■» » »■» » » » » »^. Please handle this volume with care. The University of Connecticut Libraries, Storrs 370r44# 58508 *-S BOOK 370.6273.N213Y »H «. i NATTIONAL SOCIETY FOR THF qt. ,nv ™^'° N * VEARBQOK S UDY ooe^TMbq The Eighth Yearbook OF THE NATIONAL SOCIETY FOR THE SCIEN- TIFIC STUDY OF EDUCATION Part I EDUCATION WITH REFERENCE TO SEX PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS BY Charles Richmond Henderson, Ph.D. Professor of Sociology, University of Chicago, President of Chicago Society of Social Hygiene Associate Member of American Academy of Medicine THIS YEARBOOK WILL BE DISCUSSED AT THE CHICAGO MEETINGS OF THE NATIONAL SOCIETY, FEBRUARY 22 AND 24, 1909 CHICAGO THE UNIVERSITY OF CHICAGO PRESS 1909 Copyright 1909 By Manfred J. Holmes SECRETARY OF.THE SOCIETY Published February, 1909 Composed and Printed By The University of Chicago Press Chicago, Illinois, U. S. A. OFFICERS AND EXECUTIVE COMMITTEE Charles McKenny, State Normal School, Milwaukee, Wis. President W. S. Sutton, University of Texas, Austin, Texas J. Stanley Brown, Township High School, Joliet, 111. Henry Suzzallo, Columbia University, New York, N. Y. Clarence F. Carroll, Superintendent of Schools, Rochester, N. Y. Manfred J. Holmes, Illinois State Normal University, Normal, 111. Secretary- Treasurer PAGE TABLE OF CONTENTS PART I. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS OF THE PROBLEM Preface 7 Wisdom, timeliness, and necessity of this study for the teachers — General considerations — Testimonies in respect to this particular book — The purpose and scope of this study — Historical precedents: the philanthropists. Chapter I 2I Social loss from sexual vice — Neglect of well-meaning citizens largely due to ignorance of the facts. I. Medical authorities on the nature of the social damage from sexual vice. Section i, Solitary vice, excess, and precocious sexual activity; Section 2, Venereal diseases and prostitution; gonorrhea, nature, cause, and effects; syphilis, nature, cause, and effects; no sexual necessity; prostitution not a desirable social institution. II. Economic loss by sexual vice. III. Moral degradation. Chapter II 53 Methods of social control and movements for amelioration. Relation of legal and administrative measures to education. I. The sanitary point of view and the policy of reglementation; the policy of toleration and of license, on the basis of medical inspection and certification; arguments pro and con. II. The policy of repression; the "abolitionists." III. The policy of moral regulation; its principles and methods; various experiments in cities; societies and movements; all legal methods de- pend for efficiency in the last analysis on general enlightenment; hence the duty of educators to be leaders in this movement for public health and morality. PART II. AGENCIES AND METHODS Preface 7 Introduction 9 Definition of "education." The end of education: (1) personality, (2) social obligation, (3) religion. Scope of educational activity: (1) control, (2) instruction, (3) nurture. Co-operating agents: parents, teachers, church, physicians, authors, and editors. 6 THE EIGHTH YEARBOOK Chapter I 13 Care of infancy, with particular reference to sex life — Duty of parents — Who shall teach ignorant parents ? — Personal hygiene and training. Chapter II 15 Ideal interests. Chapter III 17 Formal instruction in matters of sex — Ignorance part of cause of vice and disease — Call to give information — The appeal of the bishop of London — Action of the diocese of Massachusetts. I. Necessity of instruction. II. Legitimate scientific interest of every person — child, youth, adult. III. Difficulties in the way of formal instruction in this subject. IV. Paths of approach for formal instruction: (a) nature-studies, biological sciences; (b) hygiene; (c) physical culture; (d) morality. V. Selection and adaptation of materials of instruction; stage of develop- ment of pupil. Section 1, Childhood; Section 2, Puberty and early adolescence — boys; question of separation of boys from girls from the twelfth year; agricultural schools; suggestive counsels of experts; "the boy problem," by a member of the American Society of Sanitary and Moral Prophylaxis; passages from Lyttleton, "Training of the Young in Laws of Sex;" citations from President G. S. Hall's Adolescence; Section 3, Puberty and early adolescence — girls; Section 4, High-school years; instruction of apprentices; high schools; principles; methods; night schools as an opportunity; continuation schools; Section 5, College years — young men; illustrations; "the venereal peril;" letter from a physician to his son in college. VI. Training of teachers for this task; normal-school preparation; plea for more biology and hygiene. VII. Preparation of young parents for their duties; review. VIII. The religious organizations. Appendix 59 Summary of the discussions of the German society for fighting venereal perils on Socialpadagogik; theses