbes from 
 getting into you. To do that one must find how they travel 
 from one person to another, and stop them on the way. 
 Some microbes live in the air passages of the sick person 
 in his nose, mouth, or lungs and the sick man breathes or 
 coughs them out into the air. That happens in measles, 
 colds, influenza, and such-like complaints, and that is why 
 it is dangerous to go into a room where there is measles, for 
 instance. The only way to stop such diseases as these is 
 to isolate the sick man and disinfect his room you cannot 
 help much here it is the M.O.'s work. 
 
 But with some other diseases you can help a lot. The 
 microbes of some diseases live in the stomach and bowels, 
 generally causing diarrhea. They pass out of the sick man 
 in his stools and may thus get into drinking water in a 
 stream or pond, or be carried on the legs of flies to food.
 
 APPENDIX III 347 
 
 When there is such a disease as typhoid or dysentery 
 about, one must be careful, therefore, that no infection 
 reaches the food or drinking water. If one cannot be sure 
 of that one must only eat hot, cooked food, and drink only 
 boiled or disinfected water. General Maude died recently 
 in Mesopotamia of cholera because he drank a single glass 
 of unboiled water. 
 
 Some diseases are carried by insects. Thus typhus fever 
 is carried by lice. The microbes live in the blood, and are 
 sucked up by the lice when they feed on the sick person ; 
 they are thus conveyed by the lice to the next person on 
 whom they feed. You could sleep quite safely with a man 
 suffering from typhus fever if there were no lice about. 
 Plague is carried in much the same way by fleas, and mos- 
 quitoes carry malaria and yellow fever, so whenever there 
 are any of these diseases about you must be careful about 
 vermin. 
 
 But the diseases which you can most easily prevent by 
 the use of your own common sense are what is known as 
 the contagious diseases so called because they are caused 
 by actual contact with sick persons. Scabies, or " The 
 Itch," is a contagious disease, and ringworm is another ; 
 but the chief of the contagious diseases are venereal 
 Gonorrhoea and Syphilis. Venereal diseases are much the 
 most terrible and prevalent of all, and yet they are the easiest 
 to prevent, as I shall show you. 
 
 Of course the right way for you to avoid venereal disease 
 is not to put yourselves in danger. You cannot get it if 
 you keep straight. But in every lot of men there are sure 
 to be some who will put themselves in danger, and it is to 
 them especially that I now speak. Suppose that I got 
 some of the poison of a venereal disease on my hands, what 
 do you think I should do ? Of course, I should disinfect 
 my hands at once. The germs of venereal disease are the 
 easiest of all to kill, and by using the disinfectant at once I 
 should be perfectly safe. That is what you should do when 
 you get any of the venereal poison on other parts disinfect 
 and, just as I don't wait a moment before dipping my 
 hands in the disinfectant, so should you disinfect at once. 
 
 I must tell you how a man gets the venereal poison on
 
 348 PREVENTION OF VENEREAL DISEASE 
 
 his private parts, because some of you may think that you 
 need disinfect only at some times and not at others. A 
 man contracts venereal disease by having connection with 
 a woman who is in the habit of going with all and sundry 
 in the same way. Not only women who do it for payment 
 what are known as prostitutes, but any woman with 
 loose morals. In fact, it is those we call " amateurs " who 
 have caused such a frightful amount of venereal disease in 
 the British Army, and it is the same in France. I expect 
 there are some amongst you think I am exaggerating 
 because they have already been with such women and not 
 got venereal. So they think they can ensure their safety 
 by choosing carefully. But they are wrong and for this 
 reason. A woman who goes with an infected man cannot 
 escape getting venereal disease. That means that almost 
 any woman who can be " picked up " has got venereal, 
 because there are thousands of infected men about, and it is 
 almost a certainty that she has already been with one of 
 them. Very often she does not know she has it, and none 
 of you could tell from looking at her that she was suffering 
 from venereal ; only a doctor could tell by a skilled ex- 
 amination that she was infected. So she goes about her 
 work much as usual, and carries on with men the same as 
 before. A man who goes with such a woman may easily 
 enough escape without taking any special precautions, 
 because it is different in that way with men. The microbes 
 are planted on the outside in his case, and may easily be 
 washed away. But you know the old saying, " The pitcher 
 went once too often to the well," and there is nothing truer 
 than that in the case of venereal disease. Sooner or later 
 the man who goes with loose women without taking the 
 precaution to disinfect himself afterwards gets caught. It 
 may not be until the fiftieth time, but very often it is the 
 first. There are plenty of instances where a man has 
 contracted both gonorrhoea and syphilis the very first time 
 he went with a loose woman. Since the war began an 
 enormous number of men in our Army have caught venereal 
 disease. The plague grew so bad that ablution rooms were 
 set up in barracks where men could go and wash the poison 
 out of their pipes by irrigating themselves, and kill it on
 
 APPENDIX III 349 
 
 the surface by rubbing in some antiseptic ointment when- 
 ever they had been in the way of getting venereal. Those 
 ablution rooms did a great deal of good when they were 
 properly used. They stopped a great deal of venereal, but 
 they had some faults. For one thing, many men were shy 
 about being seen going into them, and did not go at all, or 
 at any rate not until it was much too late. Others could 
 not use them because they were on leave and not living near 
 barracks. You must remember that time is everything in 
 the prevention of venereal. The microbes are easy enough 
 to kill when they are still on the surface, but in both syphilis 
 and gonorrhoea they burrow very quickly, especially the 
 syphilis germ, and once they have got below the surface of 
 the water pipe or the skin of the penis it is the most difficult 
 thing, taking many weeks, to turn them out. So the Army 
 authorities have now provided antiseptics which can be used 
 anywhere. All that a soldier has to do after exposure is 
 to go to the medical orderly and ask for some early treat- 
 ment antiseptic. No questions are asked, and he is given 
 a small bottle of Condy, a piece of cotton-wool, and a little 
 tin tube containing some antiseptic ointment. He takes 
 these w^th him to some quiet spot a w.c. or a dark doorway, 
 for instance and first wipes his parts thoroughly well with 
 the cotton-wool soaked in the Condy. He should wash the 
 mouth of his foreskin and all the little crannies round about 
 his bridle-string or bobstay, as sailors call it particularly 
 well, because those parts are apt to have the skin rubbed 
 away from them and let in the syphilis poison very easily. 
 When he has washed in this way, he takes the tube of 
 antiseptic ointment, sticks a pin through the nozzle end of 
 it, and squeezes about half the antiseptic ointment out 
 into his pipe ; the rest of the ointment he rubs well into the 
 end of his penis, and again he takes great care that the mouth 
 of his foreskin and all around the bridle-string are well dosed 
 with the ointment. All this should be done at once. Re- 
 member that the germs are trying to burrow^all the time so 
 as to get into safety, and if you give them too much start 
 you will never catch them. 
 
 You would, no doubt, like to know how much this pre- 
 vents venereal when it is properly carried out. A medical
 
 350 PREVENTION OF VENEREAL DISEASE 
 
 officer in Portsmouth was looking after 2000 troops for 
 about eighteen months. There were something like 16,000 
 men through that barracks in the time, and only four cases 
 of venereal occurred in the whole 16,000. That was because 
 most of them carried out his instructions with regard to 
 disinfecting themselves as soon as possible after exposure to 
 infection. The four men who did get it had not used the 
 disinfectant at all. I could tell you a number of instances 
 like that, but here is just one other to show you the value 
 of disinfecting early. The troopships from New Zealand 
 used to touch at Cape Town, and a lot of men were always 
 allowed to go ashore. The result was that by the time they 
 got to England there was always a crowd of venereal 
 patients to send to hospital. But on one trip the medical 
 officer got the men together before they reached Cape Town, 
 and told them all about the importance of disinfecting 
 after going with women. He told them that if they went 
 with women and did not disinfect afterwards many of them 
 would be sure to get venereal, and advised them very 
 strongly to come and be disinfected as soon as they got back 
 to the ship if they had been in any sort of danger while they 
 were ashore. They practically all took his advice, and the 
 ship landed in England without a single case of venereal. 
 
 This is not told you to show you how to indulge in vice 
 without penalty. You know that on every ship's railings 
 there are always a number of lifebuoys. Of course they 
 are there to save the life of any one who is fool enough to 
 fall overboard. Everybody knows they are for that pur- 
 pose, but nobody thinks they are to encourage men to 
 jump overboard. Well, the early treatment antiseptics are 
 like the lifebuoys. 
 
 One other thing you must bear in mind, and that is this. 
 The disinfectants which are provided for your own use are 
 no good after the disease has really started. The only hope 
 of stopping it, then, is by getting skilled treatment. It is 
 the very worst kind of folly to wait a day after the first 
 signs of the disease have appeared, as all the time it is getting 
 more and more into the system, and every day lost means 
 weeks more treatment, and ever so much less chance of a 
 cure. So, even though he has used the early treatment
 
 APPENDIX III 351 
 
 antiseptic, a man who has been in the way of getting venereal 
 should examine himself every morning for weeks to see if 
 there is any discharge from his pipe or anything looks 
 wrong about his penis. If there is the least feeling of 
 irritation, even only a little itching, or any part looks 
 redder than it should, he should go at once to the medical 
 officer to get advice about it. Remember that nobody 
 can tell at that early stage whether the disease is starting 
 or not unless he uses a microscope, but that is the time which 
 gives the best hope of a rapid cure. The man who waits, 
 hoping for the best, or runs off to some quack or other for a 
 bottle of medicine or lotion, is simply playing ducks and 
 drakes with his future health, and probably condemning 
 his future wife and family to a miserable existence. 
 
 For the sake of our country we must prevent venereal 
 disease at all costs. All the thousands of soldiers who are 
 now suffering from venereal disease have to be replaced by 
 other men. That means so many more men called up, 
 millions more money spent, and so much longer the war. 
 After every war venereal spreads through the country like 
 the plague, and wherever it goes it causes endless misery. 
 Clean, decent, healthy young women who marry infected 
 men get the disease, and perhaps never know a day's enjoy- 
 ment of health afterwards. Children inherit it from their 
 parents and grow up cripples, insane, or blind. Think of 
 the responsibility which lies on a man who causes all that 
 misery, and remember that he could have prevented it if 
 he had only avoided intercourse with women beforehand, 
 or if he had only taken the precaution to disinfect himself 
 at once whenever he had indulged. 
 
 You must remember the history of all this. Four hundred 
 years ago there was a condition of war in Europe much the 
 same as at the present day. The armies marched all over 
 Europe, and when the war was over the soldiers went home. 
 Then two great plagues which had been spread by the 
 soldiers ravaged all the countries. One was small-pox, 
 which killed millions. The other was more awful, and in- 
 vaded every home, striking down prince and peasant. It 
 was called " great pox," and it was the same disease as we 
 call syphilis or " the pox " to-day. Something like that
 
 352 PREVENTION OF VENEREAL DISEASE 
 
 happens after every war, and the bigger the war the more 
 likely the country is to be infested with these horrible 
 diseases. This is the biggest war that has ever been, as you 
 know, and unless we take precautions the venereal plague 
 will be worse after it than it has ever been before. We don't 
 want the homes of England ravaged by these diseases after 
 the war, and now we know how to prevent them it is up to 
 every one to do his best to keep venereal out. 
 
 Now, that is all I want to say. I have talked to you as 
 decent, reasonable men. I have appealed to your common 
 sense. You know as well as I do now how venereal is 
 caught ; you know what a terrible thing it is, and you know 
 how it is prevented. I don't want you to be immoral, but 
 if you will incur danger of disease you must not come back 
 here in a filthy state, bringing disease into the barrack room. 
 For the sake of your comrades, to say the least for the 
 sake of your country, your future wives and families, for 
 the sake of almost everything which makes life worth living, 
 you must disinfect yourselves. 
 
 APPENDIX IV 
 
 INTER - DEPARTMENTAL COMMITTEE ON IN- 
 FECTIOUS DISEASES IN CONNECTION WITH 
 DEMOBILISATION 
 
 NOTE BY THE CHAIRMAN OF THE COMMITTEE (THE HON. 
 WALDORF ASTOR, M.P.) TO THE MINISTER OF HEALTH 
 ON PROPHYLAXIS AGAINST VENEREAL DISEASE 
 
 To the Right Hon. 
 
 CHRISTOPHER ADDISON, M.D., M.P., 
 
 Minister of Health. 
 SIR, 
 
 i. Towards the end of January you appointed an Inter- 
 Departmental Committee to consider the question of what 
 concerted measures should be taken by the Departments 
 concerned to mitigate the dangers of the dissemination of 
 tropical and other diseases among the civil population of
 
 APPENDIX IV 353 
 
 this country from the process of demobilisation and the 
 abnormal shifting of population in the country during the 
 restoration of industry to peace conditions. The Committee 
 comprised myself as Chairman, and representative Medical 
 Officers from the Local Government Board, 1 the National 
 Health Insurance Joint Committee, 1 the Navy, Army, and 
 Air Forces, and such other representatives as might be 
 specially suitable either in place of, or in addition to, the 
 above, at particular meetings or for particular subjects. 
 
 2. Terms of Reference. The terms of reference of the 
 Committee were " to consider the possible risks of intro- 
 duction of infectious and parasitical conditions into the 
 country in the course of demobilisation from the various 
 fronts, and to make recommendations for the purpose of 
 securing close and effective co-operation in administrative 
 measures for dealing with these conditions on the naval 
 and military (including Air Service) and the civil side." 
 
 The Committee considered that the objects coming 
 within their terms of reference were thus threefold : 
 
 (i.) To institute inquiry and to make recommenda- 
 tions with a view to preventing the spread of infection 
 on demobilisation. 
 
 (ii.) To consider and advise as to the co-ordination 
 of the administrative activities of the Departments 
 concerned, and to render assistance by the interchange 
 of information. 
 
 (iii.) To consider whether any special methods of 
 preventing and treating various infective conditions 
 might be required in consequence of demobilisation, 
 or of the occurrence from time to time of epidemics or 
 other disturbing factors in the civil community. 
 
 3. The Committee decided to meet once a week at the 
 outset, and less frequently later, for the consideration of 
 periodical statements on the incidence of various infectious 
 diseases at home and abroad, and in all the various theatres 
 of war. As a result of these meetings, they arranged for 
 the adoption of certain correlations of administrative action 
 in regard to venereal diseases, tuberculosis, malaria, and 
 
 1 Now the Ministry of Health. 
 23
 
 354 PREVENTION OF VENEREAL DISEASE 
 
 certain epidemic diseases in foreign parts. They also 
 appointed a Sub-Committee on malaria which agreed upon 
 the issue of a pamphlet on the subject to Medical Prac- 
 titioners. It was arranged that further leaflets on treat- 
 ment should be put before this Sub-Committee as occasion 
 arose. 
 
 4. The Committee are satisfied as to the substantial 
 advantage of having regular meetings between representa- 
 tives of Departments with common interests and responsi- 
 bility, and they desire to suggest to you that this Committee 
 should form a Standing Inter-Departmental Committee for 
 the present, to consider and to advise from time to time as 
 to the taking of appropriate and concerted measures in 
 respect of public health. Such a Committee would facilitate 
 the effective co-operation of the several Departments in 
 various ways. Representatives of the Home Office and of 
 other Departments concerned should, in that case, be 
 included. 
 
 MEMORANDUM ON PROPHYLAXIS OF VENEREAL DISEASE 1 
 
 5. At the outset of their work the Committee considered 
 a group of infective diseases most likely to be affected by 
 demobilisation, including some acute infectious diseases, 
 malaria, tuberculosis, and venereal disease. In view of the 
 public interest in the subject, the Committee consider it 
 desirable to present to you forthwith a Note in relation to 
 the Prophylaxis of Venereal Disease, reserving for subse- 
 quent statements, as may become necessary, any re- 
 commendations they have to make with regard to this or 
 other diseases. The present memorandum is concerned, 
 therefore, mainly with the advisability or otherwise of 
 officially making available for the civil community certain 
 methods of prophylaxis against venereal diseases (commonly 
 spoken of as the " packet " system), which have been 
 publicly commended as having been successful among 
 combatants during the war. 
 
 1 Including syphilis, gonorrhoea, soft chancre, balanitis, 
 venereal warts, etc.
 
 APPENDIX IV 355 
 
 6. In regard to this question of the prophylaxis 1 of ven- 
 ereal disease, the Committee have sought to ascertain 
 whether the claims of the advocates of such methods have 
 been substantiated : 
 
 First, on the ground of indisputable and substantial 
 benefit in the Services where they have been adopted, 
 and 
 
 Secondly, on the ground that, if proved efficacious 
 in the Services, they may be adjudged applicable and 
 appropriate to the civil community. 
 
 With a view to a determination of this matter, the Com- 
 mittee have addressed themselves in the main to three 
 questions : 
 
 (a) The general value of the various drugs and 
 medical or mechanical means which have been adopted 
 for the prevention of venereal disease, and which have 
 been made available before exposure to infection. 
 
 (6) The extent to which the issue of drugs mentioned 
 in the previous paragraph has proved effective in 
 diminishing the incidence of these diseases in the 
 Forces in which they were used. 
 
 (c) Whether any of these methods, and if so which, 
 are applicable to the civil population. 
 It will be understood that this narrow engagement does 
 not include any direct consideration of the other aspects 
 of the problem of dealing with venereal disease either in 
 the Services or in the civil population. For instance, the 
 Committee have excluded from their consideration of pro- 
 phylaxis, for the purposes of this Note, the whole subject 
 
 1 To avoid ambiguity it was agreed that, for the purpose of 
 the Committee, the following terminology should be adopted : 
 
 Prophylactic Treatment to connote the issue of drugs and 
 appliances made available before exposure to infection, for use 
 by the individual. 
 
 Early Preventive Treatment to connote treatment applied 
 immediately after exposure to infection. 
 
 Abortive Treatment to connote treatment applied immediately 
 on the appearance of symptoms with a view to cutting short 
 the duration of the disease.
 
 356 PREVENTION OF VENEREAL DISEASE 
 
 of the incidence of venereal diseases generally, and the 
 desirability or otherwise of introducing a system of com- 
 pulsory notification of venereal diseases. Nor does this 
 Note include an examination of the desirability, method, 
 or means of providing skilled treatment after exposure to 
 risk of infection. 
 
 The issue which it is desired to lay before you in this 
 Note is restricted to a consideration of the advisability or 
 otherwise of special encouragement being given officially 
 by the Government to the sale of " packets," i.e. the 
 provision, before exposure to infection, of means of prophy- 
 laxis for application or use by the individual, whether before 
 or after such exposure. 
 
 Witnesses 
 
 7. With a view to acquiring a full and adequate pre- 
 sentation of the case, the Committee invited medical 
 representatives speciaUy qualified from professional ex- 
 perience, as well as others who had taken an active interest 
 in the question, to meet the Committee or to furnish them 
 with memoranda of their views. Among those invited to 
 give us the benefit of their experience or advice in this way 
 were Colonel J. G. Adami, C.B.E., F.R.S., M.D., F.R.C.P., 
 Sc.D., Colonel J. A. Amyot, C.M.G., M.B., Canadian 
 Army Medical Corps; Lt.-Col. G. Raffan, M.D., F.R.C.S. 
 (Ed.), Sir J. Barrett, K.B.E., C.B., C.M.G., M.D., M.S., 
 F.R.C.S., Australian Medical Corps ; Major J. Falconer 
 Brown, M.D., New Zealand Medical Corps ; Col. A. M. 
 Whaley, Colonel H. Young, Colonel W. F. Snow, United 
 States Medical Corps ; Major C. F. White, M.B., R.A.M.C., 
 from the British Expeditionary Force ; Sir H. Bryan'JDonkin, 
 M.D., F.R.C.P. ; Sir G. Archdall Reid, M.B., F.R.S. (Ed.) ; 
 Temp. Maj.-General Sir Bertrand Dawson, G.V.C.O., C.B., 
 M.D., B.Sc., F.R.C.P. ; Sir William Osier, Bt., M.D., F.R.S. ; 
 Lady Barrett, C.B.E., M.D., M.S. ; Dr. Agnes Savill ; and 
 Dr. Morna Rawlins. The Appendix to this Report contains 
 a brief abstract of the various data which have been laid 
 before the Committee, of memoranda kindly furnished by 
 some of these experts, and of extracts from the minutes of 
 the Committee. In this note I put before you merely the
 
 APPENDIX IV 357 
 
 main conclusions of the Committee on the particular point 
 under consideration. 
 
 8. The Committee are satisfied that, while certain drugs 
 and medical preparations may be relied upon to remove or 
 destroy the infection of venereal disease, if applied by 
 skilled attendants very shortly after exposure, such satis- 
 factory results cannot be secured if those drugs and pre- 
 parations are used unskilfully or too long a time after 
 exposure. 
 
 As shown in this note, experience indicates that, however 
 careful the instruction, and however scientifically effective 
 the prophylactic in itself might be if used under proper 
 conditions, it frequently fails to protect when applied by 
 the individual, even when this self-application is supported 
 later by additional skilled treatment. The consumption 
 of alcoholic liquors, carelessness, natural excitement, 
 forgetfulness, or ignorance, has been the cause of numerous 
 failures, even amongst those troops where the use of such 
 prophylactic measures has been most efficiently organised 
 and taught. 
 
 9. For purposes of reference the figures showing the 
 incidence of venereal disease x amongst Canadian, Austra- 
 lian, British, and American troops, and also in the British 
 Navy, are set out in separate tables. The Committee invite 
 their careful consideration. 
 
 TABLE A 
 Canadian Forces. 
 
 Admission Rates fov Venereal Disease per 1000 for 
 United Kingdom 
 
 Per Month. Per Annum. 
 
 1915 . . . 18-5 222-0 
 
 1916 . . . 17*45 209-40 
 
 1917 ... 9-5 114-0 
 
 1918 ... 6-8 81-6 
 
 The diminution shown by these figures was attributed by 
 Colonel Adami to a combination of factors, including early 
 treatment,* issue of packets, skilled disinfection, organised 
 
 1 See footnote, p. 354. * See footnote, p. 355.
 
 858 PREVENTION OF VENEREAL DISEASE 
 
 recreation and diminution of alcohol. What part each 
 had played he could not say. 
 
 TABLE B 
 
 The following figures are quoted showing the experience 
 among Canadian troops at Le Havre. A full account of the 
 arrangements adopted at this base will be found in the 
 Appendix on pages 383-5. 
 
 Venereal Disease Rates, Canadian Base 
 Depot, Havre 
 
 Date. 
 
 No. of Men 
 passing through 
 Can. Base and 
 Permanent Staff. 
 
 No. of Treat- 
 ments taken 
 by Officers, 
 N.C.O.s and 
 Men. 
 
 No. of Men who 
 developed V.D.I 
 after Treatment. 
 
 November 1916 
 
 13.959 
 
 155 
 
 O 
 
 December 1916 
 
 I3H3 
 
 476 
 
 O 
 
 January 1917 
 
 5.H3 
 
 542 
 
 O 
 
 February 1917 
 
 6,304 
 
 853 
 
 
 
 March 1917 
 
 7,204 
 
 1,492 
 
 O 
 
 April 1917 
 
 n.573 
 
 1.635 
 
 O 
 
 
 57,266 
 
 5.153 
 
 O 
 
 TABLE C 
 Australian Forces. 
 
 The system organised by the Australian Forces was most 
 thorough. Men were almost individually instructed, and 
 packets were handed with full directions to men going on 
 leave. Theoretically it should have reduced the venereal 
 rate to negligible proportions. 
 
 (a) United Kingdom. The admissions for venereal 
 
 1 This column relates to disinfection by skilled men, after 
 exposure to risk of infection, and not to the results obtained by 
 the issue of packets before such exposure, although both methods 
 of prevention may have been adopted by the men concerned}
 
 APPENDIX IV 
 
 359 
 
 disease l in the Australian Imperial Forces in the United 
 Kingdom since July 1917 as supplied by the Australian 
 Headquarters were as follows : 
 
 Period, Three Months, 
 ended 
 
 Average 
 Strength in 
 A.f.F. 
 Depots in 
 
 Average 
 Weekly 
 Admissions 
 for Venereal 
 
 Total 
 Admissions 
 for Three 
 Months for 
 
 Ratio per 
 1000 per 
 Annum. 
 
 
 U.K. 
 
 Disease. 
 
 Disease. 
 
 
 3Oth September 1917 
 
 62,IO6 
 
 2OO 
 
 2,6OO 
 
 I6 7 
 
 3ist December 1917 
 
 58,288 
 
 IOO 
 
 2,470 
 
 ISO 
 
 3ist March 1918 
 
 55.574 
 
 189 
 
 2,457 
 
 176 
 
 3Oth June 1918 
 
 49,087 
 
 126 
 
 1,638 
 
 133 
 
 3oth September 1918 
 
 5L47I 
 
 131 
 
 1,703 
 
 132 
 
 3 ist December 1918 
 
 53,666 
 
 152 
 
 1,976 
 
 147 
 
 (6) France. The admissions for venereal disease in the 
 Australian Imperial Force in France were : 
 
 Period, Three Months, 
 ended 
 
 Average 
 Strength. 
 
 Average 
 Weekly 
 Admissions. 
 
 Total 
 Admissions 
 for Three 
 Months. 
 
 Ratio per 
 1000 per 
 Annum. 
 
 3Oth September 1917 
 
 118,742 
 
 231 
 
 3,003 
 
 101 
 
 3ist December 1917 
 
 Il8,OOO 
 
 I 5 8 
 
 2,054 
 
 6 9 
 
 3ist March 1918 
 
 "9,743 
 
 ill 
 
 2,353 
 
 78 
 
 3Oth June 1918 
 
 II9,Il8 
 
 134 
 
 1,742 
 
 58 
 
 3Oth September 1918 
 
 109,240 
 
 116 
 
 1,508 
 
 55 
 
 3ist December 1918 
 
 94,130 
 
 US 
 
 i,495 
 
 63 
 
 During the latter part of the war, however, the Austra- 
 lians developed a system under which men in the earlier 
 stages of gonorrhoea reported at a station for abortive 
 treatment, and in the event of this proving successful, 
 patients were not admitted to hospital. 
 
 (c) Figures supplied by the Australian Headquarters 
 
 1 See footnote, p. 354.
 
 860 PREVENTION OF VENEREAL DISEASE 
 
 show that the results of abortive treatment of gonorrhoea 
 in the United Kingdom 1 were as follows : 
 
 
 
 
 
 
 
 Period, Three Months, ended 
 
 
 
 
 Number with Signs of 
 
 Number cured after 
 
 
 Gonorrhoea treated. 
 
 Signs of Gonorrhoia. 
 
 3Oth September 1917 
 
 2,278 
 
 I.37I 
 
 3ist December 1917 
 
 1,787 
 
 I,OOO 
 
 3ist March 1918 . 
 
 1,629 
 
 I,H3 
 
 30th June 1918 . 
 
 1,821 
 
 1,564 
 
 3Oth September 1918 . 
 
 2,195 
 
 1,692 
 
 3ist December 1918 
 
 1,721 
 
 1, 08 1 
 
 Those who were cured by this abortive method were not 
 admitted to hospital, and are therefore not included in the 
 figures under (a) and (6) above. 1 
 
 (d) If, therefore, to the number of admissions in (a) and 
 (6), the number of cures by the abortive methods, shown 
 in (c) be added, the total known venereal incidence for the 
 periods in question is obtained. This total is as follows : 
 
 
 
 Incidence of V.D. 
 
 
 
 
 . 
 
 
 > fc 
 
 Period, Three Months, 
 ended 
 
 Total 
 Strength 
 U.K. and 
 
 Admissionsto 
 Hospital. 
 
 Cures by 
 
 
 ^ ol 
 
 H 
 
 
 
 
 Abortive 
 
 Total. 
 
 S s< 
 
 
 
 
 
 Method. 
 
 
 'o 0. 
 
 
 
 U.K. 
 
 France. 
 
 
 
 
 30th Sept. 1917 
 
 180,848 
 
 2,6OO 
 
 3,003 
 
 1,371 
 
 6,974 
 
 154 
 
 3ist Dec. 1917 . 
 
 176,378 
 
 2,470 
 
 2,054 
 
 I,OOO 
 
 5,524 
 
 125 
 
 3ist March 1918 
 
 I753I7 
 
 2,457 
 
 2,353 
 
 1,113 
 
 5,923 
 
 135 
 
 3Oth June 1918 . 
 
 l68,2O5 
 
 1,638 
 
 i,742 
 
 1,564 
 
 4,944 
 
 118 
 
 3Oth Sept. 1918 
 
 l6o,7II 
 
 i,703 
 
 1,508 
 
 1,692 
 
 4,903 
 
 122 
 
 3ist Dec. 1918 . 
 
 147,796 
 
 1,976 
 
 1,495 
 
 1, 08 1 
 
 4,552 
 
 123 
 
 1 Abortive treatment was not officially carried out in the A.I.F. 
 in France, and no figures are available. 
 
 * It will be noted that the Australian figures for troops in 
 France (which are included in this column) show a V.D. rate
 
 APPENDIX IV 
 
 361 
 
 TABLE D 
 
 British Army. 
 
 
 
 
 Returns for Venereal Disease 
 
 1 per looo per annum 
 
 among 
 
 troops in the United 
 
 Kingdom from 1870 to 1913 
 
 are as 
 
 follows : 
 
 
 
 
 
 1870 
 
 . 201-0 
 
 
 1892 . 
 
 20 1 -2 
 
 
 1871 
 
 . 201-5 
 
 
 1893 
 
 194-6 
 
 
 1872 
 
 . 202 -2 
 
 
 1894 . 
 
 182-4 
 
 
 1873 
 
 . 167-6' 
 
 
 1895 
 
 173-8 
 
 Contagious 
 
 1874 
 
 1457 
 
 
 1896 . 
 
 I58-3 
 
 Diseases 
 
 1875 
 
 . 139-4 
 
 
 1897 
 
 1397 
 
 Acts 
 
 1876 
 
 . 146-5 
 
 * 
 
 1898 . 
 
 132-7 
 
 in force. 
 
 1877 
 
 I53-2 
 
 
 1899 . 
 
 122-4 
 
 
 1878 
 
 I75-5 
 
 
 1900 . 
 
 93 "2 
 
 
 1879 
 
 I79-5 J 
 
 Contagious 
 
 1901 . 
 
 105-4 
 
 
 1880 
 
 - 245-9 
 
 Diseases / 1902 . 
 
 122-7 
 
 
 1881 
 
 245-5 
 
 Acts 
 
 1903 . 
 
 125-0 
 
 
 ^ 1882 
 
 . 246-0 
 
 abolished. 
 
 1904 . 
 
 107-6 
 
 Contagious (1883 
 
 . 260-0 
 
 
 1905 . 
 
 90-5 
 
 Diseases Acts -j 1884 
 
 . 270-7 
 
 
 1906 . 
 
 81-8 
 
 suspended. I 1885 
 
 275-4 
 
 
 1907 . 
 
 72-0 
 
 11886 
 
 . 267-1 
 
 
 1908 . 
 
 68-0 
 
 1887 
 
 . 252-9 
 
 
 1909 . 
 
 66-0 
 
 1888 
 
 . 224-5 
 
 
 1910 . 
 
 65-0 
 
 1889 
 
 . 2I2-I 
 
 
 1911 . 
 
 60-5 
 
 1890 
 
 . 212*4 
 
 
 1912 . 
 
 56-4 
 
 1891 
 
 . 197-4 
 
 1913 
 
 50-9 
 
 lower than that obtaining in England. Figures showing the 
 V.D. incidence among Canadian and Imperial troops in France 
 are not available (and therefore cannot be included in Tables 
 A and F), but it is understood that they show a considerably 
 lower incidence than that among these troops in the United 
 Kingdom. 
 1 See footnote, p. 354.
 
 362 PREVENTION OF VENEREAL DISEASE 
 
 TABLE E 
 
 Rates of Venereal Disease l per 1000 per annum for certain 
 Areas 
 
 Year. 
 
 United Kingdom. 
 
 Aldershot. 
 
 London. 
 
 1885 
 
 27S'4 
 
 3217 
 
 339-4 
 
 1886 
 
 267'! 
 
 30I-I 
 
 259-8 
 
 1897 
 
 1397 
 
 I30-0 
 
 165-2 
 
 1898 
 
 1327 
 
 II5-2 
 
 160-5 
 
 1899 
 
 I22'4 
 
 96*2 
 
 I5O-2 
 
 I9OO 
 
 93-2 
 
 84-4 
 
 I32-2 
 
 I9OI 
 
 I05-4 
 
 69-8 
 
 121*1 
 
 I9O2 
 
 I22'7 
 
 86-0 
 
 I79-I 
 
 1903 
 
 125-0 
 
 1197 
 
 165-4 
 
 1904 
 
 107-6 
 
 79-1 
 
 165-2 
 
 1905 
 
 90-5 
 
 79'9 
 
 176-5 
 
 1906 
 
 81-8 
 
 69-0 
 
 186-0 
 
 1907 
 
 72-0 
 
 60-0 
 
 I62-0 
 
 1908 
 
 68-0 
 
 52-0 
 
 99-0 
 
 1909 
 
 66-0 
 
 48-0 
 
 1 6O'O 
 
 I9IO 
 
 65-0 
 
 50-0 
 
 137-0 
 
 I9II 
 
 60-5 
 
 44-1 
 
 93'2 
 
 1912 
 
 56-4 
 
 37'i 
 
 107-1 
 
 1913 
 
 50-9 
 
 29-8 
 
 95-6 
 
 This Table shows an almost continuous fall in the rate in 
 all three sets of figures. The fall is, however, most marked 
 in the Aldershot Command, where the rate in 1913 was less 
 than one-tenth of the rate in 1885. At the earlier date 
 there was little in Aldershot to attract the soldier except 
 the canteen and the street ; at the later date Aldershot was 
 a model military station, where recreation offered in 
 barracks compared advantageously with the attractions 
 of the streets. On the other hand, in London, where there 
 
 1 From October 1873 to November 1879 soldiers forfeited pay 
 whilst under treatment for Venereal Disease. The low rates 
 during this period are probably due to concealment of disease.
 
 APPENDIX IV 363 
 
 has always been, and there still exists, more to attract the 
 soldier out of barracks than within, the decrease in the 
 venereal rate is least marked. 
 
 TABLE F 
 
 Approximate Rates of Venereal Disease l per 1000 per annum 
 for ALL troops stationed in the United Kingdom, 1916 to 
 1918 
 
 1916* 1917 1918 1919 
 
 January to June . 38 36 43 39 
 
 July to December 34 36 38 
 
 Comparison of Tables 
 
 The figures in Table A refer only to Canadian troops in 
 the United Kingdom. Those in Table C (a) refer to Austra- 
 lian troops in the United Kingdom. As the figures in 
 Table F are an average of all troops (including Australian 
 and Canadian men) in the United Kingdom, it is fair to 
 state that the incidence among British troops in the United 
 Kingdom was very much lower than the incidence among 
 Canadians and Australians. 
 
 1 See footnote, p. 354. 
 
 1 Prophylactic methods were introduced tentatively in 1916, 
 but, until the middle of 1918, were largely neglected, as they were 
 not under adequate supervision. 
 
 1 This figure is for May only, other figures not yet available.
 
 364 PREVENTION OF VENEREAL DISEASE 
 
 TABLE G 
 
 Table showing the Incidence of Venereal Disease in a Certain 
 London Barrack 
 
 Station and Period. 
 
 Ratio of Admissions 
 for Venereal Disease 
 per 1000 per Annum. 
 
 Remarks. 
 
 Special London 
 Barrack 
 Jan. to June 1916 . 
 
 July to Dec. 1916 . 
 _ an. to June 1917 . 
 July to Dec. 1917 . 
 Jan. to June 1918 . 
 
 July to joth Sep- 
 tember 1918 
 Oct. to Dec. 1918 . 
 
 8 9 
 
 37 
 52 
 35 
 44 
 
 42 
 32 
 
 Energetic early 
 treatment cam- 
 paign, with volun- 
 tary self-irrigation 
 and the issue of 
 packets with indi- 
 vidual instruction 
 commenced in 
 May 1916. 
 
 
 
 Voluntary irriga- 
 tion abandoned, 
 and reliance 
 placed only on 
 packets with in- 
 dividual instruc- 
 tion from April 
 1918. 
 
 
 
 The above figures show a remarkable reduction in the 
 venereal rate commencing immediately after the intro- 
 duction of prophylactic methods. They indicate that 
 careful individual instruction can effect reduction. It 
 will be seen from Table F that provision of packets through- 
 out the Army did not reduce the incidence. The returns 
 from individual units appear to show that a reduction is 
 effected only when the medical officer takes a very special
 
 APPENDIX IV 365 
 
 interest in the subject, and neglects no opportunity of im- 
 pressing the importance of prompt disinfection on the men 
 under his charge. It is clear from Table E that this effort 
 must be exceptionally energetic and personal, since the 
 rate has not yet been reduced in spite of the careful instruc- 
 tions issued by the War Office, and the provision of District 
 Inspectors to see that those instructions are carried out. 
 It will be recognised that conditions in the Army are much 
 more favourable to the imparting of individual instruction 
 and to the pressure of personal influence than could ever 
 obtain in the civil community.
 
 366 PREVENTION OF VENEREAL DISEASE 
 
 TABLE H 
 
 Results of questioning 2193 Venereal Patients at Rochester 
 Row Military Hospital, from ist September 1918 to 
 3Oth June 1919, as to the extent to which Self -applied 
 Medicaments were used 
 
 
 
 Admitted with 
 
 
 . 
 
 Stated to have used 
 
 Within 
 u/m 
 
 .2 
 
 8 
 
 q 
 
 Total. 
 
 .1 
 
 o c/j 
 
 
 Hours. 
 
 9 
 
 m 
 B 
 
 ^ 
 
 
 S 
 
 
 
 ft 
 
 
 
 J3 
 
 
 < 
 
 
 
 in 
 
 o 
 
 O 
 
 6 
 
 
 
 Early treatment 
 
 I 
 
 6 
 
 23 
 
 2 
 
 31 
 
 I '4 
 
 (complete calomel 
 
 4 
 
 2 
 
 12 
 
 2 
 
 16 
 
 07 
 
 and pot. perman- 
 
 10 
 
 I 
 
 6 
 
 
 
 7 
 
 0-3 
 
 ganate lotion). 
 
 Later 
 
 I 
 
 5 
 
 I 
 
 7 
 
 
 Calomel tube only . 
 
 i 
 
 2 
 
 14 
 
 4 
 
 20 
 
 0-9 
 
 
 4 
 
 I 
 
 3 
 
 
 
 4 
 
 0-18 
 
 
 10 
 
 I 
 
 3 
 
 
 
 4 
 
 0-18 
 
 
 Later 
 
 
 
 3 
 
 
 
 3 
 
 0-13 
 
 Pot. permanganate 
 
 i 
 
 19 
 
 74 
 
 17 
 
 no 
 
 5-0 
 
 lotion only. 
 
 4 
 
 II 
 
 20 
 
 3 
 
 34 
 
 1*5 
 
 
 10 
 
 3 
 
 6 
 
 2 
 
 ii 
 
 o'S 
 
 
 Later 
 
 2 
 
 21 
 
 6 
 
 29 
 
 i '3 
 
 Antiseptic wash only, 
 
 i 
 
 II 
 
 47 
 
 8 
 
 66 
 
 3-0 
 
 e.g. lysol. 
 
 4 
 
 2 
 
 8 
 
 4 
 
 14 
 
 0-6 
 
 
 10 
 
 
 
 3 
 
 
 
 3 
 
 0-13 
 
 
 Later 
 
 
 
 5 
 
 
 
 5 
 
 O'2 
 
 Took no precautions, 
 
 
 
 419 
 
 1,226 
 
 184 
 
 1,829 
 
 83-4 
 
 including 178 in- 
 
 
 
 
 
 
 
 fections by wives. 
 
 
 
 
 
 
 
 This table appears to show that many soldiers do not use 
 properly the packets which are provided for them, and that 
 a very large number of soldiers do not use packets at all, 
 even when they are made readily available. This may 
 partially explain the apparent failure to reduce the V.D. 
 rates as shown in Table F. The Army returns show that 
 the expenditure of packets is approximately ten per hun- 
 dred men per month. It is known, however, that many 
 men take away more than one packet.
 
 APPENDIX IV 
 
 367 
 
 ROYAL NAVY 
 
 TABLE I 
 Rates of Venereal Disease l 
 
 Year. 
 
 Ratio per 1000. 
 
 Cases. 
 
 Daily Sick. 
 
 1884 
 
 166-35 
 
 I4-I 
 
 1884 
 
 166-35 
 
 I4-I 
 
 1885 
 
 15672 
 
 1 2 -O2 
 
 1886 
 
 148-83 
 
 H-73 
 
 1887 
 
 I54-OI 
 
 12-59 
 
 1888 
 
 I54-49 
 
 12-4 
 
 1889 
 
 179-66 
 
 1373 
 
 1890 
 
 163-58 
 
 I3-II 
 
 1891 
 
 I53-4 
 
 12-15 
 
 1892 
 
 148-05 
 
 12-16 
 
 1893 
 
 i55-o"3 
 
 12-85 
 
 1894 
 
 149-89 
 
 12-18 
 
 1895 
 
 151-44 
 
 12-38 
 
 1896 
 
 I5I-9 
 
 12-14 
 
 1897 
 
 147-81 
 
 10-95 
 
 1898 
 
 I43-97 
 
 10-85 
 
 1899 
 
 130-63 
 
 9-42 
 
 1900 
 
 120-4 
 
 8-71 
 
 I9OI 
 
 H373 
 
 8-56 
 
 I9O2 
 
 "5'45 
 
 8-26 
 
 1903 
 
 121-75 
 
 8-92 
 
 1904 
 
 110-85 
 
 8-22 
 
 1905 
 
 121-49 
 
 8-21 
 
 I9O6 
 
 121-93 
 
 7-99 
 
 1907 
 
 124-33 
 
 8-29 
 
 1908 
 
 122-49 
 
 8-13 
 
 1909 
 
 II9-53 
 
 7-90 
 
 I9IO 1 
 
 118-03 
 
 773 
 
 I9II 
 
 114-92 
 
 7-21 
 
 1912 
 
 105-95 
 
 6-14 
 
 1913 
 
 93-I7 
 
 5-19 
 
 1914 
 
 73-u 
 
 377 
 
 This table shows a steady decrease, due probably to the 
 same factors as affected the Army rates (Tables D and E). 
 
 1 See footnote, p. 354. 
 
 1 Health lectures were made general in 1910.
 
 368 PREVENTION OF VENEREAL DISEASE 
 
 TABLE K 
 
 American Army. Annual Admission Rates l per 1000 per 
 annum for Venereal Diseases 
 
 Year. 
 
 18/3 
 
 1874 - 
 
 18/5 
 
 1876 . 
 
 1877 
 
 1878 . 
 
 1879 
 
 1880 . 
 
 1881 . 
 
 1882 . 
 
 1883 . 
 
 1884 . 
 
 1885 . 
 
 1886 . 
 
 1887 . 
 
 1888 . 
 
 1889 . 
 
 1890 . 
 
 1891 . 
 
 1892 . 
 
 1893 
 
 1894 
 
 1895 
 
 Venereal 
 Disease. 
 
 1 08 
 90 
 1 08 
 in 
 no 
 
 95 
 92 
 
 97 
 92 
 
 78 
 77 
 75 
 80 
 
 72 
 
 74 
 80 
 
 85 
 75 
 72 
 
 77 
 73 
 80 
 
 74 
 
 Spanish- 
 American 
 War and 
 Philippine 
 Insurrection 
 
 Year. 
 
 1896 
 1897 
 
 '1898 
 1899 
 1900 
 1901 
 
 ^ 1902 
 1903 
 1904 
 
 1905 
 
 1906 
 
 1907 
 
 1908 
 
 1909 
 
 1910 2 
 
 1911 
 
 1912 
 
 1914 
 
 1915 
 1916 
 1917 
 
 Six months ended 27th December 1918 : 
 
 All troops in United States 
 Departmental and other troops . 
 Divisional camps .... 
 Cantonments , 
 
 Venereal 
 Disease. 
 
 78 
 
 85 
 81 
 
 138 
 155 
 150 
 161 
 136 
 136 
 156-95 
 143-62 
 149-21 
 I55-I7 
 I5I-35 
 I37-98 
 I45-29 
 115-74 
 85-83 
 
 83-60 
 
 90-0 i 
 
 113-82. 
 
 1 50-62 
 
 84-80 
 
 182-11 
 
 189-89 
 
 In this country, for a strength of some 5000, the U.S-.A. 
 rate has decreased steadily to about 40 per 1000. 
 
 1 From reports of the Surgeon-General, U.S. Army, 1913, 
 1915, 1916, and 1918. In these Reports venereal diseases are 
 classified as syphilis, chancroid, and gonococcal infection. 
 
 * Campaign against venereal disease started in 1910.
 
 APPENDIX IV 369 
 
 American evidence (see Appendix, page 394) showed that 
 packets are distrusted in the American Army, and reliance 
 is placed chiefly on skilled disinfection by a medical officer 
 or a trained orderly. Colonel Whaley stated in his evidence 
 that packets had been found a failure. 
 
 Sir Archdall Reid's Evidence 
 
 The only other statistical evidence supplied to the 
 Committee was that of Sir Archdall Reid, whose evidence 
 included the following statements : 
 
 At Whale Island, in a R.N. establishment of 2000, potas- 
 sium permanganate was used for a period of nine months. 
 During that time there were no cases of gonorrhoea and only 
 one of syphilis in men who used the lotion according to 
 instructions. In the last-named case the man did not 
 apply the lotion for six hours after exposure. 
 
 At Portsmouth, in a body of troops 2000 strong, the men 
 were supplied with a solution of potassium permanganate 
 and swabs of cotton-wool, and were directed to swab 
 themselves immediately after exposure. Only 6 cases of 
 gonorrhoea and i of syphilis occurred. Of these 7 cases 
 (a) 2 were infected by wives, no precautions being taken ; 
 (6) 2 were intoxicated, and so no precautions were taken ; 
 (c} i had just arrived in camp, and had not yet received 
 instruction and took no precautions ; and (d} 2 did not use 
 any disinfectant for an hour or more (i of these was syphilis). 
 
 In considering the above figures I am asked by the 
 Committee to point out that Sir Archdall stated that he 
 did not know 
 
 (1) The percentage of men who used the permanganate 
 
 solution and were subsequently (a) infected ; 
 (6) not infected. 
 
 (2) The percentage of men who did not use the solution. 
 
 (3) The number of men who had venereal disease 
 
 (a) on arrival at the camp ; (6) on departure 
 from the camp. 
 
 He further stated that no routine examinations of the 
 men, who were constantly changing, were made. 
 The Committee have not any figures giving the incidence 
 24
 
 370 PREVENTION OF VENEREAL DISEASE 
 
 of venereal disease among the civilians in Portsmouth nor 
 in other units in the garrison, and no record was made by 
 Sir Archdall Reid 1 to show whether the incidence was 
 higher among those categories who did not use the solution. 
 
 Summary of Examination of Figures 
 
 10. There is much that the figures set out in all the 
 foregoing tables and paragraphs cannot prove, and the 
 Committee recognise the severe limitations which govern 
 deductions to be drawn from them. These figures are 
 few and open to certain statistical fallacies fallacies due to 
 differences of age, marriage, occupation, social factors, 
 and so forth, which bear a much more ultimate relation to 
 the incidence of Venereal Disease than to that of other 
 infectious diseases. Still, the fact remains that they are 
 the only figures of their kind available. So far as they go, 
 they show 
 
 First, that there was an almost continuous fall in 
 the venereal rate in the British Army and Navy during 
 a long period before the war ; throughout that period 
 there was no organised system of any form of pro- 
 phylaxis, but continuous improvement was taking place 
 in social and other conditions affecting the incidence of 
 these diseases ; and 
 
 Secondly, that amongst those forces which during 
 the war employed the prophylactic packet system most 
 energetically, no proportionate reduction was brought 
 about in the infection rate. 
 
 In examining these figures it must also be borne in mind 
 that certain conditions of war, such as absence from home, 
 boredom, and loneliness, irresponsibility, unnatural sur- 
 roundings and unsuitable companionship, exert an effect 
 on human desire and action which tends to create an arti- 
 ficially high rate of exposure to risk of venereal disease in 
 the services during the war. 
 