and conclusions in illustration — Paper by Dr. Helen C. Putnam on "Sex Instruction in Schools," written for this volume — Bibliography. List of Active Members of the National Society for the Scien- tific Study of Education 85 PREFACE No apology is made for urging upon teachers, the moral guides of the nation, the duty of helping in the cause of fighting the black plague of the world. A policy of concealment, silence, ignorance, and quackery has borne its monstrous brood of disease, misery, and moral degradation. A false modesty is guilty of much of this giant wrong. There never was a more chivalrous fight for pure women and innocent childhood than that on behalf of which this book is written. Yet, in the present darkened state of the public mind, itself due largely to past ignorance and neglect of medical men, teachers, and pastors, some explanation is necessary of the plan of this study, and evidence will be offered that it is timely and wholly necessary. It has been objected to this study at this time that it diverts the attention of teachers from the consideration of their normal task to exceptional and pathological cases. But this is not a fair statement. The truth is that our schools have professed to teach physiology, hygiene, and morality and have neglected vital factors, the function of elimination of waste and the function of reproduction. Partly in consequence of this neglect we have sexual abuses, excesses, and the plagues of venereal disease. It is high time to recall the teaching profession to its duty, in order that the next generation of parents may be better fitted to rear and educate a wiser and healthier race. The story of pathology is rehearsed only to demonstrate the necessity of a complete education for life. Some good and wise men among our leading educators have seri- ously questioned the timeliness and prudence of this effort to inter- est teachers ; and they say that others should first break ground and prepare the soil. But who are these others? The physicians? They have already sounded the note of alarm in all their professional magazines. They have organized, in New York, Chicago, and other cities, associations whose purpose it is to lay the facts before parents, teachers, pastors, women's clubs, and legislators. The medical men have done their duty. How long should members of the teaching profession wait? How many more thousands should they see drag their miserable way to physical and moral ruin before 7 8 THE EIGHTH YEARBOOK they utter a protest or lend a hand to help? The right time to speak and write and teach is now. For multitudes another ten years of guilty delay would mean disaster. Let him be silent who can with clear conscience. The first draft of this book was read carefully and approved by Dr. J. M. Dodson, dean of Rush Medical College, Dr. C. P. Small, physician of the University of Chicago, and by Dr. W. T. Belfield, an eminent expert in venereal diseases and secretary of the Chicago Society of Social Hygiene. Suggestions of these gentlemen were utilized to improve the text. Dr. Belfield's letter is here reproduced. Chicago. III., November 10, 1908 Dear Dr. Henderson: Have just finished reading your MS. As you will see when you open the envelope, I took a sheet and started "comments" with references from your pages. But I now feel that the only important comment I can make is an expression of warmest admiration for both matter and manner. I can really suggest no changes that seem to me improvements, beyond the few pertaining to your first page.5, already noted. It is a monograph that will do even you much credit. Sincerely, Wm. T. Belfield A few encouraging expressions are added because the author really needed cheer where he was obliged to act contrary to the judgment of some men whose opinion he valued and whose approval he would be glad to win. Ex-Governor W. J. Northen, of Georgia, in an address on "Civic Righteousness in Georgia," before the Georgia Baptist Convention, December 2, 1908, said : "I trust that every citizen who now hears me will study closely the statements in Dr. Henderson's book," and he urges a campaign against that "social institution that has stood for years as an expression of our community life, practi- cally without challenge, and corrupting the morals of men to a most alarming degree." The paper written for presentation has proved to be scholarly and tactful to our fullest expectancy, considering the nature of its subject matter. — Professor Henry Suzallo, Teacher's College, Columbia University. President Charles McKenny, of the Wisconsin State Normal PREFACE 9 School and of the Milwaukee society dealing with "social hygiene," says: I want to thank you and congratulate you on the manuscript. I believe you have done a very great service in its preparation. Its ideals are high, its tone pure, its conviction strong, its facts convincing. The author has, upon invitation, co-operated with