 Under any mechanical system which does not afford 
 absolute protection, the venereal incidence must be propor- 
 tionate to the risks taken, and it must be borne in mind that 
 
 1 Se Appendix, pp. 403-4. ;
 
 APPENDIX IV 371 
 
 the introduction of such a mechanical system may easily, 
 by its promise of protection, lead to an increase in the 
 number of exposures. 
 
 ii. The Committee desire me to point out that in their 
 view, many of those who wish the Government to utilise in 
 peace time for the civil population, methods which have 
 been tried among the forces in war, have not sufficiently 
 appreciated the fundamental differences between the two 
 groups, or between the conditions of war and peace ; nor 
 have they been aware of the comparative failure of packets 
 even in a disciplined force. The civil authorities cannot 
 command or control the general population (men and 
 women) as officers can properly and legitimately control 
 enlisted men. In dealing with the latter, officers in different 
 forces have had power 
 
 (1) To make medical examinations at regular intervals ; 
 
 (2) To provide facilities for continuous and direct 
 
 propaganda ; 
 
 (3) To punish disobedience of official advice, con- 
 
 cealment of disease, or disregard of treatment ; 
 
 (4) To exclude certain persons from camps, etc. ; 
 
 (5) To put certain places out of bounds ; 
 
 (6) To organise recreation, etc.,; 
 
 (7) To enforce other service regulations. 
 
 It is also the direct interest of the officers in charge of men 
 to keep the venereal rate amongst them as low as possible. 
 There can be nothing in the civil population analogous to 
 this pressure of responsibility and discipline. Unfortunately 
 no civil peace figures are obtainable, but the military and 
 naval pre-war figures are significant as showing a decline 
 in the venereal rate following upon improvement in general 
 conditions and surroundings and the development of re- 
 creation and social amusements. Table E is interesting 
 in showing the more rapid reduction among troops in 
 Aldershot, when recreation was organised, than in London, 
 where social recreations, etc., within barracks had to contend 
 with the counter attractions of the streets. I would also 
 draw special attention to the Army figures from 1870,* 
 
 1 See Table D.
 
 372 PREVENTION OF VENEREAL DISEASE 
 
 which show the venereal rate in the British Army before, 
 during, and after the operation of the Contagious Diseases 
 Acts, and which seem to suggest that methods no less 
 vaunted in their time than is the use of prophylactic 
 " packets " at the present time, were not effective in re- 
 ducing the disease when put into operation. 
 
 Finally, it is the Committee's view that the assumption 
 that the present incidence of venereal disease in the Army 
 is greater than that among a similar number of men in 
 civilian life is not established. 
 
 Conclusions based on Service Experience 
 12. In regard to the general experience of prophylactics 
 distributed before exposure to infection, as prevailing in 
 the various services, the Committee have come to the 
 following conclusions : 
 
 (1) That certain drugs, if properly applied, are 
 efficacious in preventing venereal disease ; 
 
 (2) That if these drugs are not properly or skilfully 
 applied, their efficacy cannot be relied upon ; 
 
 (3) That the issue of prophylactic " packets " tends 
 to give rise to a false sense of security, and thus to 
 encourage the taking of risks which would not be 
 otherwise incurred, and the neglect of facilities for 
 early treatment when available ; and, in certain cir- 
 cumstances, might even increase the spread of disease. 
 
 (4) That in spite of the most careful instruction, 
 the grant or issue of " packets " results in many an 
 individual using them for self-treatment after he finds 
 himself infected. They are not intended for this 
 purpose, and are ineffective when so used. Drugs 
 which are accredited with the power of preventing 
 diseases are very frequently accepted by the public as 
 useful in their treatment. Their use for the treatment 
 of developed disease may be definitely harmful, since 
 they delay diagnosis and the application of proper 
 treatment at a time when promptitude is of the very 
 first importance to its success. 1 
 
 1 This and other points would suggest, too, that the general 
 sale of such medicaments by chemists and unqualified persons
 
 APPENDIX IV 373 
 
 (5) 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 ; 
 
 (6) That the excessive consumption of alcoholic 
 liquors not only diminishes the sense of responsibility, 
 but also tends to prevent the proper use of prophy- 
 lactics and to delay the individual's application for 
 skilled treatment ; 
 
 (7) That the most carefully organised packet 
 system, such as exists now in the Army (a system which 
 would be unattainable in the civil community), has 
 not produced such a general reduction in the incidence 
 of venereal disease as to counteract the disadvantages 
 mentioned in these conclusions ; 
 
 (8) That the organisation of recreation and social 
 amenities has assisted in the reduction of the incidence 
 of venereal diseases in the services before the war, 
 and has also assisted in preventing that increase in 
 the incidence of these diseases which, from past ex- 
 perience, might have been anticipated during the war. 
 
 (9) That energy should not be dissipated on measures 
 of doubtful value, but concentrated rather on wise 
 propaganda and the provision of early, prompt, and 
 skilled treatment, in order to diminish the prevalence 
 of these diseases. It should be recognised that failure 
 to cure these diseases is one of the main causes of their 
 prevalence, and that failure to cure, in the most skilled 
 hands, results largely from failure to treat them in 
 their early stages. 
 
 I have also been asked on behalf of all the representatives 
 of the different Departments who assisted at various times 
 in our deliberations on this subject to record their unanimous 
 view that the true safeguard against these diseases is 
 individual continence and a high standard of moral life. 
 
 might tend to nullify the beneficial results of the Venereal 
 Diseases Act, 1917, as regards the prohibition of treatment, and 
 advertisement of treatment, by unqualified persons.
 
 374 PREVENTION OF VENEREAL DISEASE 
 
 This implies a sound public opinion and a healthy national 
 tone. The Committee set out to examine the evidence 
 placed before them from the scientific and the medical 
 point of view, and it is strictly in this spirit that they desire 
 to record it as their opinion that the irreplaceable effect 
 of the moral factor has been too frequently neglected or 
 forgotten. 
 
 General Conclusion 
 
 13. In view of these findings the Committee are not 
 satisfied that there has been sufficient evidence put before 
 them of the beneficial results gained by the distribution 
 of prophylactic packets in various Forces to prove the value 
 of the system or to justify them in recommending its official 
 encouragement among the civil population. Unquestion- 
 ably there have been many individual cases which appear 
 to afford positive evidence in favour of a system of distri- 
 bution of such prophylactics before exposure to infection ; 
 but the volume of such evidence is too small and too ex- 
 ceptional, and the instances of its failure, even under favour- 
 able circumstances, are too numerous, to allow of any other 
 conclusion than that, in view of the considerations men- 
 tioned above and of the administrative and social difficulties 
 involved, the official application of a packet system to the 
 civil community is neither desirable nor practicable. 
 
 I desire, on behalf of the Committee, to place on record 
 their high appreciation of the manner in which Dr. Seymour, 
 the Secretary to the Committee, has assisted in the pre- 
 paration of this Note. 
 
 Signed on behalf of the Committee, 
 
 WALDORF ASTOR. 
 
 August 1919.
 
 APPENDIX IV 375 
 
 LIST OF CONTENTS 
 
 CANADIAN FORCES 
 
 PAGE 
 
 1. Memorandum submitted by CoL J. G. Adami, 
 F.R.S., M.D., Sc.D. (Professor of Pathology, M'Gill 
 University), on the Prophylactic and Early Treat- 
 ment of Soldiers of the Overseas Military Forces of 
 Canada in Great Britain ..... 377 
 
 2. Evidence of Col. J. G. Adami and Capt. J. Gibbs, 
 from the Office of the D.G.M.S. Overseas Military 
 Forces of Canada . . . . . . .380 
 
 3. Further Information supplied by Col. Adami on 
 the Results of Preventive work at the Canadian Base 
 Depot, Havre ....... 383 
 
 4. Further Information forwarded by Col. Adami 
 regarding work done at Canadian Special Hospital, 
 Etchinghill, in 1918 385 
 
 AUSTRALIAN IMPERIAL FORCES 
 
 5. Information given by Col. Raff an, M.D., F.R.C.S. 
 (Ed.), on the Preventive Measures in connection with 
 V.D. in the A.I.F 386 
 
 6. Addendum to evidence given by Col. Raff an in 
 Appendix 5 . . . . . . . . 389 
 
 NEW ZEALAND FORCES 
 
 7. Evidence of Major J. Falconer Brown, M.D., as 
 
 to the methods adopted in the New Zealand Forces . 390 
 
 GREAT BRITAIN 
 
 8. Navy : Memorandum from the Navy Medical De- 
 partment on the Campaign against V.D. in the Royal 
 Navy . . . . . . . . .391
 
 376 PREVENTION OF VENEREAL DISEASE 
 
 PAGE 
 
 9. Air Force : Information received from Brig.-Gen. 
 Critchley, C.M.G., D.S.O., regarding measures taken 
 to prevent V.D. among the Cadets of the Royal Air 
 Force ......... 392 
 
 AMERICAN FORCES 
 
 10. Evidence of Colonel A. M. Whaley and Major 
 Skelton, Medical Corps, U.S. Army, on the Pre- 
 vention of V.D. in the United States Forces . . 394 
 
 11. Extract from Report of Surgeon-General, U.S. 
 Army, 1918. ....... 398 
 
 VARIOUS MEDICAL VIEWS 
 
 12. Memorandum submitted by Sir G. Archdall 
 Reid,M..B.,CM.,F.R.S.E 399 
 
 13. Evidence of Sir G. A. Reid .... 400 
 
 14. Evidence of Sir H. Bryan Donkin, M.D., 
 M.R.C.S., F.R.C.P 405 
 
 15. Memorandum received from Medical Department, 
 Royal Navy, regarding the results of prophylaxis at 
 Whale Island (vide App. 13, page 402) . . . 406 
 
 1 6. Memorandum submitted by Mr. Frank Kidd, 
 F.R.C.S 407 
 
 17. Evidence submitted by Medical Women on 
 Prophylaxis among Women. ..... 408
 
 APPENDIX IV 377 
 
 APPENDIX i 
 
 THE PROPHYLACTIC AND EARLY TREATMENT OF SOLDIERS 
 OF THE OVERSEAS MILITARY FORCES OF CANADA IN 
 GREAT BRITAIN 
 
 Memorandum submitted by Col. J. G. AD AMI 
 
 A. Issue of Medicaments for Prophylactic Treatment l 
 
 before Exposure to Risk of Infection 
 i . Medicaments employed. 
 
 At first various combinations of drugs were tested ; 
 these have given place during the last 18 months to ... 
 calomel ointment, put up in collapsible tubes. 
 2. Methods adopted for distributing 
 
 (a) Information. The Department provides no litera- 
 ture on the subject, the information given to each man is 
 verbal, in part during the course of the regulation lectures 
 to all units, in part by the N.C.O.s in the early treatment 
 centres in each unit. 
 
 (6) Medicaments. The collapsible tubes are issued 
 gratis to men upon application ; their issue is not com- 
 pulsory, although it is made easily available. 
 3. Statistics. 
 
 (a) With reference to the number of persons who have 
 been supplied with medicaments, the distribution has 
 been to all soldiers at all times upon application. As a 
 matter of policy, no record has been kept of the indi- 
 
 1 To avoid ambiguity it was agreed that, for the purpose of 
 the Committee, the following terminology should be adopted : 
 
 Prophylactic Treatment to connote the issue of drugs and 
 appliances, made available before exposure to infection, for use 
 by the individual. 
 
 Early Preventive Treatment to connote treatment applied im- 
 mediately after exposure to infection. 
 
 Abortive Treatment to connote treatment applied immediately 
 on the appearance of symptoms with a view to cutting short the 
 duration of the disease. 
 
 In Appendix 10 (U.S.A. methods), Col. Whaley used the terms 
 prophylaxis and prophylactic treatment to include early prevent ive 
 treatment.
 
 378 PREVENTION OF VENEREAL DISEASE 
 
 viduals to whom the tubes are distributed, but since 
 April 1917, when the issue was begun, 571,180 tubes 
 have been distributed to the different units for use in 
 England, the number of Canadian troops in Great Britain 
 during this period varying between 180,000 and 275,000. 
 
 It may be noted that at the early treatment centre 
 established by the Canadian Y.M.C.A. at La Pepiniere 
 Barracks, in Paris, Capt. H. L. Walker, C.A.M.C., reports 
 that from ist November 1917 to the beginning of the 
 March campaign 1918, some 22,000 men of the Imperial 
 troops (British and Dominion) were granted leave to 
 Paris, there being from 100 to 1 50 men in attendance daily, 
 and here over 50,000 preventive tubes were given out. 
 
 (6) This Office possesses no figures bearing upon the 
 incidence of syphilis and gonorrhoea in those who have 
 adopted prophylactic treatment. 
 
 B. Early Preventive Treatment 1 
 
 i . Medicaments employed. 
 
 The procedure adopted in the Canadian early treatment 
 centres is indicated in D.M.S. Letter, 25.1.4, of ist May 
 1917. * * * * 
 
 ****** 
 
 2. Methods adopted for distributing 
 
 (a) Information. This is given primarily to every 
 man in the lectures given periodically to all units by the 
 Medical Officers of those units. So soon as Canadian 
 troops arrive in England and pass the segregation camp, 
 they are given a lecture upon venereal disease and its 
 dangers. Every six weeks in the lines, and once a week 
 in Convalescent Hospitals, instructional talks are given 
 to the men. At the Convalescent Hospitals they are 
 given to those admitted during the week, and to those 
 about to be discharged. (The same procedure of frequent 
 lectures to the troops upon sexual hygiene and provision 
 of early treatment centres is adopted in France.) 
 
 (6) Distribution of medicaments for early treatment 
 occurs only in the early treatment centres situated in all 
 
 1 See footnote, p. 355.
 
 APPENDIX IV 379 
 
 hospitals and training areas among Canadian troops. 
 In these early treatment centres the order of the procedure 
 is given in clear language upon easily read wall charts. 
 3. Statistics. 
 
 As a matter of policy, in order to encourage the largest 
 number of men to undertake early treatment, and so 
 reduce the spread of venereal infection 
 
 (a) The treatment is given by non-commissioned 
 officers acting as orderlies in the early treatment centres, 
 under the supervision of the Medical Officers of the unit. 
 
 (6) The names of the men applying for treatment are 
 not officially taken down. 
 
 This Office therefore possesses no official statistics 
 regarding the efficacy of preventive treatment. (Un- 
 officially it learns that a sergeant at the South Camp at 
 Seaford, an old soldier greatly respected by all the men, 
 did, as a matter of fact, keep a list of 5000 men in that 
 camp who applied for early treatment. At this camp all 
 soldiers going sick are passed first to the Detention Hut 
 before being transferred to hospital, which is at some 
 distance, and the sergeant, comparing his list with that of 
 admissions to the Detention Hut, found that out of the 
 5000 only four cases of venereal disease presented them- 
 selves.) 
 4. Information as to the value of the treatment. 
 
 Similarly, no clear information, beyond that of general 
 impression, can be gained as to the value of the treatment 
 according to the length of time that has elapsed between 
 exposure and application of treatment, but the good 
 results just noted as occurring at Seaford appear to be 
 associated with the fact that this camp is relatively 
 isolated, and that the local infection there has been 
 relatively early treatment, as the men return to camp. 
 
 For this information I am indebted to Lieut.-Col. J. A. 
 Amyot, Sanitary Expert attached to the Office of the 
 D.G.M.S., O.M.F.C. 
 
 (Signed) J. G. AD AMI, 
 Col. A.D.M.S., for Director-General. 
 
 Medical Services, O.M.F.C.
 
 380 PREVENTION OF VENEREAL DISEASE 
 
 APPENDIX 2 
 
 Extract from the Minutes of the Committee containing the 
 Evidence of Colonel J. G. ADAMI and Captain J. GIBBS 
 from the Office of the D.G.M.S., Overseas Military Forces 
 of Canada 
 
 The methods for distributing information and encour- 
 aging men to attend for preventive treatment, together 
 with details of the treatment given, had already been sent 
 out in a letter from Colonel Adami, dated i2th February 
 1919. This letter is summarised in Appendix i, pages 
 
 377-9- 
 
 Colonel Adami stated that the following were the average 
 admission rates for 1000 men per month among the Can- 
 adian troops in England : 
 
 1915 .... 18-5 
 
 1916 .... 17-45 
 
 1917 .... 9-5 
 
 1918 .... 6-8 
 
 He attributed this reduction not to preventive measures 
 alone, but also to dissemination of information, to fines 
 imposed on those contracting venereal disease, and to the 
 activities of the Y.M.C.A. 
 
 The Canadian system involved both prophylactic and 
 early preventive treatment. He considered that both had 
 contributed to the results, but there were no data to show 
 which had been the most effective. 
 
 No figures were available showing the V.D. rate in camps 
 where no precautions were adopted as compared with 
 camps where preventive measures were energetically carried 
 out. In his opinion the amount of V.D. was in an inverse 
 ratio to the keenness and energy of the M.O. This was 
 exemplified at * * * * Camp, where the average number 
 of admissions for V.D. in a certain battalion under the 
 first Officer Commanding had been from five to seven per 
 month for several months. When this officer was replaced, 
 the numbers under the second O.C. were, for the first month,
 
 APPENDIX IV 381 
 
 23 ; for the second month, 27 ; and the third month, 35. 
 Following upon this, the O.C. was replaced. 
 
 The average number of daily sick with V.D. could not 
 be stated. If available, such figures might be misleading, 
 as the length of stay in hospital might vary at different 
 periods. 
 
 In the early part of the war, V.D. accounted for 40 per 
 cent, to 50 per cent, of all the sick in Canadian hospitals in 
 England. 
 
 He was unable to supply any figures bearing on the effi- 
 cacy of early preventive treatment according to the time 
 after exposure at which it was applied, but stated that 75 
 per cent, to 80 per cent, of men admitted with venereal 
 disease had acknowledged that they had been infected 
 while under the influence of alcohol. Doubtless such men 
 would not have carried out preventive measures, at least, 
 for some six or eight hours. From this it might be inferred 
 that disinfectants were of little use unless applied within a 
 short time after exposure. The statistics published by the 
 U.S.A. War Department showed conclusively that to be 
 efficacious, disinfection should take place at most within 
 six hours. 
 
 As to whether the methods practised among the Canadian 
 troops would be practicable if applied to the civil population, 
 Colonel Adami thought that while an elaborate sexual 
 toilet would not be generally feasible, it would be possible 
 to issue packets containing some simple antiseptic such as 
 permanganate of potash, accompanied by very clear in- 
 structions for its use. Simple washing with soap and 
 water should be urged. 
 
 The trend of opinion in Canada indicated that such an 
 issue by the Dominion Government might be hoped for 
 before long. There is a great demand there by educated 
 opinion and by organised associations of women, for measures 
 which will prevent these diseases, and there is no disposition 
 to shirk such action on account of the disagreeableness of 
 publicity. The Government might authorise chemists to 
 give out the packets on demand. Ultimately public opinion 
 might be sufficiently educated to demand notification of 
 V.D.
 
 382 PREVENTION OF VENEREAL DISEASE 
 
 In reply to questions by various members of the Com- 
 mittee, Colonel Adami gave the following additional in- 
 formation. 
 
 He was aware that detailed notes had been kept at 
 the Canadian Instruction and Treatment Centre at La 
 Pepini&re Barracks, Paris. The data received by the 
 D.G.M.S. are given in a monthly return, consisting of the 
 following heads : 
 
 (1) Number of Imperial troops on leave in Paris per 
 
 month. 
 
 (2) Number of tubes issued (usually about double the 
 
 number of men on leave). 
 
 (3) Number of early treatments given. 
 
 (4) Number of lectures given. 
 
 (5) Number of actual cases of V.D. reporting (a) 
 
 contracted in Paris ; (6) contracted outside 
 Paris. 
 
 Regarding this last item, it was to be noted that there is 
 a considerable body of troops attached to various offices 
 in Paris, so that in this return there are mixed up cases 
 among those on duty in Paris and those on leave in the 
 city. There is no means, apparently, of obtaining a record 
 of the number of men who, having been on leave, have de- 
 veloped V.D. on return to their units. Thus these figures 
 were not fited to give information regarding the effective- 
 ness of either " tubes " 1 or early treatment. 
 
 Colonel Adami had no special reason for advocating 
 potassium permanganate as a disinfectant ; both the 
 gonococcus and the treponema pallidum were delicate 
 organisms highly susceptible to the action of disinfectants, 
 and a powerful disinfectant was not demanded. 
 
 Great care would be necessary in the names adopted ; 
 thus it had been found in Portsmouth that owing to the 
 dislike of the name, civilians would not attend at an early 
 preventive treatment centre. Again, if the word " treat- 
 ment " is used, the Medical Profession may object to the 
 " treatment " being given by unqualified persons, e.g. 
 ex-army N.C.O.s. 
 
 1 I.e. packets.
 
 APPENDIX IV 383 
 
 He did not agree with the suggestion that the issue of 
 prophylactic packets, by leading to self-medication, might 
 do more harm than good. The advantages of disinfection, 
 in his opinion, outweighed the possible or actual disadvan- 
 tages. 
 
 He considered that the Government would be acting 
 wisely in encouraging the issue or even themselves issuing 
 propaganda literature. He thought that the Government 
 might use the machinery of the local authorities for the 
 distribution of information and advice. Voluntary agencies 
 with branches in all towns might be of great use in conveying 
 information. 
 
 APPENDIX 3 
 Col. Adami sent the following further information : 
 
 On the Result of Preventive Treatment 1 at the Canadian Base 
 Depot, Havre, in the year 1917 
 
 The accompanying statistics * have been received from 
 Lieut.-Col. R. E. Brown, C.A.M.C., now A.I.D., Etaples 
 area, at the time S.M.O. at the Canadian Base Depot, 
 Havre. 
 
 Lieut.-Col. Brown gives the following descriptions of the 
 conditions under which the system of preventive treatment 
 was put into effect. Throughout the summer of 1915 the 
 amount of venereal disease in the Canadian Base Depot 
 was excessive, so much so that in October the Specialist 
 Sanitary Officer, R.A.M.C., brought the matter to the 
 attention of the D.D.M.S. of the Area, pointing out that a 
 large proportion of the cases had contracted the disease in 
 Havre or the neighbourhood, and suggesting that the con- 
 dition was such that the time had come to institute pre- 
 ventive treatment at the Canadian Base Depot. By 
 D.D.M.S. orders this treatment was put in practice at 
 
 1 This refers to treatment after possible infection, not to the 
 issue of packets before risk of infection is incurred. 
 * See p. 380 et seq.
 
 384 PREVENTION OF VENEREAL DISEASE 
 
 Base I, Havre, on ist November 1916. The conditions 
 there were such as to favour the institution of this treat- 
 ment. The Canadian camp was situated at ROuelles in 
 the Harfleur valley, seven miles out of Havre. The evidence 
 was that little disease was contracted in the immediate 
 neighbourhood of the camp, which was sparsely populated, 
 but the opportunities for infection were abundant in Havre 
 itself. The men in the Base Depot were given leave to go 
 into Havre for the afternoon and evening ; those given 
 leave left the camp in a body between 2.30 and 3 o'clock. 
 In Havre itself there was little opportunity for infection 
 before the evening, and this because the houses of ill-fame 
 were each connected with some restaurant, and only at 
 six o'clock were the restaurants and licensed houses thrown 
 open, and could liquor be obtained. Thus it was only 
 after six o'clock that opportunity was afforded for inter- 
 course with habitual prostitutes. The leave men left Havre 
 at 9.30, arriving back in camp about 10 o'clock. 
 
 Here the N.C.O.s, whose duty it was to " tick off " the 
 returned men, were instructed to ask these as they filed in 
 whether they had exposed themselves, and if they replied 
 in the affirmative, they advised them to go to the medical 
 hut to receive preventive treatment. Details of that treat- 
 ment are given on the accompanying return. No names 
 were taken, but a record was made of the number of treat- 
 ments given daily. It deserves note that of 5153 officers, 
 N.C.O.s and men receiving treatment, not one case was 
 reported of development of venereal disease, after that 
 treatment which, as a result of the conditions above- 
 mentioned, was administered between three and five hours 
 after exposure ; further, that the majority of admissions 
 into hospital for venereal treatment, namely, 70 per cent, 
 of the cases, were among men forming new drafts from 
 England. 
 
 The treatment was not compulsory, but its value was 
 made evident to the men, and as a matter of fact, during 
 the six months from November 1916 to April 1917 inclusive, 
 only 49 cases of venereal disease, acquired in Havre by those 
 who had not taken the treatment, were reported from among 
 57,266 troops.
 
 APPENDIX IV 
 
 385 
 
 Prevention of Venereal Disease Canadian Base 
 Depot, Havre 
 
 
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 5,113 
 
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 5,153 
 
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 527 
 
 49 
 
 APPENDIX 4 
 
 The following further information has been forwarded 
 by Colonel Adami : 
 
 Extract from Report covering the work done at Canadian 
 Special Hospital, Etchinghill, during the year ending ist 
 Novemberi 918, by Colonel W. M. MACKINNON, C.A.M.C., 
 O.C. Hospital. 
 
 " Much valuable information has been obtained from 
 the study of the Social Case Sheet, the use of which was 
 originated at this hospital in 1917. A study of 2880 such 
 records shows that practically one-half of all men infected 
 with venereal disease expose themselves to the risk of 
 contracting the disease while under the influence of alcohol. 
 
 " Careful records have been kept with a view of determin- 
 ing the efficiency of prophylaxis and early treatment. The 
 conclusion reached has been that antiseptics used imme- 
 
 25
 
 386 PREVENTION OF VENEREAL DISEASE 
 
 diately before exposure are of little value. Of 2728 men 
 examined, 2132 used prophylaxis in this way, and in spite 
 of this contracted venereal disease. Early treatment after 
 exposure is of a much higher value. . . . 
 
 APPENDIX 5 
 AUSTRALIAN IMPERIAL FORCES 
 
 Extracts from Minutes of the Committee 
 Preventive Measures in connection with Venereal Disease 
 
 Colonel Raffan gave the following information regarding 
 precautionary measures adopted in the A.I.F. : 
 
 The methods consist of 
 
 (1) General instructions to all men on the subject of 
 
 venereal disease. 
 
 (2) Establishment of " Blue Light " depots for early 
 
 preventive treatment and abortive treatment, 
 etc. 
 
 (3) The issue of " Blue Light " outfits. 
 
 (4) The sale of rubber sheaths (condoms). 
 
 (5) Early preventive treatment at the " Blue Light " 
 
 depots. 
 
 (6) Abortive treatment (gonorrhoea). 
 
 Instruction, Outfits, etc. Men are very fully Instructed in 
 the subject of venereal disease, its dangers and prevention. 
 Instruction is specially pushed when troops arrive in 
 England : lectures at intervals are also given in France. 
 All men going on leave are paraded before the M.O., for 
 V.D. instruction. They are offered " Blue Light " outfits, 
 and can at any time obtain further outfits on application 
 at the " Blue Light " depot. They are advised to use 
 rubber sheaths as an additional precaution. These can be 
 obtained at all " Blue Light " depots and canteens at a 
 cost of 3d. each. 
 
 The " Blue Light " outfit contains three tubes of calomel 
 with camphor and carbolic acid added ; a packet of potas- 
 sium permanganate tablets ; wads of cotton-wool and a
 
 APPENDIX IV 387 
 
 card of directions. A bottle for making the permanganate 
 solution is also supplied. 
 
 The instructions contained in the outfit are to use the 
 calomel ointment before exposure to infection, and also 
 immediately after, at the most within one hour ; this 
 protects chiefly against syphilis ; the use of permanganate 
 as a protection against gonorrhoea is also urged. The lotion 
 is to be applied by swabs. Syringes are not issued, though 
 
 he thought they might be advantageous. 
 
 ******* 
 
 The majority of men come for early preventive treatment 
 from 12 to 1 8 hours after exposure. Less than i per cent, 
 report after more than 24 hours. 
 
 Colonel Raffan said he would supply any available figures 
 as soon as possible, but it had been considered necessary to 
 the success of the system that no records should be made of 
 the names, etc., of men attending, so that it was impossible 
 to trace the after-history of the individuals who had come 
 for early preventive treatment. 
 
 In London, from August 1916 to February 1919, 222,882 
 attendances were recorded at the London early preventive 
 treatment depot. For a period of six months the average 
 weekly attendances in the United Kingdom (18 early 
 preventive treatment depots) was 4623. 
 
 ******* 
 
 Any man reporting more than 24 hours after exposure 
 is given semi-abortive treatment against gonorrhoea only. 
 If there is any abrasion he is given a saline dressing, and 
 told to report to the M.O. 
 
 Abortive treatment is given at all " Blue Light " depots at 
 all hours. 
 
 The results show 
 
 Men reporting within 8 hours of appearance of dis- 
 charge =96 per cent, cures. 
 Men reporting within 8-12 hours of appearance of 
 
 discharge = 86 per cent, cures. 
 Men reporting within 12-24 hours of appearance of 
 
 discharge = 86 per cent, cures. 
 
 Men reporting over 24 hours of appearance of discharge 
 =60 per cent, cures.
 
 388 PREVENTION OF VENEREAL DISEASE 
 
 In reply to various questions, Colonel Raffan gave the 
 following further information. 
 
 It is hardly practicable to judge of the effect of any single 
 one of these combined measures. He believed that without 
 these measures V.D. would be enormously greater. But 
 how far they are kept down by prophylactic measures, by 
 early preventive treatment, or by abortive treatment, it 
 is impossible to say. The figures for hospital admissions 
 have no doubt been greatly influenced by the growing 
 adoption of abortive treatment. 
 
 Although the results of prophylaxis did not show a very 
 marked diminution in the number of hospital cases in the 
 past two years or thereabouts, he thought the methods are 
 of value because the number of men attending the "Blue 
 Light " depots had greatly increased, and the number exposed 
 to infection is probably much larger. Men are now more 
 reckless. 
 
 Where, by accident, a unit arrives in a town (in France) 
 before the " Blue Light " depot has been set up, there is an 
 immediate increase in V.D. Also, where a unit shows a 
 V.D. rate markedly higher than the average, inquiry almost 
 invariably shows that prophylactic methods are not well 
 organised or carried out. 
 
 Rubber sheaths alone are not safe they vary in quality 
 and are sometimes very fragile a (calomel) lubricant in 
 addition is desirable. 
 
 Most infections are derived from professional prostitutes. 
 This is the case at present, but previously " amateur " 
 infections have been equal to the professional, or even 
 greater. 
 
 Fifty per cent, of infections In the United Kingdom are 
 acquired in London. 
 
 In Australia no civil scheme of prophylaxis is carried out 
 by the Government, though there are treatment centres in 
 the chief towns. He would inquire further as to recent 
 developments in Australia.
 
 APPENDIX IV 889 
 
 APPENDIX 6. 
 
 Colonel RAFFAN has requested that the following addenda may 
 be made to his evidence given before the Committee (vide 
 Appendix 5) regarding the Australian Imperial Forces. 
 
 1 . I am supplying statistics l showing the main towns in 
 the United Kingdom where disease was acquired, and 
 whether from amateur or professional. This evidence was 
 gathered quite carefully and systematically, and repre- 
 sents as true a picture as can be gained by this means, 
 extending over a period of twelve months. As will be seen, 
 over 60 per cent, of all infections are ascribable to London, 
 the majority being acquired from professional prostitutes 
 or clandestine prostitutes, no distinctions having been 
 made between these two classes. 
 
 2. The Australian system of voluntary prophylaxis is con- 
 sidered by critics to be a good one, and the fact that the 
 incidence of disease has not been markedly decreased is 
 quoted as proof of the comparative failure of the system. 
 
 The prophylactic outfit used exactly according to direc- 
 tions, both before and after connection, will undoubtedly 
 prevent a large number of infections. But unfortunately 
 for various reasons due to carelessness, excitement, and 
 mainly excess of alcohol, there are a large number of men 
 who fail to use the outfit correctly, if at all. Hence the 
 importance of early treatment centres (" Blue Light " depots), 
 where treatment can be given many hours after connection, 
 when a man has regained command of his senses, and when 
 timely treatment will, at any rate, prevent the development 
 of gonorrhoea. 
 
 To me it is not astonishing that thousands of Australians 
 acquired venereal disease in London, because although we 
 had a good system, we did not provide adequate means for 
 carrying it out. In this large city we had only one early 
 treatment centre, viz. 103 Horseferry Road. I have per- 
 sistently advocated the establishment of several additional 
 centres, but this was not agreed to. In order to succeed, 
 
 1 These statistics have not been received.
 
 390 PREVENTION OF VENEREAL DISEASE 
 
 it must be rendered comparatively easy for a man to obtain 
 treatment, and not difficult, as it has been for Australian 
 soldiers on leave in London. 
 
 If we had established half a dozen centres in various 
 parts of London district, I feel certain that the incidence 
 of disease would have been markedly decreased. 
 
 On Salisbury Plain more soldiers attend " Blue Light " 
 depots for prophylactic treatment than in London per 
 month, yet disease acquired in the camp area is negligible, 
 
 and very great in London. 
 
 ******* 
 
 The experiment of including additional antiseptics to 
 calomel, with a view to prevent gonorrhrea, was tried. 
 The ointment was rendered irritating without much, if any, 
 Increase in germicidal action. 
 
 Many men objected to using them on account of the 
 irritation produced. 
 
 (Signed) GEORGE RAFFAN, 
 
 Lieut.-Colonel. 
 
 APPENDIX 7 
 
 Evidence by Major J. FALCONER BROWN regarding the 
 Procedure among the New Zealand Forces 
 
 Major Falconer Brown gave information as to the methods 
 practised in the New Zealand Forces. 
 
 The system is modelled on the lines of the Australian 
 system, and does not materially differ, but the issue of 
 permanganate has not been so constant as in the A.I.F. 
 
 His personal experience is specially that of a V.D. hospital 
 unit. He had made inquiries of the men as to the precautions 
 taken or neglected, and would be glad to forward figures, 
 with explanatory notes. 
 
 In his opinion lack of imagination as to the results of 
 V.D. on the part of the men causes precautions to be 
 neglected. Perhaps only 25 per cent, of the V.D. hospital 
 admissions have used precautions. Probably not one man 
 in 20 will trouble to use a rubber sheath. 
 
 In his view many old cases of gleet might attend at early
 
 APPENDIX IV 391 
 
 preventive treatment centres. The symptoms would tem- 
 porarily disappear, and the result be erroneously claimed 
 as a successful abortive treatment. 
 
 APPENDIX 8 
 
 MEMORANDUM FROM THE NAVY MEDICAL DEPARTMENT ON 
 THE CAMPAIGN AGAINST V.D. IN THE ROYAL NAVY 
 
 (A.) 
 Prevention of Venereal Disease 
 
 1. Lectures. Health lectures, delivered on board ships 
 and other establishments, which include venereal diseases. 
 
 The subject-matter discussed as a rule includes the pre- 
 vention of venereal disease (referred to in section 2). 
 
 2. Prophylaxis before Exposure. The method most 
 generally advised is the use of the Service outfit (calomel 
 ointment . . . and nargol jelly the latter is now no 
 longer issued). The method of use is usually explained in 
 the lectures, or, as in the case of H.M.S. Highflyer, a printed 
 slip was placed in each box, and on it were printed minute 
 directions as to the use of the tubes, both before and after 
 exposure to infection. The importance of the injurious 
 effects of alcohol, which may render a man incapable of 
 carrying out these instructions, was insisted upon. 
 
 Other methods of prophylaxis before exposure are not, 
 so far as I know, generally advised. 
 
 3. Early Treatment after Exposure 
 
 (a) The use of calomel cream. 
 
 (6) Washing with soap and water and the application 
 
 of Condy's fluid, perchloride of mercury lotion or 
 
 mercury unguentum. 
 (c) Injection or irrigation with Condy's fluid. 
 
 4. Exercise, Games, etc. As far as I know, games and 
 exercises have been organised with a view to keeping the 
 men generally fit, and have thus been an indirect deterrent 
 from opportunities of risking infection. The importance of
 
 392 PREVENTION OF VENEREAL DISEASE 
 
 such means have been insisted upon in health lectures to 
 ships' companies. 
 
 5. No figures are available showing the effect of any of 
 the above methods of prevention. 
 
 APPENDIX 9 
 
 Information received from Brigadier-General A. C. CRITCHLEY, 
 C.M.G., D.S.O., Royal Air Force, regarding measures 
 taken to prevent Venereal Disease among the Cadets of 
 the Royal Air Force 
 
 I was in charge of the preliminary training of all pilots 
 of the R.A.F., and about 25,000 cadets and other ranks, 
 from all parts of the British Empire, between the ages of 
 18-30, passed through my hands during the year 1918. 
 The average age, I should think, would be about 19 years. 
 Owing to the fact that when the Armistice was signed the 
 Cadet Brigade, R.A.F., ceased functioning, any figures I 
 give you must be regarded as only roughly approximate. 
 
 When I took over the training of cadets for the R.A.F., 
 the venereal disease in the command was between 8 and 10 
 per cent. ; at the end of the next nine months the disease 
 was reduced to less than 0-4 per cent. 
 
 The methods adopted were as follows : 
 
 i. The cadets arrived at the Cadet Brigade in drafts 
 varying between 400 and 600 per week. When they had 
 been there about a fortnight and had been pronounced fit 
 to carry on with their more advanced training, as General 
 Officer Commanding the Brigade I gave three-quarters of 
 an hour's lecture to them before they passed on to their 
 higher training. During this lecture I talked to them on 
 the following headings : 
 
 (1) Discipline. 
 
 (2) Sportsmanship and Cheerfulness. 
 
 (3) Loyalty and Patriotism. 
 
 (4) Clean Living. 
 
 I may here say that these cadets were the most receptive 
 audiences I have ever talked to ; this, I think, was due to
 
 APPENDIX IV 893 
 
 their average youthful age and their real desire for know- 
 ledge. 
 
 The reason I mention the other subjects I spoke on is to 
 show that one gradually worked them up to what I con- 
 sidered to be the most important part of their training, 
 i.e. clean living. 
 
 Under paragraph (4) I talked to them about venereal 
 disease in the most open way possible, not as a parson, nor as 
 a doctor, but as one of themselves. I told them everything 
 I knew about the disease, its causes and effects, how it 
 would probably affect them in after-life, and their wives and 
 children as well. In a word, I told them the absolute truth 
 regarding venereal disease, and frightened them consider- 
 ably. 
 
 This talk I considered to have more effect than anything 
 else in reducing the percentage of the disease, because they 
 were of that age when it affected them profoundly. But 
 in any talk of this kind, there must be no " camouflaging " 
 or beating about the bush, a spade must be called a spade, 
 and the lecturer must talk to them as a man. 
 
 2. I issued no posters, and do not believe in them, as I 
 consider they defeat their purpose, because there are 
 always a few hardened sinners who ridicule them, and, as 
 a result, that with the majority they do more harm than 
 good. 
 
 3. I issued no leaflets. These I consider are not much 
 better than posters, unless a lecturer will take one during 
 his address and go through the points in it with his audience. 
 
 4. Games and outdoor amusements I consider essential 
 to the control of V.D. In the curriculum of training I had 
 about 1 5 hours of compulsory games and physical training 
 per week, and I think they are big factors in the reduction 
 of venereal disease. 
 
 5. The more social entertainments that can be arranged 
 the better ; they are a great help in assisting the fighting 
 of the disease. 
 
 6. Clothing and feeding need careful consideration, and 
 are factors that must be brought in when going into a case 
 of this kind. 
 
 7. I refused to issue prophylactic " packets," because I
 
 394 PREVENTION OF VENEREAL DISEASE 
 
 considered that the cadets as a whole were much too young, 
 and that to issue the " packets " to lads of their age would 
 be more inclined to encourage immorality than otherwise. 
 I told them that if they did expose themselves to infection, 
 to go to their regimental doctor at once, and the doctors 
 were given instructions to do all in their power to help them. 
 
 If the Government propose to take this matter up seri- 
 ously, I would make the following suggestion as one of the 
 most important measures in the fighting of V.D., that a 
 law be passed making circumcision essential within a year 
 of birth ; this would curtail a tremendous amount of 
 venereal disease. 
 
 April 1919. 
 
 APPENDIX 10 
 
 UNITED STATES FORCES 
 
 Evidence on Venereal Disease Prevention 
 
 Extract from the Minutes of the Committee containing the 
 Evidence of Col. WHALEY and Major R. SKELTON, who 
 handed in a Statement on the Methods and Results of 
 V.D. Prophylaxis in the United States Army. 
 Relative to the issue of medicaments for prophylactic 
 treatment before exposure to risk of infection : The 
 American Army does not issue for use, nor encourage the 
 use, of any medicaments or any other protective method 
 before intercourse. To men going on pass or leave to an 
 area at a distance from a prophylactic station, individual 
 prophylactic tubes have lately been issued. When prophy- 
 laxis was first instituted in the American Army, individual 
 prophylactic tubes, put in a wooden cover to resemble a 
 cigar, were issued to enlisted men going to nearby towns 
 from their garrison or camp. Public sentiment, on the 
 ground that such issue was morally wrong and tended to be 
 suggestive, forced the Army authorities to abandon the issue 
 of individual prophylactic tubes. Prophylactic stations 
 were then established, to which men report upon return to 
 their garrison or camp. It was quite apparent, also, that in 
 the case where men reported at a station for proper treat-
 
 APPENDIX IV 395 
 
 ment and official registry, the authorities could be assured 
 that such prophylactic was administered, whereas when 
 individual tubes were issued to a man there was no assur- 
 ance of such treatment other than the soldier's statement. 
 ******* 
 
 Methods adopted for Distribution. (a) Medical officers of 
 all commands are required, usually once a week, oftener 
 depending on the venereal rate, to lecture to their command, 
 explaining the danger of venereal disease, with a few simple 
 facts as to how each of the three venereal diseases affects 
 a man, how venereal disease may be prevented, and the 
 value of the venereal prophylactic. General orders require 
 that enlisted men report for prophylaxis within three hours 
 after intercourse. This order must be read frequently to 
 the command. The enlisted man soon learns that if he 
 contracts a venereal disease he will be court-martialled for 
 neglect of duty, whether he takes the prophylactic or not. 
 If he fails to take the prophylactic, he is court-martialled 
 on a separate charge for this offence. 
 
 (6) Men with venereal disease are treated on a duty 
 status, i.e. they are not admitted to hospital until a com- 
 plication arises which demands hospital treatment. While 
 in hospital for venereal disease all pay and allowances stop. 
 
 (c) Medicaments are not issued to men except when they 
 go on leave to an area at a distance from a prophylactic 
 station. 
 
 Figures showing accurately as possible. (a) Number of 
 persons who have been supplied with medicaments. This 
 report not required by the Statistical Division for this 
 base section. For the week ending Wednesday, 5th March, 
 the strength of American troops in England was about 
 4803. The entire number of prophylactics administered 
 during this week was 172. This is considered entirely too 
 low. The average number of prophylactics administered 
 to any command per month varies between 10 and 30 per 
 cent., depending upon the amount of leisure granted the 
 command and the facili ties at hand for intercourse. There 
 is a marked difference in the number of prophylactics 
 administered in different commands. Base Hospital No. 
 6, Bordeaux, gave prophylactics to 50 per cent, of its
 
 396 PREVENTION OF VENEREAL DISEASE 
 
 strength in one month. Base Section No. i, St. Nazaire, 
 averaging 100,000 strength, gave prophylactics to 1 1 per 
 cent, of its strength in a month ; Base Section No. 2, 
 Bordeaux, 25 per cent., and Tours 33 per cent. 
 
 (b) The number of instances in which syphilis and gon- 
 orrhoea have developed in men who have taken prophylactic 
 treatment. 
 
 A table showing the new cases of venereal disease con- 
 tracted in England since ist January 1919 shows that 
 61-5 per cent, failed to take the prophylactic. The Sur- 
 geon-General, A.E.F., states one-third of the cases of 
 venereal disease which developed hi the A.E.F. failed to 
 take prophylaxis (i.e. early prevention treatment, see 
 footnote, p. n). 
 
 4. Information as to the Value of the Treatment. Within the 
 first hour the failures are only one-tenth of i per cent., or 
 i in looo ; the second hour one-half of i per cent., or i in 
 200 ; and after three hours from i to i to 7 per cent., or 
 i in 75 to i in 14. The average rate of failure for the A.E.F. 
 is 2 per cent., which indicates that the men do not report 
 within three hours. 
 
 Of 23,702 men taking prophylaxis over a period of 22 
 weeks, only i per cent, developed venereal disease, although 
 many of them did not apply within the three-hour limit of 
 greatest value (statistics S.O.O., D.C.). 
 
 Inspections and prophylaxis caused reduction from 155 
 per looo in 1910 (first introduced) to 83*6 per 1000 in 1915. 
 
 In answer to questions by various members of the Com- 
 mittee, the following additional information was given : 
 
 The use of permanganate had been adopted, but subse- 
 quently given up, as protargol was considered more efficient. 
 
 As a working basis it might be taken that three hours 
 was the maximum safe limit which might be allowed after 
 exposure before early preventive treatment was applied. 
 Under three hours the number of failures was well below 
 
 1 per cent. If three hours or more were allowed to elapse 
 the failure rate varied from i per cent, to 7 per cent. 
 The average rate of failures among American troops being 
 
 2 per cent, indicates that the majority of men fail to 
 report for treatment within three hours. This is in spite of
 
 APPENDIX IV 397 
 
 the fact that men are punished for contracting V.D., and 
 the punishment is doubled if they have not taken pre- 
 cautions. 
 
 Colonel Whaley thought that penal measures did not lead 
 to concealment, as it would be difficult for men to escape 
 detection owing to the weekly or fortnightly medical in- 
 spections that are made, in which the body is stripped for 
 examination. 
 
 The average V.D. rate in the A.E.F. for the past six 
 months has been between 30 and 40 per 1000 per annum. 
 In Colonel Whaley's opinion the rate among civilian men 
 of comparable ages was, perhaps, as much as three times 
 that in the Army. Wassermann tests applied to men on 
 joining from civil life showed that about 16 per cent, showed 
 a positive reaction. 
 
 In answer to various questions as regards the desirability 
 of issuing calomel tubes for use before exposure to in- 
 fection, Colonel Whaley stated that the failure of this 
 method of prevention which has been experienced in the 
 American forces was, in his opinion, due to the fact that 
 the women concerned would not allow the men to use the 
 tube, as calculated to cast a slur upon their health. 
 
 In his opinion, prophylactics by means of calomel tubes 
 would be badly administered by the man himself. Differ- 
 ences in results had been noted at various early preventive 
 treatment centres where the treatment was given by trained 
 attendants, and the variation in technique where the 
 treatment was applied to himself by an unskilled man would 
 be greater. Further, in his opinion, the habit of going to a 
 centre, once established, the man would be more likely to 
 return there and obtain proper treatment in the event of 
 his developing disease. Therefore centres should be under 
 the supervision of a qualified doctor, to whom cases of 
 disease can be referred. 
 
 A higher V.D. rate had been noted when calomel tubes 
 were used than when sole reliance was placed on centres. 
 
 Colonel Whaley was strongly of opinion that for the civil 
 population good propaganda and centres would be of con- 
 siderable value, but he was decidedly not in favour of the 
 issue of packets for self-disinfection. He realised that to
 
 398 PREVENTION OF VENEREAL DISEASE 
 
 meet the needs of the civil population large numbers of 
 centres would be necessary. He considered that the centres 
 could be established in towns in places where exposures 
 were likely to take place. In spite of the fact that two- 
 thirds of the failures of prophylaxis were due to the length 
 of time that had elapsed after exposure, he considered 
 centres preferable to self-disinfection. 
 
 He was of opinion that every effort should be made to 
 promote morality among men, and to do away with the 
 arbitrary differences of moral standard which existed be- 
 tween girls and young men in the same class of life. 
 
 APPENDIX ii 
 
 The United States programme of attack on venereal 
 diseases is summarised under the following headings in 
 the Report of the Surgeon-General, U.S. Army, 1918 : 
 
 A. Social measures to diminish sexual temptations : 
 
 (1) Especially repression of prostitution and the liquor 
 
 traffic. 
 
 (2) The provision of proper social surroundings and 
 
 recreation, both within and without the military 
 establishments. 
 
 B. Education of soldiers and civilians in regard to ven- 
 ereal diseases and the moral hazards related thereto : 
 
 (1) For soldiers through official lectures, pamphlets, 
 
 exhibits, motion pictures, and correlated edu- 
 cational work of the chaplains and representa- 
 tives of religious and social agencies under the 
 supervision of the Commission on Training 
 Camp Activities. 
 
 (2) For civilians through encouragement and assistance 
 
 to professional, business, commercial, religious, 
 men's and women's organisations and social 
 welfare associations.
 
 APPENDIX IV 399 
 
 C. Early treatment (or prophylactic measures) against 
 venereal diseases : 
 
 (1) Through treatment stations established in regi- 
 
 mental infirmaries and in cities accessible to 
 large numbers of troops. 
 
 (2) Through follow-up measures adapted to individual 
 
 cases to discourage subsequent exposures to 
 infection. 
 
 D. Medical care of those infected : 
 
 (1) Through hospitalisation of all cases requiring such 
 
 action for the best interests of the patient, for 
 shortening of the non-effective period, and for 
 the protection of other soldiers. 
 
 (2) Dispensary treatment and follow-up supervision 
 
 for those who do not require admission to or 
 further detention in the hospital. 
 
 APPENDIX 12 
 
 PRECIS OF A MEMORANDUM SUBMITTED BY Sir G. 
 ARCHDALL REID, M.B. 
 
 Sir Archdall Reid said that as regards prophylaxis before 
 exposure to infection, no medicaments were, in his opinion, 
 of use in preventing syphilis or gonorrhoea. Calomel is 
 probably inert on the surface of the body, but is apparently 
 converted into perchloride within the tissues. Hence good 
 results are obtained by rubbing calomel into the site of 
 infection. 
 
 For use after Risk of Exposure to Infection. Probably an 
 active antiseptic is an almost certain preventive if applied 
 very soon after exposure. Sir A. Reid has only experience 
 of perchloride and potassium permanganate. He has 
 recently used only the latter (solution of i in 1000). He 
 contended that what is required is not that men should go 
 to an early preventive treatment centre on return to 
 barracks, but that disinfectant should be applied imme- 
 diately after exposure, because immediately after exposure 
 infectious material will be on the surface. No surgeon
 
 400 PREVENTION OF VENEREAL DISEASE 
 
 would wait some hours before disinfecting his hands after 
 handling infective material, and it is even more necessary 
 that the glans, which is a highly tender and sensitive part 
 of the body, should receive immediate disinfection. 
 
 In his opinion the War Office specimen lecture on the 
 prevention of disease failed to be effective owing to the 
 insertion of the words " after exposure " in the following 
 sentence, " All that a soldier has to do after exposure is to 
 go to the medical orderly and ask for some early treatment 
 antiseptic." Otherwise the specimen lecture was more or 
 less identical with a lecture which Sir Archdall Reid was 
 accustomed to give to troops in his charge. 
 
 Sir Archdall Reid strongly urged that the essential ele- 
 ment is not any particular disinfectant, but immediate 
 disinfection, the materials for which should be ready in 
 the man's pocket, not on the shelves of the early preventive 
 treatment hut. He considered that it was unnecessary to 
 deal with women. It is almost impossible to disinfect a 
 woman. If men are kept free from disease, women will 
 cease to suffer. 
 
 APPENDIX 13 
 
 Extract from the Minutes of the Committee 
 
 Sir G. Archdall Reid gave the following information to 
 the Committee : 
 
 In his opinion prophylaxis before exposure to infection was 
 of no value, but the use of any active disinfectant im- 
 mediately after exposure was of great value in preventing 
 V.D. Even soap and water might be effective if used at 
 once. He advocated the use of permanganate of potash 
 in a solution. Immediately after exposure gonococci 
 would not have entered the urethral canal, and treponemata 
 would be still on the surface. It was, however, dangerous 
 to allow any time to elapse before disinfecting. No surgeon 
 would wait some time before disinfecting his hands after 
 handling infective material. Disinfection after exposure 
 to V.D. infection should be within five minutes, earlier if
 
 APPENDIX IV 401 
 
 possible, therefore a disinfectant that could be used at any 
 time and in any place was required. Treatment centres 
 would be of no use as treatment would be too late, and many 
 persons would be ignorant of the address of the centre. 
 
 He considered that swabbing could be carried out by the 
 man who had exposed himself, with almost as great likeli- 
 hood of success as if it were carried out by a trained person. 
 
 He did not think permanganate was the only disinfectant 
 that could be employed, but it recommended itself on 
 account of its simplicity and the readiness with which it 
 could be obtained. In his opinion, however, perman- 
 ganate was a more powerful disinfectant than calomel 
 ointment. Owing to its insolubility he did not think that 
 calomel was a disinfectant at all. Whatever preventive 
 action calomel ointment possessed was due, not to the 
 calomel, but to the vehicle in which it was suspended. 
 The ointment plugged the urethra and clogged and cleansed 
 the surface of the penis, much as soap and water would do. 
 The large number of failures to prevent disease which have 
 marked the use of calomel ointment clearly indicate a 
 mechanical, not an antiseptic, action, and is in sharp con- 
 trast to the total, or almost total, lack of failures which 
 follow the -immediate use of an active antiseptic. In the 
 records of the Army and Navy may be found the cases of 
 thousands of men who have acquired disease after the use, 
 immediate or delayed, of calomel, or after the delayed use 
 of permanganate, but very few, if any, cases of men who have 
 acquired disease after the immediate use of permanganate. 
 At the same time he was prepared to admit that if any 
 delay occurred in disinfecting after exposure to infection, it 
 would be necessary to use calomel ointment as a preventive 
 of syphilis probably when applied to an abrasion, and, 
 therefore, acting in the tissues, calomel was converted into 
 perchloride. When delay occurred, an injection would 
 also be necessary, but he did not think syringes necessary 
 unless there was delay. A syringe might be used by an 
 ignorant person with comparative safety, but the civilian 
 would use the simplest possible method and would be more 
 likely to obtain and use the permanganate lotion. 
 
 He considered that it was both desirable and practicable 
 26
 
 402 PREVENTION OF VENEREAL DISEASE 
 
 to convey to the public the necessary information on 
 self-disinfection. This might be done by means of posters 
 in public urinals, etc., and by suitably worded articles in 
 the press. He would word the posters and articles so that 
 men would be able to follow the instructions, and that there 
 would be no danger of the public falling into the error of 
 supposing that prophylactic methods were of any use in 
 the treatment of established disease. It was necessary to 
 make clear to men that " as soon as possible " meant 
 " at once," and not " as soon as disease appears." He 
 referred to poster which he had had exhibited in the camp 
 of which he was in charge. 
 
 In support of his views Sir Archdall Reid gave the 
 following information : 
 
 (a) Before the war, ist Battn. Yorks Regiment was 
 at a hill station in India, where there were no women 
 and no V.D. On moving to Delhi (" a hotbed of 
 disease ") the M.O. issued potassium permanganate 
 crystals, with instructions to make a solution and swab 
 immediately. In the four years following, the battalion 
 had only six cases of gonorrhoea, and none of syphilis. 
 
 (6) At Mhow, V.D. was " reduced to negligible 
 proportions " by similar means. 
 
 (c) At Whale Island, in a R.N. establishment of 
 2000, potassium permanganate has been used for the 
 past nine months. There have been no cases of 
 gonorrhoea and only one of syphilis among those using 
 the solution. In the last-named case the man did not 
 apply the lotion for six hours after exposure. 
 
 (d) At Portsmouth, in a body of troops 2000 strong, 
 the men were supplied with solution of potassium 
 permanganate and swabs of cotton-wool, and were 
 directed to swab themselves immediately afer exposure. 
 Only six cases of gonorrhoea and one of syphilis occurred. 
 Of these seven cases - 
 
 Two were infected by wives no precautions taken ; 
 Two were intoxicated no precautions taken ; 
 One had just arrived in camp had not yet received 
 instructions, and took no precautions ;
 
 APPENDIX IV 403 
 
 Two did not use any disinfectant for an hour or more 
 (one of these was syphilis). 
 
 The personnel was undergoing constant change, some 
 men only remained a few weeks, some a year, the majority 
 several months. 
 
 He could not supply any information as to 1 
 
 (1) The percentage of men who used the permanganate 
 
 solution and were (a) infected ; (6) not infected.* 
 
 (2) The percentage of men not using the solution. 1 
 
 (3) The number of men who had V.D. (a) on arrival at 
 
 the camp ; (6) on departure from the camp. 4 
 
 1 Sir Archdall Reid's subsequent comments are given In the 
 four following footnotes : 
 
 1 The foregoing questions and answers, unless they be sup- 
 plemented, are apt to convey very misleading impressions. By 
 the instructions issued by the Army authorities, the bottles con- 
 taining the permanganate solution were placed in situations 
 whence the men could help themselves by day and night. Control 
 by the M.O. was ordered, but in the same memorandum instruc- 
 tions were given which entirely precluded all possibility of 
 effective control. It was quite impossible to know what men took 
 bottles, or what use they made of them. It is impossible, 
 therefore, to ascertain what percentage of men used the bottles 
 and thereafter were (a) infected, and (b) not infected. It can 
 only be said that not one man who stated he used the solution 
 immediately, or even an hour after exposure, reported sick. 
 But two men who delayed its use for more than an hour were 
 infected, and four others who took no precautions also reported 
 sick. 
 
 8 Any knowledge as to this is rendered impossible by the 
 Army instructions. 
 
 4 A fair number of men suffering from V.D. in its later stages 
 (some 30 or 40 probably) were sent to the camp, presumably 
 because it was near an Army V.D. hospital, with orders for 
 continuation of treatment. It was ascertained that these men 
 were returned in reports asked for by the Director-General, 
 R.A.M.C., as " cases from Clarence Barracks." One healthy 
 man was ordered from Gosport to Clarence Barracks, but went 
 on the spree for a week, and was then captured and brought to 
 the barracks suffering from acute alcoholism and commencing
 
 404 PREVENTION OF VENEREAL DISEASE 
 
 He believed, however, that all men who had V.D. would 
 have reported to him as M.O. of the unit. He had no in- 
 formation as to the prevalence of V.D. (a) in Portsmouth 
 generally ; (6) in other units in the garrison. 1 
 
 In support of his claim for early disinfection, he drew 
 attention to the following U.S.A. figures published by the 
 N.C.C.V.D. : 
 
 Hours subsequent 
 to Exposure. 
 
 Number of 
 Treatments. 
 
 Number of 
 Infections. 
 
 Percentage of 
 Infections. 
 
 I 
 
 1180 
 
 I 
 
 0'08 
 
 2 
 
 1172 
 
 7 
 
 0'S9 
 
 3 
 
 521 
 
 4 
 
 077 
 
 4 
 
 330 
 
 2 
 
 0-61 
 
 5 
 
 199 
 
 3 
 
 1-57 
 
 6 
 
 321 
 
 3 
 
 i-58 
 
 7 
 
 277 
 
 6 
 
 4-27 
 
 8 
 
 390 
 
 16 
 
 4*22 
 
 9 
 
 283 
 
 10 
 
 3-62 
 
 10 
 
 214 
 
 ii 
 
 5-14 
 
 More than 10 
 
 216 
 
 16 
 
 7-40 
 
 Total 
 
 5103 
 
 81 
 
 I- 5 8 
 
 gonorrhoea. No other men are known to have joined or left the 
 station suffering from V.D. The circumstances are such that 
 it is immensely improbable that an appreciable number so 
 suffering did join or leave. 
 
 1 Information as to this was Sought, but declined (on the ground 
 that it was confidential) by the authorities responsible. It may 
 be stated, however, that the permanganate method was explained 
 in conversation to the medical officers of troops in Portsmouth 
 (proper), Southsea, and Portsea ; and the fact that the essence of 
 the method consisted not in the use of permanganate, but in 
 the speedy use of any real antiseptic, was insisted on. At least 
 one M.O. (Dr. Cashin) has stated that he got much improved 
 results. As to the others, no information is at hand. Possibly 
 a very useful return might be compiled, if the percentage of 
 cases occurring within the areas above indicated were compared 
 with districts in the neighbourhood, but farther afield. , - t
 
 APPENDIX IV 405 
 
 VENEREAL DISEASE 
 Extract from Minutes of the Committee 
 
 The following is an extract from a letter from Sir G. A. 
 Reid to the Secretary of the Committee : 
 
 I do not know if it would be in order for me to make 
 an additional suggestion ; but, if it be possible, I should 
 be glad if it were brought to the notice of the Committee. 
 
 I am aware that many authorities do not share my 
 view that calomel is inert on the surface of the body. 
 Moreover, calomel, if not useful, is at any rate harmless 
 on the surface, and is certainly very valuable in de- 
 stroying the organisms of syphilis after they have 
 penetrated the tissues. The suggestion I wish to make 
 is this that an active antiseptic (say, perchloride of 
 mercury) shall be added to the calomel cream. If the 
 perchloride were added ... it would make no addition 
 to the bulk of the ointment and would probably make 
 it an almost ideal preventive agent. 
 
 APPENDIX 14 
 
 Extract from Minutes of the Committee containing the evidence 
 of Sir H. BRYAN DONKIN 
 
 Sir H. Bryan Donkin said he had no personal clinical 
 experience in the use of medical prophylactics against V.D., 
 nor any statistics, owing to the obstacles which have been 
 put in the way of administering the prophylactic method, 
 but generally concurred in Sir Archdall Reid's views. In 
 his opinion the desirability of prophylaxis should be im- 
 pressed on the public. He agreed that it was difficult 
 officially to advocate any particular disinfectant unless 
 supported by figures. He thought any simple method of 
 disinfection would be effective : a solution was preferable to 
 an ointment. He did not think that the dissemination of 
 knowledge of prophylaxis would lead to increased indulgence. 
 
 Jii his opinion, in default of large numbers, and in view of
 
 406 PREVENTION OF VENEREAL DISEASE 
 
 the present impossibility of getting comparative figures, 
 so-called " isolated " sets of statistics, such as those of Reid 
 and Boyden, are of considerable value. 
 
 APPENDIX 15 
 
 Copy of Memorandum from Senior Medical Officer, H.M.S. 
 Excellent, Portsmouth, to Medical Director-General, 
 Admiralty, dated 2nd April 1919 
 ******* 
 
 In this establishment two methods of prevention of V.D. 
 have been in vogue since ist April 1918, and detailed 
 instructions as to mode of application are given in my 
 weekly hygiene lectures. 
 
 (a) Immediate prophylaxis, by means of a solution of 
 permanganate of potash, a i-oz. bottle of which is carried 
 on the man's person. 
 
 (t) Calomel ointment, as supplied by the Service and 
 recommended to be employed either immediately after the 
 risk of infection has been incurred, or as soon as possible 
 afterwards. In this latter event the application is usually 
 carried out at the hygienic lavatory at Whale Island. 
 
 (1) Total number or preventive outfits issued between 
 ist April 1918 and 3ist March 1919 : 
 
 Sol. potas. permang. . . 496 
 
 Calomel ointment . . . 1681 
 
 (2) Total number of cases between ist April 1918 and 
 3 ist March 1919 of 
 
 Gonorrhoea, 54, of which 8 stated they had used pre- 
 ventive treatment, 44 did not, and in 2 it is un- 
 known. 
 
 Syphilis, 36 cases, of which 4 used preventive treat- 
 ment, 30 did not, and 2 it is unknown. 
 
 Chancroid, 2 cases, neither of which used any preventive 
 treatment. 
 
 (3) It is not known with certainty in every case whether 
 preventive treatment was used before or after exposure to 
 infection, but men are always told to use it afterwards.
 
 APPENDIX IV 407 
 
 (4) The treatment is carried out by the men themselves, 
 after detailed instructions are given them by petty officers 
 in charge of the hygienic lavatory, or the sick berth staff. 
 
 (5) Sol. potas. permang. has now been in use for a year. 
 Amongst 496 men employing this method one case of 
 
 syphilis is recorded, but he used the treatment six hours 
 after exposure. There have been no cases of gonorrhoea 
 or chancroid. 
 
 It may be of interest to note that during the past three 
 months there have been recorded only nine fresh cases of 
 gonorrhoea and six of syphilis. With one exception none 
 of these cases used preventive treatment. 
 
 (Signed) P. H. BOYDEN, 
 
 Surgeon-Commander. 
 
 APPENDIX 1 6 
 Abstract of Memorandum submitted by Mr. FRANK KIDD 
 
 1. The English do not ordinarily indulge in promiscuous 
 intercourse otherwise than on exceptional occasions ; 
 perhaps once a year or less. 
 
 2. In peace-time men who fall are generally drunken, 
 intercourse is not premeditated, and therefore outfits 1 
 would not be provided, nor would the men be sober enough 
 to use the outfits properly. Alcohol is an almost equally 
 important factor in war-time. 
 
 3. Englishmen are foolhardy and take sporting risks, 
 but in the depressed state which supervenes after a drunken 
 bout men are frightened and ashamed. 
 
 4. If, in this state, they see a suitable poster (e.g. in a 
 public urinal), telling them the address of the nearest Venereal 
 Clinic, they would be likely to go there and receive " ade- 
 quate early treatment." 
 
 5. Even if they did not go for some days, early treatment 
 would quickly cure them. In Mr. Kidd's opinion, if a 
 man with syphilis will come for treatment within two to 
 three weeks of his fall, it is possible to cure him with four 
 injections of 606, and nothing more. If men will come 
 
 1 I.e. " packets."
 
 408 PREVENTION OF VENEREAL DISEASE 
 
 within five days of an infection with gonorrhoea, about 90 
 per cent, of them can be cured in about a week. 
 
 6. " Early treatment, organised at the Venereal Clinics 
 and advertised in the public and other urinals all over the 
 country," is the practical remedy to help the 90 per cent, 
 of those who fall and who are casual unpremeditated sinners. 
 " The hardened sinners " can use outfits if they wish. 
 
 7. That " any chemist can supply the simple chemicals 
 to any one to prevent the disease " is incorrect. The 
 chemicals are not simple ; they need to be carefully prepared 
 and chosen, and to be applied by a trained person. Those 
 who advocate prophylactic packets probably do not appre- 
 ciate this. 
 
 8. Women are more deliberate sinners than men. If 
 prophylaxis is desired, an effort should be made to apply 
 prophylactic treatment to women. Suitable preventive 
 measures adopted by women immediately after exposure 
 will probably prevent gonorrhoea or syphilis. Women, 
 however, may dislike the trouble involved ; a pessary 
 might be designed which would prevent infection. 
 
 9. Mr. Kidd added that he put forward these views as a 
 result of practical knowledge of the subject spread over a 
 number of years. 
 
 APPENDIX 17 
 PROPHYLAXIS AMONG WOMEN 
 
 The following replies have been received in answer to an 
 inquiry on the following points : 
 
 (1) Methods of prophylaxis scientifically proved to be 
 
 of value nature and method. 
 
 (2) Methods of prophylaxis practicable for general use. 
 
 (3) The desirability of and means of distributing in- 
 
 formation to the public nature of information. 
 
 A. From Lady BARRETT, C.B.E., M.D., B.S. : 
 
 My views in relation to the questions asked by you are as 
 follows : 
 
 i. Methods of prophylaxis scientifically proved to be of 
 value in the case of women,
 
 APPENDIX IV 409 
 
 I do not consider that we have at present sufficient 
 evidence as to the value of methods of prophylaxis to say 
 that they are scientifically proved to be effective. 
 
 * * * * Prophylaxis, if considered as treatment 
 applied before the risk of infection, would of course be 
 more likely to give satisfactory results from the point of 
 view of venereal disease, but treatment which would 
 certainly kill gonococci contained in semen would almost 
 certainly prevent conception, and for this reason I consider 
 that such prophylaxis in women is equivalent to race 
 suicide. 
 
 With regard to information to be given to the public. 
 
 No scheme of prophylaxis can be successful unless the 
 knowledge of it is universally spread. But it is extremely 
 difficult to say how such knowledge can be spread without 
 appearing to teach all young men and women that promis- 
 cuous intercourse is allowable and can be indulged in 
 without risk if sufficient care is taken. This ignores the 
 whole question of other physical disabilities arising from 
 promiscuous intercourse. For this reason I am of opinion 
 that any information as to the facilities for protection of 
 disease should be accompanied by a carefully drawn-up 
 warning as to the effects on the individual and on the race 
 of promiscuous and excessive sexual intercourse. 
 
 B. From Dr. MORNA RAWLINS, M.B., B.S. : 
 
 The following are my views with regard to prophylactic 
 measures for the prevention of venereal disease in women : 
 Prophylactic measures having proved of value in the 
 prevention of venereal disease in men, it seems reasonable 
 to think that they would be of value in checking the de- 
 velopment of venereal disease in women. I therefore think 
 it is desirable to let women have the same facilities as those 
 offered to men with regard to early treatment. 
 The difficulties in the way appear to me to be 
 
 (a) The possibility of preventing conception. If 
 the prophylactic measures are confined to early treat- 
 ment after intercourse and not to measures employed 
 before intercourse has taken place, the danger of 
 preventing conception will be much minimised,
 
 410 PREVENTION OF VENEREAL DISEASE 
 
 (6) The majority of patients attending the clinics I 
 
 know of personally are married women, and it is unlikely 
 
 that married women, having lawful intercourse, will use 
 
 prophylactic measures, except such measures that are 
 
 already employed to prevent conception. Hence a large 
 
 body of potentially diseased women will be untouched. 
 
 To meet this I would urge that the facilities for using 
 
 methods of prophylaxis against venereal disease for men 
 
 should be extended, as soon as possible, to the civilian 
 
 population. 
 
 In answer to the points brought forward 
 
 (1 ) As far as I know, no methods of prophylaxis among 
 women have been used extensively under medical 
 supervision, and therefore none have been proved of 
 value scientifically. 
 
 (2) That advocated by the National Council for 
 Combating Venereal Disease. 
 
 (3) I consider it advisable to inform the public that 
 the earlier the treatment the greater the chance of 
 eradicating the disease, and at the same time state the 
 places where such early treatment can be obtained. 
 
 The information can be distributed to the public in the 
 same way as the information ra special venereal clinics is 
 now distributed. 
 
 C. From Dr. AGNES SAVILL, M.D. : 
 
 As regards your questions i and 2 on methods of prophy- 
 laxis, I have not a sufficiently wide experience to make my 
 opinion of any value. 
 
 As regards 3 (information to the public), I think the 
 methods of the National Council for Combating Venereal 
 Diseases should be encouraged by the Government. Lec- 
 turers should be appointed and sent regularly to clubs, 
 factories, colleges, etc., lectures on the moral as well as the 
 medical side of the subject. The lecturers should be 
 selected carefully and properly paid, as it is of extreme 
 importance to have the right people. 
 
 The hospital venereal clinics should one and all have a 
 woman doctor as well as the man doctor attached to the 
 department for women patients.
 
 APPENDIX V 
 
 411 
 
 APPENDIX V 
 
 SOCIETY FOR THE PREVENTION OF VENEREAL 
 DISEASE 
 
 President. 
 The Rt. Hon. LORD WILLOUGHBY DE BROKE. 
 
 Vice-Presidents. 
 Mr. HUGH ELLIOT. 
 Prof. LEONARD HILL, F.R.S. 
 Mr. RUDYARD KIPLING. 
 Sir E. RAY LANKESTER, K.C.B., F.R.S. 
 Lt.-Gen. Sir FRANCIS LLOYD, K.C.V.O., K.C.B., D.S.O. 
 Sir LAURENCE R. PHILIPPS, Bart. 
 Mr. H. G. WELLS. 
 
 Joint Treasurers. 
 
 Sir WM. ARBUTHNOT LANE, Bart., C.B., M.S. 
 Sir JAMES CRICHTON-BROWNE, F.R.S. 
 
 Hon. Secretary. 
 Mr. H. WANSEY BAYLY, M.C., M.R.C.S. 
 
 GRAND COMMITTEE. 
 
 Dr. P. Abraham, F.R.C.S.I. 
 Col. J. G. Adami, C.B.E., 
 
 F.R.C.P.. F.R.C.S., F.R.S. 
 Sir H. G. Barling, Bart., C.B., 
 
 C.B.E., C.M.G., F.R.C.S. 
 Dr. R. D. Batten, B.S. 
 Mr. Geo. Blacker, F.R.C.P., 
 
 F.R.C.S. 
 
 Dr. W. A. Bond, M.O.H. 
 Mr. Aleck Bourne, F.R.C.S. 
 Sir Thomas Bramsdon, 
 
 M.P. 
 Prof. C. H, Browning, M.D., 
 
 D.P.H. 
 Col. E. T. Burke, D.S.O. , 
 
 R.A.M.C. 
 
 Sir G. Lenthal Chcatle, K.C.B., 
 
 C.V.O., F.R.C.S. 
 Mr. W. H. Clayton Greene, 
 
 C.B.E., F.R.C.S. 
 Dr. J. Collier, F.R.C.P. 
 Hon. John Collier. 
 Major Corbett-Smith, M.A., 
 
 F.R.G.S. 
 Mr. Harold Cox. 
 Mr. Thomas Davies, M.P. 
 Sir H. Bryan Donkin, M.D., 
 
 F.R.C.P. 
 
 Captain W. E. Elliot, M.P. 
 Dr. A. Mearns Fraser, M.O.H. 
 Sir Alfred D. Fripp, K.G.V.O., 
 
 F.R.C.S,
 
 412 PREVENTION OF VENEREAL DISEASE 
 
 Sir J. Bampfylde Fuller, 
 
 K.C.S.I. 
 Col. P. Broome Giles, C.B., 
 
 F.R.C.S. 
 Sir William Grey-Wilson, 
 
 K.C.M.G., K.B.E. 
 Mr. H. Grimsdale, F.R.C.S. 
 Dr. A. J. Harries. 
 Prof. M. May, M.D., 
 
 F.R.C.P. 
 
 Mr. E. S. P. Haynes. 
 Mr. J. P. Hedley, F.R.C.S., 
 
 M.R.C.P, 
 Mr. Eardley Holland, F.R.C.S., 
 
 M.R.C.P, 
 
 Dr. T. B. Hyslop, F.R.S.E. 
 Mr. Richard Lake, F.R.C.S. 
 Dr. R. Murray Leslie, M.R.C.P. 
 Sir William Lister, K.C.M.G., 
 
 F.R.C.S. 
 Prof. Harvey Littlejohn, 
 
 F.R.C.S., F.R.S.E. 
 Dr. R. A. Lyster, M.O.H. 
 Sir J. Y. W. MacAlister. 
 Dr. A. C. Magian. 
 Miss Norah March. 
 Mr. C. F. Marshall, F.R.C.S. 
 Sir Wm. Milligan, M.D., M.S. 
 Dr. Percy Mitchell. 
 Mr. John H. Morgan, C.V.O., 
 
 F.R.C.S. 
 Sir F. W. Mott, K.B.E., F.R.S., 
 
 F.R.C.P. 
 Sir B. Moynihan, K.C.G.M., 
 
 B.C., M.S. 
 
 Sir Thomas Oliver, M.D. 
 Mr. John Pardoe, C.M., 
 
 F.R.C.S. 
 
 Dr. William Pasteur, C.B., 
 
 C.M.G., F.R.C.P. 
 Mr. Basil Peto. 
 Sir D'Arcy Power, K.B.E. , 
 
 F.R.C.S. 
 
 Dr. F. I. Poynton, F.R.C.P. 
 Dr. Eric Pritchard, M.R.C.P. 
 Sir G. Archdall Reid, K.B.E., 
 
 M.B., C.M., F.R.S.E. 
 Dr. R. R. Rentoul. 
 Prof. E. S. Reynolds, M.D., 
 
 F.R.C.P. 
 Lord Riddell. 
 Dr. H. Leslie Roberts. 
 Mr. P. RockliS,' F.S.S., 
 
 F.F.I. 
 Sir Humphry Rolleston, K.C.B., 
 
 F.R.C.P. 
 Miss Ettie Rout. 
 Dr. C. W. Saleeby, F.R.S.E. 
 Mr. J. H. Seqeira, F.R.C.S., 
 
 F.R.C.P. 
 Prof. W. J. R. Simpson, 
 
 C.M.G., F.R.C.P. 
 Sir Arthur Sloggett, K.C.B., 
 
 K.C.M.G., K.C.V.O. 
 Prof. J. W. Smith, F.R.C.S. 
 Sir Guy Standing, K.B.E. 
 Mr. G. Stewart, M.P, 
 Sir William Thorburn, K.B.E., 
 
 C.B., C.M.G., F.R.C.S. 
 Sir Frederick Treves, Bart., 
 
 G.C.V.O., C.B., F.R.C.S. 
 Mr. W. Trotter, F.R.C.S. 
 Dr. David Watson. 
 Dr. Leonard Williams. 
 Dr. R. M. Wilson. 
 Mr. Richard Wright, M.A,
 
 APPENDIX VI 413 
 
 APPENDIX VI 
 
 STATEMENT MADE BY THE MINISTRY OF HEALTH, 
 WITH CONCURRENCE OF THE WAR OFFICE, 
 RELATIVE TO INCIDENCE OF VENEREAL 
 DISEASE AMONGST SOLDIERS IN THE PORTS- 
 MOUTH MILITARY AREA AND IN THE REST 
 OF THE COUNTRY 
 
 Presented to Parliament by Command of His Majesty 
 PAPERS RELATING TO THE INCIDENCE OF VENEREAL DISEASE 
 AMONGST SOLDIERS IN THE PORTSMOUTH MILITARY 
 AREA AND IN THE REST OF THE COUNTRY, PRESENTED 
 BY THE MINISTRY OF HEALTH WITH THE CONCURRENCE 
 OF THE WAR OFFICB. 
 
 The Question asked for Papers and Information under 
 the following heads i 
 
 A. " Information as to the yearly incidence of Ven- 
 ereal Disease in the Portsmouth area as compared to 
 the rest of England." 
 
 B. " Colonel Keble's Reports and Hilsea Hospital 
 Records giving information as to the relative frequency 
 in hospital of men who have used immediate and 
 delayed disinfection respectively." 
 
 C. Other information. 
 
 In the Debate on loth December, Lord Sandhurst gave 
 information and various figures bearing on each of these 
 points, and undertook to present to Parliament " a memo- 
 randum of those figures together with the necessary statis- 
 tical explanations without which such figures might be 
 misleading in either direction " (Hansard, loth Dec., 
 column 880). The present document has been prepared to 
 carry out that pledge as fully as possible. It should be 
 noted that only the military are in question. None of the 
 information relates to civilians. 
 
 A. COMPARATIVE INCIDENCE OF VENEREAL DISEASE IN 
 
 DIFFERENT AREAS 
 
 i. In view of the many conflicting statements generally 
 prevalent as to the " incidence rate " of venereal disease,
 
 414 PREVENTION OF VENEREAL DISEASE 
 
 it seems desirable to give some explanation of the sense in 
 which the phrase is generally used in military references. 
 The obvious method of measuring the incidence of a disease, 
 whether in one area, or comparatively in several areas, would 
 be, speaking generally, to count (i) the number of cases of 
 the disease which occur in the area in a given period ; and 
 (ii) the total number of persons who had been in the area 
 during the period ; and relate the one to the other. It is 
 obvious that the second of these figures is in many circum- 
 stances extremely difficult to arrive at with any accuracy, 
 whilst it will also often be difficult to ensure that the first 
 figure shall include no cases who were not amongst the 
 persons included in the second figure. 1 It has been the 
 
 1 It may be well to note here that not only as regards venereal 
 disease, but in general when dealing with a varying population, 
 great difficulties are of necessity involved in arriving at an ac- 
 curate statistical result by this method of relating the number 
 of cases of the disease to the total period of exposure to risk. 
 Thus, if throughout a year 1000 men have been constantly 
 resident in a given area and 100 cases of disease have occurred 
 amongst them, then the period of exposure is one year for each 
 man, 1000 years in all, and the incidence rate is too in 1000. 
 But in practice it is very unusual to have to deal with a constant 
 population ; and it is customary to use as the denominator of 
 the fraction the mean of the populations existing at the beginning 
 and end of the period. Thus, if at the beginning there were 
 1000 men in the area, and, at the end, 500, the figure 750 would 
 be taken as denominator and the rate expressed as 100 in 750. 
 If, however, the population has not varied uniformly throughout 
 the period, this method may lead to seriously erroneous results. 
 For instance, consider the two following cases, (i) 1000 men 
 reside for six months, the population is then reduced to 500. 
 (2) TOCO men reside for nine months ; the population is then re- 
 duced to 500. The method of taking the mean of initial and final 
 populations would lead to the same incidence rate in both cases. 
 But in (i) the real period of exposure is 1000 multiplied by 
 year, plus 500 multiplied by year, i.e. 750 years ; in (2) it is 
 looo multiplied by J year, plus 500 multiplied by year, i.e. 
 875 years, and the real incidence rate is smaller in the second 
 example. It follows that even when the accuracy of the num- 
 erator (i.t. the number of cases) is above suspicion, large and
 
 APPENDIX VI 415 
 
 usual military practice to count the number of cases ad- 
 mitted for venereal disease to any military hospital in a 
 given period, and to relate this to the average military 
 strength of the area served by the hospital throughout the 
 period, thus working out a rate per thousand. In peace 
 time, when the personnel in a given area was fairly constant 
 over a given period, this method of measuring the incidence 
 of the disease sufficed to give fairly accurate results ; and 
 even during times when there is considerable moving about 
 of men from one area to another, the method may be fairly 
 accurate when the figure is calculated on the V.D. ad- 
 missions in the whole of the Kingdom against the strength 
 of troops in the whole Kingdom taken together. But in 
 war-time the application of this method of calculation to a 
 particular area, during a particular period, as indicating 
 the incidence there, is necessarily open to the objection that 
 there may have been considerable changes in the per- 
 sonnel in that area, so that a larger number of soldiers may 
 have been stationed temporarily in that area during the 
 period than are included in the figure denoting the average 
 strength. This would necessarily vitiate to some extent, 
 for the purpose of measuring the true local incidence of the 
 disease, the validity of the numerical comparison instituted 
 between the number of cases occurring in that area (or 
 admitted to a hospital situated in that area) in that period 
 in proportion to the average strength of that area. For 
 this reason, the War Office have always refrained, as far as 
 
 irregular fluctuations of the resident population may render the 
 value of a simple average unreliable. 
 
 But in practice, the numerator is in need of correction too, since 
 all the cases of disease occurring in the area may not be properly 
 debitable to the resident population, while the latter may be 
 responsible for cases reported elsewhere. This source of error 
 occurs in ordinary civilian vital statistics, and leads to the ex- 
 aggeration of the death-rate of any area within which a large 
 hospital is situated. The Registrar-General transfers deaths of 
 non-residents to the area of origin and in principle the same 
 correction is applicable to morbidity rates ; in practice, as will 
 shortly appear (vid. par 3 infra), this is a difficult task when the 
 question is of venereal disease amongst a military population.
 
 416 PREVENTION OF VENEREAL DISEASE 
 
 possible, from attempting, in war-time, to institute com- 
 parisons between different areas as to their rate of incidence 
 of the disease. But, as the Question on the Paper required 
 " information as to the yearly incidence of V.D. in the 
 Portsmouth area as compared to the rest of England," an 
 attempt was made, in the interval between the Notice of 
 the Question and the date of the Debate, to work out 
 figures which would give some approximate indication of 
 the kind desired ; and the results of such investigations 
 into the figures at that time available as were then made 
 were stated orally in the Debate on December loth, to the 
 effect that the incidence of venereal disease amongst the 
 military in the Portsmouth area from 1912 to 1919 was 
 very much greater than that amongst the military through- 
 out the United Kingdom. 
 
 2. Criticisms have been publicly made as to the accuracy 
 of this statement, particularly by Sir Archdall Reid, who 
 stated (Times, i9th December) his belief that " the Ports- 
 mouth district is a model area for the whole country " ; 
 meaning thereby, as is clear from his letter, that it had a 
 quite exceptionally small number of V.D. cases per thousand 
 on the strength. In another letter on :6th December, Sir 
 Archdall Reid stated his belief that " the troops resident in 
 the Portsmouth area and under the care of a certain medical 
 authority " were " infected at the rate of " somewhat less 
 than 25 per thousand per annum. His later sentences in 
 that letter imply that, in order to arrive at such an estimate, 
 no account must be taken of cases which occurred amongst 
 men not under the medical care of the Portsmouth Area 
 Medical Authority, nor of cases " occurring among men 
 arriving on draft from other areas and contracted in those 
 areas or brought in by the troops from overseas." As has 
 been pointed out above, an incidence rate computed by 
 relating the number of cases of disease to the population 
 exposed to risk can only provide an unambiguous measure 
 of the prevalence of the disease when (i) the numerator 
 includes all cases properly chargeable to the population at 
 risk and no others, and (2) when the average population is 
 in an adequate measure of the total time of exposure to 
 risk lived by the population in the area. When either or
 
 APPENDIX VI 417 
 
 both of these conditions are unfulfilled the phrase " incidence 
 per thousand per annum " is devoid of meaning. Sir 
 Archdall Reid has produced no evidence that either postulate 
 was fulfilled by his data, nor is it known how such evidence 
 could be obtained. From the point of view of a vital 
 statistician, therefore, any discussion of such a finding is 
 idle. But in the same letter Sir Archdall Reid asserted that 
 " full materials are available " for showing what is the 
 truth in this respect, i.e., as regards the comparative figures 
 of incidence between the areas he named. For this reason 
 and in consequence of the promise that was pressed for from 
 the Government in the Debate on loth December to give 
 " information " on these matters, it has been felt that, in 
 spite of the necessarily unreliable nature of the methods 
 and considerations thus pressed for in the Question, every 
 effort should be made to set out as fully as possible, in this 
 Paper, in reply to the Question, the material on which the 
 assertions made in the Debate on loth December were in 
 fact based, together with an explanation of the only basis 
 known to be available for calculations or estimates of this 
 nature. 
 
 3. The normal method adopted by the War Office for 
 measuring, approximately, the incidence of venereal 
 disease throughout the Army has been to record, month by 
 month, in respect of each hospital (a) the number of men 
 admitted to it, excluding from the calculation (in order not 
 to count the same case twice) men who, having been pre- 
 viously admitted to some other hospital in that or any 
 other area, have been counted as " admissions " in that 
 other hospital ; and, nextly, to compare these numbers of 
 cases against (6) the average daily strength served by that 
 hospital during the same period ; the idea being that this 
 would most nearly give the normal number of men amongst 
 whom the venereal cases had occurred. As is indicated 
 above, this method would, in the case of any given area, 
 sometimes result in the inclusion amongst the V.D. cases 
 of some men who had not been normally in the particular 
 area, e.g. men passing on from elsewhere and only tempor- 
 arily staying in the particular area. According as the pro- 
 portion of such troops to what may be termed the permanent 
 27
 
 418 PREVENTION OF VENEREAL DISEASE 
 
 garrison was large or small, and as the incidence rate 
 amongst them was high or low, the inclusion of such V.D. 
 cases might incorrectly cause a greater or a less increase in 
 the figure worked out (on the lines above indicated) for the 
 incidence rate of the area. On the other hand, many 
 difficulties of calculation necessarily arise, which may also 
 have vitiating effects upon the calculation, and sometimes 
 in one direction, sometimes in another, if attempts are 
 made, when drawing inferences from the figures, to exclude 
 particular categories of men from the records that have been 
 kept, whether from the number of cases that are stated to 
 have been admitted to a hospital in a given area or from 
 the estimated " strength " of that area. 
 
 4. The normal method of arriving at a figure for estimat- 
 ing the incidence rate has been to divide the number in 
 figure (a) above by the number of thousands in the figure 
 in (6) above, thus obtaining the number of venereal disease 
 cases per thousand on the strength (in the sense defined 
 above). It is not suggested that this method gives an 
 accurate statistical calculation ; this would be impossible, 
 particularly for the purpose of comparing incidence in one 
 area with incidence in another, as already explained. The 
 calculation is, however, accepted as sufficiently accurate 
 for ordinary purposes in measuring the amount of disease 
 occurring in the whole army in normal times from one year 
 to another, which is its main purpose. As explained above, 
 any inaccuracy must, of course, greatly increase in pro- 
 portion as it is attempted to apply it to institute comparisons 
 between one area and another area. In such attempts the 
 error will vary according to (inter alia) the larger or smaller 
 number of men who happen to have passed through either 
 of the areas (and who may have contributed many or few 
 cases of V.D.) that are counted in the calculation as V.D. 
 cases, though perhaps not included, or not all of them 
 included, in the strength of the area for the period. 
 
 5. For the purposes of the Debate on loth December, 
 and in order to lessen as far as possible the liability of error 
 in attempting then to furnish the comparative information 
 that had been asked for in the Question, the " ration 
 strength " was taken (so far as it could be ascertained at
 
 APPENDIX VI 419 
 
 the time) of what was believed to be referred to in the 
 Question as the Portsmouth Area, i.e. the two contiguous 
 military stations of Portsmouth and Gosport, which 
 practically form one compact urban area. This is to be 
 noted here, because the Portsmouth Area (i.e. No. 4 Area, 
 Southern Command) includes many other stations, ex- 
 tending as far as the whole of the Isle of Wight, Winchester, 
 Weymouth, etc. 
 
 6. The information thus collected, in the manner explained 
 in paragraphs 3 and 5 above, resulted in the following 
 figures, which were the basis of the statements made in the 
 Debate as to comparative incidence in Portsmouth and the 
 United Kingdom : 
 
 TABLE I 
 
 Number of Venereal Disease A dmissions during the Year per 
 Thousand Persons on the Average Strength 
 
 United Portsmouth and 
 
 Kingdom. Gosport Stations. 1 
 
 1912 . . 56-4 97 
 
 1913 50*9 93 
 
 1914 . . 51-3 80 
 
 1915 . . Returns not complete. 
 
 1916 37 91 
 
 1917 38 92 
 
 1918 43 78 
 
 1919 . . 64 163 
 
 The figures in the last line are calculated on figures for 
 January to October. The rates per thousand for the 
 United Kingdom in the left-hand column include, of course, 
 the cases counted in the right-hand column. 
 
 7. In considering the figures in this Table I. it is to be 
 remembered that, as previously explained, any figures 
 calculated as these were necessarily calculated do not 
 purport to be an accurate measurement of the V.D. rate per 
 thousand of the men actually " in " the given area through- 
 
 1 The figures in the right-hand column for 1916 and after have 
 since been found on further investigation to be not accurate. 
 See following paragraph.
 
 420 PREVENTION OF VENEREAL DISEASE 
 
 out the given period. For the Portsmouth and Gosport 
 stations they were liable to error, as has since appeared, to 
 an extent which did not admit of being accurately measured 
 or corrected by any figures then available. They were 
 given in the Debate, based on such figures as were available, 
 solely because asked for in the Question, and no other or 
 more reliable figures of the local incidence were available. 
 In view, however, of the criticisms subsequently made in 
 the Press by Sir Archdall Reid (from his personal knowledge 
 of the local conditions) on the comparisons thus given in 
 the Debate, which were based on the figures shown in Table 
 I. above, a close scrutiny has, since that date, been instituted 
 by the War Office into all the further facts and figures that 
 could be obtained in respect of those two stations and of the 
 No. 4 Area as a whole, by detailed investigations ; and an 
 attempt has been made to exclude from the calculation 
 men not normally " in " the areas. On this revised basis 
 the figure 163 in the right-hand column of Table I. is found 
 certainly to be too high, as the measurement of the incidence 
 amongst the troops normally within the stations named or 
 within the Portsmouth Area as a whole ; very much too high. 
 On this changed basis of calculation the figure should be 54-4. 
 (The other figures in the right-hand column for the previous 
 years are probably liable to similar errors in some, not 
 necessarily the same, degree.) An explanation of the origin 
 of the differences between this and the figure arrived at last 
 December will be found in the Addendum below. At the 
 same time it has to be noted that in applying this altered 
 figure to the comparison asked for in the Question between 
 the Portsmouth incidence and that of the United Kingdom, 
 the basis of the figure (64) in the left-hand column of Table I. 
 must also be altered by making the same kind of exclusion as 
 in the case of the right-hand column. This process cannot 
 be done accurately for the reason that without a detailed 
 scrutiny of the records of each of the many hundreds of 
 hospitals throughout the Kingdom, which would require 
 months of labour, it is impossible to exclude from the 
 Returns the V.D. admissions from the Colonial Forces 
 throughout the Kingdom during 1919, as is done in the 
 revised figure of 54-4 for the right-hand column. But
 
 APPENDIX VI 421 
 
 inasmuch as the rates amongst those troops were always 
 much higher than that of the British, 1 the figure 64 in the 
 left-hand column of Table I. must clearly be reduced, if 
 worked out (as it must be if used for comparison with the 
 Portsmouth figure) on the basis now adopted for the right- 
 hand column. A further reduction must also be made in 
 the figure 64 in respect of V.D. cases imported by troops 
 returning to England from Flanders, Germany, and the 
 East, amongst whom the incidence rate of V.D. was very 
 high in 1919 ; these troops entered the country through 
 ports other than those in the Portsmouth Area, and cases 
 of V.D. detected amongst them, after arrival, must have 
 swelled the United Kingdom rate considerably without 
 materially affecting the Portsmouth rate. This last point 
 will be appreciated when it is remembered that during 
 1919 soldiers were leaving the Army at a very rapid rate, 
 leaving behind them the cases of V.D. detected amongst 
 them to be calculated against a very much reduced average 
 strength. Taking then these various considerations to- 
 gether, the outcome of these further investigations would 
 seem certainly to show that whilst, on the one hand, Sir 
 Archdall Reid is right in asserting that the incidence rate 
 of the Portsmouth Area certainly was not two and a half, 
 nor one and a half times that of the United Kingdom (as 
 the unconnected basis of the December figures had caused 
 it to appear on loth December), on the other hand there is 
 no foundation for Sir Archdall's Reid's statement, quoted 
 in paragraph 2. above, that " the Portsmouth district is a 
 model area for the whole country," or that its incidence 
 rate was anything like so low as the 25 per thousand which 
 he asserted in his other letter. 
 
 ADDENDUM 
 
 The main cause of the undue size of the December figure 
 was the fact that, in making the calculations on which it 
 was based, the figures denoting the direct admissions ob- 
 tained from returns to the War Office by the Hilsea Hospital 
 
 1 See Cd. 322, 1919, pages 4 and 5, for the figures obtained by 
 the Interdepartmental Committee;
 
 422 PREVENTION OF VENEREAL DISEASE 
 
 during those months were calculated against what was 
 understood to have been the " ration strength " of the 
 Portsmouth and Gosport garrisons. This was done because 
 the Hilsea Hospital, in accordance with standing instruc- 
 tions, distinguished between " admissions " and " transfers 
 from other hospitals " ; and it was assumed that a soldier 
 reporting sick with venereal disease at another station in 
 the Portsmouth Area would first be admitted to the hospital 
 in that station and subsequently be transferred to Hilsea, 
 and would consequently be counted amongst the " transfers " 
 in the Hilsea returns. On this assumption, " admissions " 
 were considered to have reported sick at one or other of the 
 barracks in the Portsmouth and Gosport stations and were 
 therefore counted against the garrison strength of those 
 stations. Subsequent investigation carried out by the War 
 Office, such as was not possible in the time available before 
 the Debate on loth December, has shown that there was 
 a considerable variation of practice with regard to soldiers 
 reporting sick with venereal disease at stations, within the 
 Portsmouth Area, other than Portsmouth and Gosport. 
 Sometimes the patient was admitted to the Military Hospital 
 of the other station, and then sent on to Hilsea as a " trans- 
 fer " (in this instance the case would appear in the monthly 
 return rendered by the former hospital), sometimes he was 
 not so entered, but sent on direct to Hilsea, and was then 
 counted by the latter hospital in its monthly return as an 
 " admission." This further scrutiny of the books has 
 shown that the " admissions " for Venereal Disease in the 
 Portsmouth Area (i.e. No. 4 Area, Southern Command) 
 were as follows :
 
 APPENDIX VI 
 
 423 
 
 TABLE II 
 
 Admissions of British Troops for Venereal Disease to 
 Hospitals in the Portsmouth Area, from ist January 1919 
 to joth November 1919 (excluding Royal Air Force, 
 Colonials, and all Officers). 
 
 Men stationed in 
 
 No of 
 Admissions. 
 
 Average 
 Strength. 
 
 Approx. Rate 
 per 1000 
 per Annum. 
 
 Portsmouth Garrison. 
 
 Admitted at Hilsea 
 Admitted at Cosham . 
 
 Total 
 
 322 
 
 3 
 
 
 
 
 
 325 
 
 6,503 
 
 54'4 
 
 Other Stations in No. 4 
 A rea (excluding Ports- 
 mouth Garrison}. 
 
 Admitted at Hilsea . 
 Admitted at other hos- 
 pitals in No. 4 Area . 
 
 Total 
 
 603 
 106 
 
 
 
 
 
 709 
 
 17,371 
 
 44 -6 
 
 Whole of No. 4 Area . 
 
 1,034 
 
 23,874 
 
 47'3 
 
 NOTE. Colonials and R.A.F. are excluded, as the figures 
 of their strengths are not available. 
 
 The following table shows the locality of the stations of 
 soldiers admitted directly to the Hilsea Hospital, for 
 syphilis, gonorrhoea, and soft chancre, from January to 
 November 1919. Unlike Table II., it includes Colonials 
 and Royal Air Force. It shows that all but 48 of the direct 
 admissions were normally stationed in No. 4 Area. 
 
 Patients' Stations. No. 
 
 Portsmouth Garrison . . . .327 
 Other Stations in No. 4 Area, including 
 
 Portsmouth Garrison .... 694 
 Stations not in No. 4 Area ... 48 
 
 Total 
 
 . 1069
 
 424 PREVENTION OF VENEREAL DISEASE 
 
 B. INFORMATION AS TO DIFFERENCES OF RESULTS AS 
 BETWEEN IMMEDIATE AND DELAYED DISINFECTION 
 
 8. But the chief consideration that has been discussed in 
 connection with the subject mainly at issue, viz. the 
 efficacy of self-disinfection, is related not so much to at- 
 tempts to demonstrate its efficacy by comparative figures 
 of high and low incidence in different areas, which, as above 
 shown, must always be liable to be very misleading, but 
 rather on ascertained facts in respect of individual cases ; 
 and it is usually urged that the point of importance in this 
 part of the question is as to the diminished efficacy of any 
 self-disinfection methods if not practised immediately after 
 exposure to risk. It may, therefore, be useful to explain 
 here the manner in which military hospital records on this 
 aspect of the subject are kept, which is as follows : 
 
 There is an Army Form W. 5041, which is compiled 
 monthly in each hospital by the medical officers of the 
 hospital ; it summarises statistically the oral replies given 
 by each patient, on admission to the hospital, to certain 
 questions put to him orally by the medical officers as to the 
 use (if any) which he had made of the antiseptic outfits 
 made available by the military authorities in the concluding 
 period of the war for men who choose to apply for them in 
 their barracks or camps. The actual replies given by each 
 individual patient are summarised in the Army Forms 
 W. 5041 for the hospital as a whole for each month. The 
 W. 5041 Forms, containing the summary of the soldiers' 
 replies, arrange the information under four headings only, 
 thus : 
 
 The man stated that he used the antiseptics 
 
 (1) on the same day, 
 
 (2) on the next day, 
 
 (3) later than (i) or (2), 
 
 (4) not at all. 
 
 9. For the purposes of the Debate on loth December, a 
 request for information on this matter was sent by the War 
 Office to the Southern Command, who thereupon forwarded
 
 APPENDIX VI 425 
 
 a summary of the Forms W. 5041 in respect of the V.D 
 hospitals in their areas ; viz. Military V.D. Hospital at 
 Chiseldon, the Military V.D. Hospital at Hilsea, the Venereal 
 Section of the Military Hospital at Devonport, and the 
 V.D. Section of the Detention Barracks at Devizes, during 
 the months of April to September 1919 inclusive ; all these 
 being put together by the Command into one summary. 
 The result was as follows : 
 
 TABLE IV 
 
 Total cases of V.D. admitted in six months 2952 
 Antiseptics not used . . . 1786 
 Antiseptics used . . . 1166 
 
 Of these 1166 venereal cases who had used antiseptics 
 at all, there were 
 
 565 men who stated they had used them on the same 
 
 day; 
 
 302 men who stated they had used them on the next day ; 
 299 men who stated they had used them later. 
 
 10. It is thus seen that amongst the 2952 cases of V.D. 
 who were, during the middle of 1919, in the four hospitals 
 or centres referred to, there were 565 men who stated that 
 they had practised self -disinfection with the outfits " on 
 the same day " as exposure to infection ; yet they contracted 
 the disease. 
 
 11. The table shows, of course, that amongst the three 
 thousand cases by far the larger number had not used the 
 outfits on the same day and had caught the disease ; but 
 this affords no information on the point under consideration 
 in the absence of information as to the number who took no 
 precautions at all and yet escaped infection. The main 
 fact disclosed by this table, which has bearing on the point 
 under consideration (see B on page 413), is that as many as 
 565 men were infected who stated that they had used the 
 outfit on the same day. It was these figures and those 
 resulting from a special investigation made in November 
 (see C on page 429 below) which were the basis of the state- 
 ment made by Lord Sandhurst on roth December that
 
 426 PREVENTION OF VENEREAL DISEASE 
 
 " even in circumstances specially favourable to instruction 
 and to the method proposed, the risk of V.D. was by no 
 means certainly avoided ; for even in these conditions a 
 certain number of cases occur." 
 
 12. Questions were asked at the Debate on loth December 
 as to a special report on this part of the subject from Colonel 
 Keble. Colonel Keble was the A.D.M.S. of the Portsmouth 
 area until December 1919. He has informed the War Office 
 Authorities that he has neither furnished nor forwarded any 
 Report on the subject. The Question also asked for " the 
 Hilsea Hospital records giving information as to the relative 
 frequency in hospital of men who had used immediate and 
 delayed disinfection respectively." Up to the day of the 
 Debate the War Office had received from the Hilsea Hos- 
 pital no separate statement of its records, but those records 
 were included in the collated figures of the various V.D. 
 Hospitals above set out (see paragraph 9), and therefore, 
 in the statement made, as above quoted, in the Debate on 
 loth December. Since the Debate, the actual Records of 
 Hilsea Hospital have been sent to the War Office, and the 
 following summary has been supplied by the Medical 
 Department of the War Office.
 
 APPENDIX VI 
 
 427 
 
 TABLE V 
 Hilsea Military Hospital for Venereal Diseases 
 
 Fresh cases (not recurrences) treated in the hospital, from 
 ist January 1919 to 3Oth November 1919, including Col- 
 onials, R.A.F., and transfers from other hospitals not being 
 special V.D. Hospitals. 
 
 
 Outfits stated to have been used. 
 
 Diseases stated to have been 
 
 
 contracted. 
 
 Same day. 
 
 Next day. 
 
 Later or 
 not at all. 
 
 Total. 
 
 In Portsmouth 
 
 
 
 
 
 Garrison * . 
 
 13 
 
 4 
 
 7 6 
 
 93 
 
 At other places 
 
 
 
 
 
 within No. 4 Area * 
 
 28 
 
 6 
 
 162 
 
 196 
 
 At places outside 
 
 
 
 
 
 No. 4 Area . 
 
 53 
 
 16 
 
 666 
 
 735 
 
 Doubtful or un- 
 
 
 
 
 
 known 
 
 
 
 
 
 57 
 
 57 
 
 
 94 
 
 26 
 
 961 
 
 1081 
 
 13. The Army Forms W. 5041 which were referred to in 
 paragraph 8 above and which were the basis of the in- 
 formation given on roth December, provide no record of the 
 area in which a man had actually been infected ; the division, 
 in the above Table V. of Hilsea Hospital cases admitted 
 during 1919 into those infected within and those infected 
 
 1 Comprising Portsmouth, Hilsea, Cosham, Southsea, Gosport, 
 Fareham, and Portsdown Hill Forts. 
 
 1 Comprising Winchester and Sea Forts, Regiments in the Isle 
 of Wight, Wareham, Christchurch, Bournemouth, Weymouth 
 Swaythling, and Romsey.
 
 428 PREVENTION OF VENEREAL DISEASE 
 
 without any particular area was compiled from a special 
 record of replies given to special questions put to each man 
 on admission to the Hilsea Hospital throughout the year 
 upon that point. 
 
 In this connection it must be remembered that, as is well 
 known, when questions are asked as to the place where 
 exposure to infection took place, men habitually give false 
 answers. Inquiry has shown that this was frequently the 
 case at Hilsea. Many soldiers from there have subsequently 
 stated that they had given any answer which seemed to 
 them most likely to prevent the authorities giving trouble 
 to those from whom they had contracted the disease. The 
 figures given in this table as to place of contraction cannot 
 therefore be taken as an accurate statement of the facts ; 
 they are published here only in fulfilment of the under- 
 taking to produce the Hilsea Hospital records. In illus- 
 tration of the untrustworthiness of patients' answers, it 
 may be added that, amongst the 57 cases in the above table 
 classified as doubtful or unknown (comprising 20 cases 
 diagnosed as gonorrhoea, 16 as syphilis, and 21 as other 
 venereal diseases), the majority denied having had sexual 
 intercourse, though the disease was quite clearly venereal 
 in origin. 
 
 14. In using the figures in this Table V. it is to be noted 
 that they include all cases admitted for treatment to the 
 Hilsea Hospital during the period mentioned, except those 
 who were recurrences or who were transfers from other 
 special V.D. Hospitals ; cases admitted to it from any of 
 the other (non-venereal) hospitals situated in any of the 
 stations described above, or in any other areas, were in- 
 cluded. In this latter respect the basis of this Table V. 
 differs from the basis adopted in the War Office compilation 
 of the figures in Table I. as to the incidence of V.D. in the 
 Portsmouth and Gosport stations as compared with the 
 strength in that district ; for in those there are no cases 
 included who had come from any other hospital of any kind. 
 
 15. The figures in Table V. show, as do those in Table 
 IV., that a considerably larger proportion of the men in- 
 fected had failed to use the outfits at all, than had used 
 them the same day or the next day. But the figures throw,
 
 APPENDIX VI 429 
 
 of necessity, no light as to the incidence of the disease amongst 
 those soldiers who exposed themselves to infection and took 
 precautions as contrasted with those who, having risked 
 infection, took no precautions. To obtain such a compari- 
 son it would be necessary to know also 
 
 (i) the total number who were exposed to infection 
 
 and took no precautions ; 
 (ii) the total number who were exposed and took 
 
 precautions, with the nature of the precautions ; 
 
 and 
 (iii) the total number of (i) and (ii) who were admitted 
 
 to hospitals other than Hilsea. 
 
 It is obvious that the figures for (i) and for (ii) cannot be 
 obtained ; and yet equally obvious that without them no 
 reliable inferences can be drawn as to the efficacy of the 
 treatment referred to. 
 
 C. SPECIAL INVESTIGATIONS AS TO THE EFFECTS OF 
 IMMEDIATE DISINFECTION 
 
 1 6. But it has often been asserted that many of the 
 statements made, and figures given, on this question of 
 the degree of security that is attained from self-disinfection, 
 have been vitiated by the fact that proper distinction is 
 not drawn between self-disinfection practised after some 
 interval of time and the same when practised immediately 
 after exposure to infection. A series of special investiga- 
 tions has, therefore, been made in order to throw light on 
 this point ; and, in order to supplement the information in 
 the foregoing Tables which took note only of periods of 
 24 hours, and of 48 hours or later the figures are subjoined 
 of a special inquiry, made recently on the same lines but 
 in closer detail, in three military hospitals. The hospitals 
 concerned were No. 7 General Hospital, France ; the 
 Rochester Row Military Hospital, London ; and the 
 Military Hospital, Warlingham ; all of which are places for 
 the treatment of Venereal Disease. The inquiry was 
 conducted by the Medical Officers in charge of wards, who 
 were asked to ascertain, by interrogation of each patient, 
 (i) if he took any precautions to avoid infection ; (ii) the
 
 430 PREVENTION OF VENEREAL DISEASE 
 
 nature of the precautions taken ; (iii) the length of time 
 which elapsed between the exposure and the employment 
 of any preventive procedure. It should be added that 
 particular care was enjoined to avoid giving any hint to 
 the patient as to the Medical Officer's opinion on this ques- 
 tion of early or late disinfection ; and every effort was made 
 to elicit the exact truth as to the precautions which had 
 been taken. 
 
 TABLE VI 
 
 The results, which are given in full detail as better 
 illustrative of the precise point at issue, were as follows : 
 
 No. 7 General Hospital 
 
 89 had taken No Precautions. 
 
 29 had washed immediately after with Plain Water. 
 
 2 had washed 30 minutes after with Plain Water. 
 
 6 had washed i hour after with Plain Water. 
 
 i had washed the next day with Plain Water. 
 
 i had washed some time later than the next day with 
 Plain Water. 
 
 9 had washed immediately after with Soap and Water. 
 
 i had washed i hour after with Soap and Water. 
 
 i had washed 2-3 hours after with Soap and Water. 
 
 i had washed next day with Soap and Water. 
 
 1 had washed some time later than the next day with 
 
 Soap and Water. 
 
 15 had swabbed immediately after with Permanganate 
 of Potassium Solution. 
 
 2 had swabbed 5-10 minutes after with Permanganate 
 
 of Potassium Solution. 
 
 4 had swabbed 20-30 minutes after with Permanganate 
 of Potassium Solution. 
 
 3 had swabbed i hour after with Permanganate of 
 
 Potassium Solution. 
 6 had swabbed 1-2 hours after with Permanganate of 
 
 Potassium Solution. 
 9 had swabbed 2-3 hours after with Permanganate of 
 
 Potassium Solution.
 
 APPENDIX VI 431 
 
 i had swabbed 4-5 hours after with Permanganate of 
 Potassium Solution. 
 
 5 had swabbed next day with Permanganate of Potas- 
 
 sium Solution. 
 
 8 had used Calomel Cream both before and after. 
 3 had used Calomel Cream immediately after. 
 I had used Calomel Cream before only. 
 3 had used Calomel Cream next day. 
 
 1 had used Calomel Cream later than the next day. 
 
 6 had used Calomel Cream after a delay which was not 
 
 stated. 
 
 2 had used both Calomel Cream and Permanganate 
 
 immediately. 
 2 had used both Calomel Cream and Permanganate -1 
 
 hour after, 
 i had used both Calomel Cream and Permanganate 1-2 
 
 hours after. 
 
 1 had used both Calomel Cream and Permanganate 3-4 
 
 hours after. 
 
 2 had used both Calomel Cream and Permanganate 
 
 next day. 
 
 1 had used both Calomel Cream and Permanganate later 
 
 than the next day. 
 
 2 had used both Calomel Cream and Permanganate at 
 
 a time not stated. 
 
 i had washed with Boric Lotion the next day. 
 i had used Vaseline beforehand, 
 i had used Salt and Water some days later. 
 
 222 interrogated. 
 
 TABLE VII 
 Rochester Row Military Hospital 
 
 76 had taken No Precautions. 
 3 had washed immediately after with Plain Water. 
 2 had washed 20-30 minutes after with Plain Water. 
 
 1 had washed 2-3 hours after with Plain Water. 
 
 2 had washed next day with Plain Water. 
 
 2 had washed immediately after with Soap and Water ,
 
 432 PREVENTION OF VENEREAL DISEASE 
 
 i had washed 1-2 hours after with Soap and Water. 
 I had washed 2-3 hours after with Soap and Water. 
 
 1 had washed after a time not stated with Soap and 
 
 Water. 
 
 7 had swabbed the parts immediately after with Per- 
 manganate of Potassium Solution. 
 
 2 had swabbed the parts 3-5 minutes after with Per- 
 
 manganate of Potassium Solution. 
 
 2 had swabbed the parts 5-10 minutes after with 
 
 Permanganate of Potassium Solution. 
 
 3 had swabbed the parts 20-30 minutes after with 
 
 Permanganate of Potassium Solution. 
 
 3 had swabbed the parts | i hour after with Perman- 
 
 ganate of Potassium Solution. 
 
 4 had swabbed the parts 1-2 hours after with Perman- 
 
 ganate of Potassium Solution. 
 
 2 had swabbed the parts 2-3 hours after with Perman- 
 ganate of Potassium Solution. 
 
 i had swabbed the parts 5-6 hours after with Perman- 
 ganate of Potassium Solution. 
 
 i had swabbed the parts 10-12 hours after with Per- 
 mangate of Potassium Solution. 
 
 1 had swabbed the parts next day with Permanganate 
 
 of Potassium Solution. 
 
 2 had swabbed the parts later than next day with 
 
 Permanganate of Potassium Solution. 
 i had swabbed the parts after a time not stated with 
 
 Permanganate of Potassium Solution. 
 i had applied Calomel Ointment immediately. 
 i had applied Calomel Ointment 2 minutes after. 
 
 1 had applied Calomel Ointment 5-10 minutes after. 
 
 2 had applied Calomel Ointment 10-20 minutes after. 
 
 3 had applied Calomel Ointment 20-30 minutes after. 
 
 4 had applied Calomel Ointment - 1 hour after, 
 i had applied Calomel Ointment 5-6 hours after, 
 i had applied Calomel Ointment next day. 
 
 i had used both Calomel and Permanganate 2 minutes 
 
 after, 
 i had used both Calomel and Permanganate 3-5 minutes 
 
 after.
 
 APPENDIX VI 433 
 
 2 had used both Calomel and Permanganate 5-10 
 
 minutes after. 
 2 had used both Calomel and Permanganate 10-20 
 
 minutes after. 
 2 had used both Calomel and Permanganate 20-30 
 
 minutes after. 
 
 1 had used both Calomel and Permanganate - 1 hour 
 
 after. 
 4 had used both Calomel and Permanganate 1-2 hours 
 
 after. 
 4 had used both Calomel and Permanganate 2-3 hours 
 
 after. 
 
 2 had used both Calomel and Permanganate 3-4 hours 
 
 after. 
 
 3 had used both Calomel and Permanganate 5-6 hours 
 
 after. 
 
 1 had used both Calomel and Permanganate 6-10 hours 
 
 after. 
 
 2 had used both Calomel and Permanganate next day. 
 i had used both Calomel and Permanganate later than 
 
 next day. 
 
 i had used Boric Ointment i hour after, 
 i had used Lysol to i hour after. 
 
 3 had used Lysol i to 2 hours after. 
 
 163 interrogated. 
 
 Combining the above two tables, it is seen that out of 
 385 patients interrogated 
 
 28 or 7 -3 per cent, had swabbed with Permanganate within 
 
 ten minutes. 
 
 14 or 3 -6 per cent, had used Calomel within ten minutes. 
 6 or 1-5 per cent, had used Calomel and Permanganate 
 
 within ten minutes. 
 
 48 or i2'4 per cent, had used the advised Precautions within 
 ten minutes. 
 
 Thus, the immediate self-disinfection with the prescribed 
 drug had failed to protect these 48 men from venereal 
 disease. 
 
 28
 
 434 PREVENTION OF VENEREAL DISEASE 
 
 TABLE VIII 
 
 Military Hospital, Warlingham 
 Number of Patients interrogated, 597 
 
 The results, given in percentages, were as follows : 
 
 59 per cent, took No Precautions or did so more than 
 eight hours later. 
 
 5-4 per cent, washed within 5 minutes with Soap and 
 Water. 
 
 2- 1 per cent, washed within i hour with Soap and Water. 
 
 i -2 per cent, washed over i and less than eight hours later 
 with Soap and Water. 
 
 9-3 per cent, washed within 5 minutes with Permanganate. 
 4-5 per cent, washed within i hour with Permanganate. 
 0-6 per cent, washed over i and under 8 hours later with 
 Permanganate. 
 
 0-3 per cent, used Calomel and Permanganate within 5 
 minutes. 
 
 7-4 per cent, used Calomel and Permanganate within i 
 hour. 
 
 5 '2 per cent, used Calomel and Permanganate over i and 
 less than 8 hours later. 
 
 17. This Table VIII. shows that 9-6 per cent, of the 597 
 patients interrogated at Warlingham had employed per- 
 manganate of potassium solution, or both this and calomel 
 ointment, within five minutes after exposure ; but this 
 immediate self-disinfection by the prescribed drug had 
 failed to protect these 57 men from venereal disease, as also 
 the 48 men in Table VII. 
 
 1 8. It is the figures in respect of these special and very 
 careful inquiries, as above shown in detail in Tables VI., 
 VII., and VIII., which were the basis of the figures given 
 on the subject by Lord Sandhurst on zoth December when 
 he said (Hansard, column 878) : " It is admitted that skilled 
 disinfection very shortly after intercourse will usually 
 prevent venereal disease ; but inquiries at military hospitals 
 show that this is by no means the case when the disin- 
 fectant is applied by the man himself ; and this, even when 
 he has been in a military unit under military discipline, and
 
 APPENDIX^VI 435 
 
 has been furnished with the usual lectures and posters 
 together with personal instruction. Thus in the venereal 
 hospitals where this matter had been carefully investigated, 
 7-3 per cent, of the patients stated that they had swabbed 
 themselves with permanganate of potassium solution within 
 ten minutes after exposure. A further 3-6 per cent, had 
 similarly (that is, within ten minutes) used calomel oint- 
 ment, and a further 1-5 per cent, had used both calomel 
 and permanganate. Thus, in these two hospitals there 
 were 12^4 per cent, of the venereal patients who stated that 
 they had disinfected themselves with the drugs advised, 
 within ten minutes after exposure. In another military 
 hospital 1 1 '2 1 per cent, of the patients stated that they had 
 themselves used permanganate, or calomel, or both, within 
 five minutes after exposure." 
 
 SUMMARY 
 
 19. It will be noted that none of the figures asked for 
 and given in this White Paper can be quoted as proving a 
 specifically greater or less incidence of the disease amongst 
 any given number of men occurring in direct proportion to 
 the greater or less extent of the practice of self-disinfection 
 (whether early or late) amongst such men. That informa- 
 tion could only be obtained if four figures were obtainable, 
 viz. the total number of men who had exposed themselves 
 to risk ; what number of these had practised immediate 
 self-disinfection ; what number had not ; how many in 
 each of these totals succumbed to the disease. The figures 
 in the first of these four categories has not been forthcoming 
 in any figures yet published, and obviously cannot be ob- 
 tained ; and it is, therefore, intrinsically impossible to obtain 
 specific figures of the actual percentage of failure or success 
 resulting from self-disinfection (early or late). (See also 
 paragraph 15 above on this point.) But the figures suffice, 
 at any rate, to show (i) that amongst the 982 soldiers in 
 Tables VI., VII., and VIII. suffering from venereal disease, 
 there were 105 who stated that they had practised self- 
 
 1 This figure should be 9-6.
 
 436 PREVENTION OF VENEREAL DISEASE 
 
 disinfection, with a prescribed drug, within ten minutes of 
 exposure, and yet had failed to protect themselves success- 
 fully ; and (ii) that in the 2952 cases of venereal disease 
 (Table IV.) admitted during six months to V.D. Hospitals 
 in the Southern Command, as many as 565 who had failed 
 to escape venereal disease had practised the prescribed self- 
 disinfection on the same day as exposure. It was these figures 
 which formed the basis of the following statement made on 
 loth December by Lord Sandhurst, of which it was promised 
 that the details should be communicated, with the requisite 
 explanations, as is now done by means of this present 
 White Paper : " In regard to some of the figures to which 
 my noble friend refers and I hope to be able to meet him 
 by giving the Papers and figures he requires it has been 
 frankly asserted by such gentlemen as Sir Archdall Reid 
 that, if only the civil population were instructed to use 
 proper disinfecting drugs, such as permanganate of potas- 
 sium, immediately after exposure to infection, and if outfits 
 for this purpose were made generally available, the risk of 
 venereal disease would be avoided ; and that, if this policy 
 were made general by the Government, the disease would 
 before long disappear. But careful investigation has con- 
 clusively shown that even amongst the military, where 
 disciplinary arrangements can be resorted to and instruction 
 can definitely be given, there are found amongst soldiers in 
 venereal disease hospitals substantial numbers of men who 
 state categorically that they used permanganate of potas- 
 sium within a few minutes after exposure. It is thus clear 
 that even in circumstances specially favourable to instruc- 
 tion and to the method proposed, the risk of venereal disease 
 is by no means certainly avoided ; for even in those con- 
 ditions a certain number of cases occur. How much more 
 then would this be the case, and how far removed should 
 we still be from secured immunity, with the civil population, 
 in respect of whom the arrangements as to instruction and 
 discipline adopted for the military would obviously be quite 
 impossible" (Hansard, column 87, loth December 1919). 
 Ministry of Health, 
 
 Whitehall, S.W. i. 
 February 1920.
 
 APPENDIX VII 437 
 
 APPENDIX VII 
 
 THE PREVENTION OF VENEREAL DISEASE IN THE 
 ROYAL NAVY 
 
 Contributed to the Brussels Conference of the Royal Institute 
 of Public Health, May 1920, by Surgeon-Commander 
 P. HAMILTON BOYDEN, M.D., R.N. 
 
 During the past few years the subject of the Prevention 
 of Venereal Disease has come greatly into prominence in 
 Great Britain, and interest has been awakened, not only 
 amongst the members of the medical profession, but also 
 in the minds of the general public. 
 
 With a view to conducting a vigorous campaign against 
 this social evil, affecting, as it does, all classes of the com- 
 munity, two Societies have come into existence. 
 
 Unfortunately the methods advocated by these two 
 Societies are at variance in one fundamental respect, and 
 this has led to a somewhat embittered correspondence in 
 The Times newspaper and in the medical press between 
 holders of these conflicting opinions. 
 
 The first Society formed termed itself " The National 
 Council for the Combating of Venereal Disease," and in 
 the forefront of its system of propaganda placed moral 
 suasion in advocating strict continence, emphasising the 
 dangers of illicit intercourse and also of intemperance in 
 alcoholic beverages ; physical exercise, games, and healthy 
 amusements were encouraged, and lastly, for those who had 
 exposed themselves to infection, " early treatment " by 
 means of calomel ointment and other drugs, as soon as 
 possible after intercourse. 
 
 The second organisation (The Society for the Prevention 
 of Venereal Disease), which was founded later, under the 
 chairmanship of Lord Willoughby de Broke, while in no 
 wise neglecting the giving of advice as to strict continence, 
 etc., maintained that human nature being what it is, moral 
 suasion would not suffice to prevent large numbers of young 
 people becoming infected. The Society was of opinion 
 that the best results in prophylaxis would be attained by
 
 438 PREVENTION OF VENEREAL DISEASE 
 
 carrying out disinfection immediately after exposure to 
 risk. This, of course, necessitated the carrying of a " pro- 
 phylactic packet " upon the transgressor's person. 
 
 On the grounds of encouraging vice, the former Society 
 would not admit as justifiable under any circumstances 
 the carrying of a prophylactic " packet." 
 
 As to the merits or demerits of the tenets of these two 
 Societies I do not propose to offer an opinion, except to say 
 that in my lectures to men of the Royal Navy it is im- 
 pressed upon them that any mechanical means of disin- 
 fection to be efficient must be applied immediately ; and 
 in this opinion I am supported by the results obtained in a 
 large naval establishment of which I am in medical charge, 
 and also by the convincing statistics of the American 
 Expeditionary Force in France. 
 
 The want of unanimity as to the best means of prophylaxis 
 against V.D. is having a harmful effect upon lay public 
 opinion, and may be fraught with great danger in that 
 some slackening of propaganda may result. 
 
 For the past twelve years it has been my practice to 
 advocate preventive measures by mechanical means in 
 H.M. Navy. 
 
 Few difficulties have been encountered in persuading 
 men to carry out the methods recommended if the procedure 
 is fully and clearly explained, and the advantages pointed 
 out. 
 
 For a considerable number of years tubes of Metchnikoff 's 
 ointment were provided for the prevention of syphilis, and 
 tubes of nargol jelly for the prevention of gonorrhoea. 
 Later it was found that the nargol jelly soon lost its efficacy 
 by keeping, so much so that out of seventy-one cases of 
 gonorrhoea in my practice, no fewer than twenty-four 
 stated they had employed this jelly as a preventive. 
 
 At the beginning of 1918 nargol jelly was abandoned 
 as a venereal prophylactic in H.M. Navy, and calomel 
 ointment employed as the sole agent. 
 
 Being very much impressed by the satisfactory results 
 obtained by Sir Archdall Reid in bringing about a diminu- 
 tion in V.D. amongst soldiers in Portsmouth by the appli- 
 cation of an aqueous solution of permanganate of potash
 
 APPENDIX VII 439 
 
 to the genital organs immediately after exposure to in- 
 fection, I have employed this method for the past two years 
 with equally good results. (See British Medical Journal, 
 8th February 1919.) 
 
 Between ist April 1918 and 3ist March 1920, 923 bottles 
 of i in looo solution of permanganate of potash have been 
 issued to men in a large naval establishment, and of those 
 employing the solution no one contracted gonorrhoea, and 
 only one contracted syphilis, and he, contrary to instruc- 
 tions, delayed application for six hours. 
 
 It has been found, however, that frequently men neglected 
 to carry the bottles of solution on their persons. Under 
 these circumstances, they were recommended to employ 
 the calomel ointment, which may possibly be effective up to 
 two or three hours after exposure to infection. 
 
 The disadvantages of the permanganate method are that 
 the bottles are liable to become uncorked or broken, and 
 accordingly experiments were commenced early in 1919 
 to discover some suitable non-irritating antiseptic contained 
 in a flexible tube which could be used for the prevention of 
 all forms of V.D. 
 
 Calomel by itself is at least a feeble antiseptic, on account 
 of its insolubility and non-penetrative action, although 
 one must recognise that empirically it has an undoubted 
 lethal effect on the Treponema pallidum. 
 
 After personal trial of various antiseptics the following 
 formulae were found to fulfil the object in view : 
 
 Calomel Cream 
 
 (1) Calomel, ounce. 
 
 Adeps Lanae Hydrosus, 9 oz. 
 Paraffinum Molle Flav., 4 oz. 
 Paraffmum Liquidum, i oz. 
 
 The above formulas was used as the base in the fol- 
 lowing : 
 
 (2) Mercuric Cyanide, i grain. 
 Glycerine, i dram (reduce for quantity). 
 Calomel Cream, to 2 oz. 40 grains. 
 
 (3) Solution of Chinosel, 2-100 minims. 
 Calomel Cream, 2 oz. 40 grains.
 
 440 PREVENTION OF VENEREAL DISEASE 
 
 Calomel was retained in these two creams partly for 
 pharmaceutical reasons and partly for its anti-spirochaetal 
 action. 
 
 Some observers have stated that cyanide of mercury has 
 an irritating effect upon the urethral mucous membrane, 
 but in using the above cream this has not been observed. 
 
 The chinosel cream has been found to be quite unirritating 
 and a powerful antiseptic. 
 
 To determine the bactericidal action of these creams, 
 laboratory experiments were commenced at Haslar, living 
 cultures of M. prodigiosus being used. Owing to difficulties 
 of technique, these experiments had, unfortunately, to be 
 abandoned. 
 
 The subjoined statistics of a naval establishment num- 
 bering about 2000 men show the incidence of syphilis and 
 gonorrhoea for the years 1915-1919 ; the number of pro- 
 phylactic outfits issued during 1917 (June to December), 
 1918, 1919, 1920 (up to 3ist March), and the numbers of 
 these who became infected in spite of their use. 
 
 Incidence and rate per 1000 per annum of cases of Syphilis 
 and Gonorrhoea 
 
 1915 
 
 Syphilis 
 Gonorrhoea 
 
 Syphilis 
 Gonorrhoea 
 
 Syphilis 
 Gonorrhoea 
 
 20 cases 
 104 cases 
 
 1 1 -6 per looo per annum. 
 60 
 
 1916 
 
 10 cases 
 1 06 cases 
 
 7 1 '6 
 
 4-6 per 1000 per annum. 
 50-9 
 
 557 
 
 1917 
 
 ii cases . 5-2 per 1000 per annum. 
 121 cases . 58-0 
 
 63-2
 
 Syphilis 
 Gonorrhoea 
 
 Syphilis 
 Gonorrhoea 
 
 Syphilis 
 Gonorrhoea 
 
 APPENDIX VII 441 
 
 1918 
 
 23 cases . 10-0 per 1000 per annum. 
 76 cases . 35-9 
 
 45*9 
 
 1919 
 
 1 6 cases . 13-8 per 1000 per annum. 
 34 cases . 29-1 
 
 42*9 
 
 1920 (to 3ist March) 
 
 No cases . oo-o per 1000 per annum, 
 ii cases . 9-3 
 
 9'3 
 
 Number of Prophylactic Packets issued 
 
 1 9 1 7 (June to December) 
 1296 tubes of calomel ointment and nargol jelly. 
 
 1918 
 
 1922 tubes of calomel cream and 393 bottles of solution 
 of potash permanganate (i-iooo). These latter from 
 April to December. 
 
 1919 
 
 1012 tubes of calomel cream and 441 bottles of perman- 
 ganate solution. 
 
 1920 (to 3ist March) 
 
 296 tubes of calomel cream and 89 bottles of perman- 
 ganate solution. 
 
 During the period i5th June to 3ist December 1917, no 
 less than twenty-four cases of gonorrhoea stated that they 
 used nargol jelly as a preventive. In 1918, when nargol 
 jelly was discontinued, although there were still men who 
 had the tubes in their possession and used them, ten cases 
 of gonorrhoea and three of syphilis occurred who stated 
 they had used calomel ointment and nargol jelly. One
 
 442 PREVENTION OF VENEREAL DISEASE 
 
 case of syphilis employed permanganate solution six hours 
 after exposure to infection. 
 
 In 1919, four cases of gonorrhoea used calomel or nargol 
 jelly from two to twenty-four hours after intercourse. One 
 case of syphilis applied calomel ointment twenty-four hours 
 after exposure. 
 
 In 1920 (up to 3ist March) out of eleven cases of gon- 
 orrhoea, four men stated they had employed calomel cream 
 two hours, three hours, and ten hours after exposure ; 
 the fourth man used calomel cream immediately, but the 
 tube had been in his possession for over two years, and had 
 probably lost its efficacy. The remaining seven cases used 
 no preventive of any description. 
 
 From the result of experience gained, the two following 
 conclusions have been arrived at : 
 
 (1) Venereal disease can almost certainly be prevented 
 in men if immediate prophylaxis is skilfully carried out, the 
 substance used for the purpose being of minor importance, 
 any reliable antiseptics being effective. 
 
 (2) The method of prophylaxis employed should be as 
 simple as possible, free from all complicated details, and 
 for that reason a single tube of antiseptic cream carried on 
 the person is considered the best means of prevention of all 
 forms of venereal disease. 
 
 P. H. BOYDEN, 
 Surgeon-Commander, R.N.
 
 INDEX 
 
 ABLUTION rooms, venereal, 
 
 120. 
 
 Adami, Colonel J. G., 377. 
 Advice, acceptance by 
 
 soldiers, 137. 
 Alexander the Great, 49. 
 Amateurs, 92, no, 233, 328. 
 American Naval Secretary, 
 
 272. 
 
 Animals, mind in, 29. 
 Antiseptics, 77, 135. 
 Army, American, 119, 251, 
 
 305. 39, 368, 394. 44. 438. 
 
 Australian, 22, 119, 176, 
 200, 213, 224, 251, 274, 358, 
 386. 
 
 British^ 19, 98, 118, 125, 
 294, 361. 
 
 Canadian, 22, 253, 357, 377. 
 
 New Zealand, 176, 243, 
 275, 390, 406. 
 
 Army Authorities, 20, 141, 
 
 142, 148. 
 Army Council, 8 ; letters from, 
 
 ISO- 
 Army Medical officers, 198, 
 
 215- 
 
 Aston, Sir George, 304. 
 Astor, Lord, 13, 186, 226, 262, 
 
 278, 291. 
 
 Athanasius, Saint, 48. 
 Australian. See Army. 
 
 Bacon, Francis, 48. 
 Barlow, Sir T., 257. 
 Barrett, Lady, 408. 
 Barrett, Sir James, 176, 213, 
 
 356- 
 
 Bearing in mind, 31. 
 Beliefs, 43. 
 
 Bias, 43, 47, 52, 57, 166, 322. 
 
 Birmingham, Medical Officer 
 of Health, 270. 
 
 Birth-rates, comparative, 99. 
 
 Blackmail, 18, 93, 236. 
 
 Body, development of, 33. 
 
 Boyden, Surgeon-Commander 
 P. H., R.N., 157, 177, 179, 
 188, 220, 242, 406, 437. 
 
 Bramsdon, Sir T., 313, 315. 
 
 British Army. See Army. 
 
 British Medical Journal, 305, 
 
 307- 
 
 British Navy. See Navy. 
 Brown, Major J. Falconer, 390. 
 Buchanan, Dr. G. S., 291. 
 
 Calomel, 95, 134 ; tubes, 141, 
 
 295- 
 
 Canadian. See Army. 
 Canterbury, Archbishop of, 
 
 245, 261, 267, 337. 
 Capacity to learn, 44. 
 Caterpillar, instincts of, 29. 
 Character, formation of, 43, 
 
 53i 55, 323- 
 Chastity, causation of, 28, 71 ; 
 
 among soldiers, 124. 
 Chelsea Barracks, prevention 
 
 in, 257. 
 
 Chemists, sale of pro- 
 phylactics, 172, 184, 325. 
 Children, the real teachers of 
 
 sexual morals, 63, 323. 
 Christian sexual morals, 61, 
 
 64, 323 ; history of, 65. 
 Civilisation and morals, 67. 
 Clan william, Earl of, 283. 
 Colonial troops, disease 
 
 among, 303, 305, 309, 313. 
 
 443
 
 444 
 
 INDEX 
 
 Committee, imaginary, 190. 
 
 Inter-departmental, 12, 179, 
 186, 226, 251, 261, 278 ; 
 members of, 291. 
 
 Conception, checks on, 99. 
 
 Conscription, Colonial opposi- 
 tion to, 22, 334. 
 
 Contagious diseases, 84. 
 
 Contagious Diseases Acts, 64, 
 167, 260, 335. 
 
 Convention of reticence, 64, 
 68, 323. 
 
 Convictions, mental, 43, 322. 
 
 Coutts, Dr. A. L. A., 291. 
 
 Cow, mental development of, 
 
 39- 
 
 Critchley, Brig.-Gen., 392. 
 Curiosity, 36, 41. 
 
 Dark Ages, 45. 
 
 Darwin, Charles, 49, 113. 
 
 Dawson, Lord, 15. 
 
 Delhi, venereal disease in, 139. 
 
 Deputation to War Office, 140. 
 
 Diseases, microbic, 76 ; pre- 
 vention of, 77 ; air-borne, 
 80 ; earth-borne, 81 ; water 
 and food-borne, 82 ; insect- 
 borne, 82 ; contagious, 84 ; 
 venereal, 87. 
 
 Disinfectants, used as medi- 
 cines, 173, 258, 276, 296 ; 
 as tooth wash, 147, 207. 
 
 Disinfection, quick, 10, 120, 
 126, 130, 182, 186, 197, 217, 
 232, 237, 298, 325, 424, 429 ; 
 costof, 19, 140 ; accepted by 
 authorities, 19, 140 ; pre- 
 vented, 20, 141. 
 
 Dog, mind of, 32. 
 
 Donkin, Sir H. Bryan, 138, 
 140, 143, 148, 168, 176, 177, 
 1 88, 405. 
 
 Dreadnought outfit, 177. 
 
 Early Treatment Centres, 6, 
 n, 114, 181, 221, 236, 382 ; 
 futility of, 7, 184. 
 
 Ecclesiastics, bias in, 49. 
 
 Egypt, venereal disease in, 
 176, 213. 
 
 Ehrlich, discovers salvarsan, 
 
 114. 
 
 Elgood, Col., 213. 
 Elliot, Mr. Hugh, 95. 
 English character, 51, 333, 
 
 339- 
 
 Excellent, H.M.S., venereal 
 disease in, 157, 177, 437. 
 
 Family life, beginning of, 
 32. 
 
 Fanaticism, 46, 161. 
 
 Fear of disease, 71, 328. 
 
 Feeble-mindedness, 39. 
 
 Flexner, History of Prostitu- 
 tion, 281. 
 
 France, venereal disease in, 
 201, 281, 314. 
 
 Galileo, 113. 
 
 Game, playing the, 331, 333, 
 
 334. 
 
 German offensive, 21, 145. 
 Germany, venereal disease in, 
 
 SM- 
 
 Gibbon, 48, 270. 
 Gonorrhoea, discovery of 
 
 microbe of, 2 ; prevalence, 
 
 of, 23 ; cure of, 231. 
 Greece, ancient, 45. 
 
 Habit, 36, 44, 330. 
 Habituation to toxins, 79. 
 Harrison, Colonel L. W., 114, 
 
 182, 203, 205, 209, 233, 
 
 239, 259, 273, 277, 291, 294, 
 
 300. 
 Havre, venereal disease in, 
 
 200, 358, 385. 
 Health, public, 89. 
 Herodotus, 91. 
 Hilsea Hospital, 161, 205, 228, 
 
 297, 317. 421, 427- 
 Home, Lieut.-Colonel, 291. 
 Hospitals, venereal, 22, 130, 
 
 158, 161, 208, 295. 
 
 Idiot, 39. 
 Imbecile, 39. 
 
 Imitation, instinct of, 36, 
 41.
 
 INDEX 
 
 445 
 
 Immorality, sexual, prevalence 
 of, 65 ; among soldiers' 
 wives, 131, 216 ; among 
 Christians, 64 ; cause of, 
 27 ; prevention of, 67. 
 
 Imported disease, 132, 305, 
 314, 321, 428. 
 
 Incidence of venereal disease, 
 23. 137. 155, 157, 206, 207, 
 209, 220. 
 
 Index Expurgatorius, 53, 113. 
 
 Inspecting officers, 147, 233. 
 
 Instinct, 29, 330 ; nature of, 30. 
 
 Instruction, 2, 187, 295, 325, 
 338 ; importance of, 137, 
 
 141. 253- 
 
 Intelligence, nature of, 32. 
 
 Inter - Departmental Com- 
 mittee, 12, 179, 1 86, 226, 
 251, 261, 278, 320, 352 ; 
 members of, 291. 
 
 Japan, venereal disease in, 48. 
 
 Keble, Colonel, 228, 297, 299. 
 Kidd, Mr. F., 407. 
 Killing diseases, 2, 23. 
 Knowledge, 53 ; of the causes 
 
 of immorality, 71. 
 Koch, Professor, 114. 
 
 Lancet, The, letters to, 138, 344. 
 Law, regard for, 330 ; as to 
 
 venereal infection, 18. 
 Learning, 32. 
 Lecky, 48. 
 Lectures, moral, 70, 125 ; on 
 
 prevention, 127. 
 Letters from Army Council, 
 
 150. 
 London, venereal disease in, 
 
 200, 218. 
 Luther, 113. 
 
 Mahdi, 48. 
 Mahometans, 44, 61. 
 Maisonneuve, M. Paul, 96. 
 Man, the educable animal, 38, 
 
 54- 
 
 Marriage, effect on morality, 
 64, 124. 
 
 May, Dr. Otto, 306. 
 M'Nabb, Sir Daniel, 291. 
 Medicines against microbes, 
 
 78. 
 Metchnikoff, 2, 94, no, 112, 
 
 134. 238, 333- 
 Mhow, venereal disease in, 
 
 139. 
 
 Microbes, 75. 
 
 Mill, John Stuart, 56. 
 
 Mind, development of human, 
 35. 58. 322, 330 ; in babies, 
 36 ; in cow, 39 ; in pike, 
 39 ; in caterpillar, 29 ; in 
 dog, 32. 
 
 Ministry of Health, 227, 233, 
 289, 296, 304, 320, 413. 
 
 Monkeys, experiments with, 
 96. 
 
 Moral codes, 60 ; hygiene, 
 167 ; admonitions, 61 ; 
 lectures, 70, 125, 323. 
 
 Morality, sexual, not an in- 
 stinct, 59, 330 ; real 
 teachers of, 62, 323 ; Chris- 
 tian, 61, 64, 65, 323. 
 
 Morris, Sir M., 280. 
 
 Mott, Sir F., 4. 
 
 Muir Mackenzie, Lord, 261, 
 288. 
 
 Municipal Early Treatment 
 Centres, 181. 
 
 National Council, n, 106, 149, 
 166, 180, 186, 225, 233, 245, 
 257. 304, 336, 437; aims 
 and objects, 116. 
 
 Navy, British, 157, 177, 367, 
 
 39i, 437- 
 Neisser, 2. 
 New Statesman, letters in, 240, 
 
 256. 
 
 New Zealand. See Army. 
 Newton, 49. 
 
 Opportunities for unrestrained 
 
 vice, 8, 151, 176, 181. 
 Osier, Sir W., n, 17, 228. 
 
 Parents, kinds of, 53 ; re- 
 sponsibilities of, 57.
 
 446 
 
 INDEX 
 
 Paris, venereal disease in, 201, 
 
 244. 
 Permanganate of potash, 128, 
 
 293, 295, 325, 430 ; used as 
 tooth-wash, 147, 207. 
 
 Peter the Hermit, 48. 
 
 Pike, mental development of, 
 
 39- 
 
 Play, instinct of, 36. 
 
 Playing the game, 64, 331. 
 
 Poisons, 78. 
 
 Portsmouth, venereal disease 
 among civilians, 206 ; 
 among soldiers, 304, 305, 
 311, 419, 427 ; prevention 
 in, 127, 158, 202, 294 ; 
 Medical Officer of, 234. 
 
 Portsmouth Area, 158, 225, 
 
 294. 297. 30i, 305, 307. 309, 
 311, 313, 416, 419, 423, 427. 
 
 Posters in lavatories, 159, 
 
 343- 
 Preaching as distinguished 
 
 from teaching, 64, 90, in, 
 
 167, 323. 
 Prejudice, 44. 
 Prevention, 2, 3, 6, 19, 27, 73, 
 
 87, 92, 109, 126, 167, 173, 
 
 294. 325. 343 5 cost of, 20. 
 Prophylactic packets, n, 120, 
 
 141, 222, 231, 243, 249, 280, 
 
 291. 
 
 Prostitutes, 93, no, 168, 328. 
 Prostitution, licensed, 120. 
 Public opinion, 7, 188, 340. 
 Purity, campaigns of, 73. 
 
 Quick disinfection, 10, 183, 
 325, 424 ; cost of, 20 ; ac- 
 ceptance by authorities, 19, 
 141 ; prevented, 20, 143 ; 
 alleged failure, 214, 217, 
 2 53, 317 ; real test of, 318. 
 
 Raffen, Colonel, 252, 386. 
 
 Ranksborough, Lord, 297. 
 
 Rawlins, Dr. Morna, 409. 
 
 Reason, 29, 49. 
 
 Reid, Sir Archdall, 12, 203, 
 241, 249, 250, 253, 254, 256, 
 258, 265, 268, 293, 294, 302, 
 
 34. 3 I 5, 369, 399, 4 l6 . 4 2 <>, 
 
 436, 438. 
 Reticence, on sexual matters, 
 
 62, 323. 
 
 Revolutions, 50. 
 Robson, Dr., 3. 
 Rochester Row Hospital, 214, 
 
 317, 366, 431. 
 Rome, ancient, 45. 
 Rout, Miss E., 176, 200, 243, 
 
 274, 300. 
 
 Roux, Professor, 2, 95, 238. 
 Royal Air Force, 305, 308, 
 
 392. 
 Royal Commission on Venereal 
 
 Diseases, 4, 23, 97, 101, 166, 
 
 186, 264, 333. 
 Russell, Earl, 285. 
 Russian Revolution, 52. 
 
 Salvarsan, 114, 231. 
 Sandhurst, Lord, 226, 289, 
 
 291, 300, 303, 305, 307, 426. 
 Sanitation, 80 ; reasons for 
 
 opposition to, 70. 
 Savages, mental development, 
 
 49.- 
 
 Saville, Dr. Agnes, 410. 
 Schaudinn, 2. 
 Secretary, American Navy, 
 
 271. 
 Shaw, Surgeon-Commander E. 
 
 A., R.N., 136. 
 Simeon Stylites, 49. 
 Skelton, Major R., 394. 
 Skill, 38, 53 ; in disinfection, 
 
 255- 
 
 Smales, Major C. W., 291. 
 Snow, Colonel, 271. 
 Soap and water, i, 258, 299, 
 
 430. 
 Society for the Prevention of 
 
 Venereal Disease, 12, 14, 188, 
 
 224, 230, 245, 247, 337.4". 
 
 437- 
 Socrates, method of teaching, 
 
 46. 
 
 Soldiers, moral lectures to, 
 70 ; sanitary lectures to, 
 127 ; teachability, 137. 
 
 Specimen Lecture, 143, 346.
 
 INDEX 
 
 447 
 
 Stupidity, nature of, 32, 45. 
 
 Surgeons, Army, 93, 218. 
 
 Surgery, modern, 85. 
 
 Sydenham, Lord, 97, 234, 237, 
 248, 285. 
 
 Syphilis, discovery of microbe, 
 2 ; epidemic in fifteenth 
 century, 18; prevalence, 23. 
 
 Taboos, 60, 62, 323. 
 
 Teaching of bias, 43 ; of 
 morality, 57, 60, 323 ; dis- 
 tinct from preaching, 64. 
 
 Times, The, 3, 180, 228, 230, 
 300. 
 
 Tradition, racial, 42. 
 
 Truth, suppression of, 247, 264. 
 
 Turner, Dr. E. B., 306. 
 
 United Kingdom, venereal 
 disease in, 294, 416, 419. 
 
 United States Army. See 
 Army, American. 
 
 Venereal diseases, prevalence 
 of, 2, 19, 98, 118, 132, 329 ; 
 as punishments for sin, 69, 
 70, 267 ; prevention of, 23, 
 87, 92, 109, 157, 324 ; 
 antiquity of, 91, 329 ; treat- 
 
 ment of, 173 ; connection 
 with immorality, 27 ; cure 
 of, 109, 115 ; ablution rooms, 
 120, 125 ; incidence of, 23, 
 r 37. I 55 2O 5 > & t outbreak 
 of war, 219 ; decline, 99, 
 199, 277 ; imported, 132, 
 305, 314, 321 ; Army method 
 of calculating incidence, 417; 
 Act of 1917, 166. 
 
 War, increase of disease after, 
 1 8 ; sufferings of British 
 troops in, 19. 
 
 War Office, deputation to, 8, 
 19, 140 ; letters to, 141, 
 142, 146 ; statement of 
 disease in Germany, 133 ; 
 change of front, 141, 253. 
 
 Webb, Colonel, 291. 
 
 Whale Island, 157, 177, 406, 
 
 437- 
 
 Whaley, Colonel, 394. 
 Whitaker, Dr. J. Smith, 291. 
 Willoughby de Broke, Lord, 
 
 224, 225, 298, 301. 
 Wives, infection by, 131, 216. 
 Women, disinfection of, 17, 
 
 201, 327, 408. 
 Wycliffe, 113.
 
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