a committee of one of the most influential societies of Chicago, the Chicago Womans' Club, and this volume is in part a response to their appeal to all citizens for help : The preservation of the moral, mental, and physical health of your own and the interests of social order will enlist your philanthropic efforts in this world-wide movement of moral and physical portent. A man well known in work for boys and young men writes of the need of this effort : I should like to say, however, that there are two things which seem to me very important for parents and teachers to realize. The first is, that the existence of any such district or section which is unrestrained, as this West Side district was, is an open menace to the physical as well as the moral welfare of the young men and boys of the community. Indeed, the attention of some of us was called to the district by the death of a 16-year-old lad, as a direct result of an evening spent in that section. The other point is that no one is safe. There are many parents and teachers as well, who have the feeling that because they live in a good section of the city or out in the suburbs, their boys are safe from the contaminating influ- ences of a section that is so degraded as the one of which we are speaking. No more serious mistake could be made. Hundreds of boys who would not deliberately start out to go in a house of ill fame of any class will be led by morbid curiosity, and in crowds, into a section where, as they say to themselves, they can see the sights without going into danger. The first thing they know they are swept off their feet. Those who conducted the investigations in that section during the last few months found men and boys from all over the city and from some of the best homes in the suburbs thronging the streets. It was a common experience to find from two to three thousand men and boys in that district in a single hour, and they were by no means all of them from the lower class. In a matter of this kind it is certainly well for us all to remember that not one of us is living to himself alone, and that so long as people are ignorant of the terrific dangers involved, someone has neglected his duty. — Herbert W. Gates. IO THE EIGHTH YEARBOOK The dean of women in the University of Chicago expresses this judgment: Race suicide and divorce are symptoms of a social disorder, doubtless very grave and certainly very evident, whose remedy in my opinion lies in the direction of training both boys and girls for parenthood If boys were taught the principles of social hygiene and their part in maintaining life upon high levels, I can but believe that with their increased knowledge their moral natures would be aroused and strengthened and the difficulties by which all teachers who deal with young boys are baffled would largely disappear. Without analogous training for girls we cannot expect that .... good conditions .... will necessarily produce good mothers. 1 We are simply taking up a line of educational effort which was carried far by the "Philanthropists" of the eighteenth century, 2 and then long neglected. The Illuminists discovered and discussed practically all the prob- lems touched in this volume. It is true they had not the scientific equipment which is at our disposal ; they did not know the specific germs which cause venereal diseases ; they could have improved their instruction by later discoveries in anatomy, embryology, and the laws of evolution. But they had a knowledge of the essential facts of the sexual life, of birth and growth, of the influence of the sexual appetite, and of some of the dangers of prostitution. They knew the value of instruction in preserving youth from vicious conduct, and they gave to knowledge an even more important place than it deserves. In spite of much that is grotesque, coarse, and ridiculous, they left to us many precious suggestions in matters of principle. They were fully aware of the danger of giving instruc- tion about conception, birth, and secret and social vice, and the wise men sought to teach without morbid excitement and premature awakening of curiosity. They studied the problems of feeling in relation to the subject; the cultivation of modesty and shame; the influence of nudity and dress ; the preservation of modesty. They gave careful attention to the management of the appetites, the direction of the will, and the formation of wholesome habits. 1 Professor Marion Talbot, in a paper before the American Sociological Society, December, 1908. - Franz Xaver Thalhofer, Die sexuelle P'ddagogik bei den Philanthropen, 1907. PREFACE II They discriminated carefully between the normal and the unwhole- some manifestations of sexual life and studied the methods of inhi- bition and the reinforcement of character by idealistic and religious motives. They availed themselves of the best medical counsel in relation to a regime of hygienic conduct in the control of the lower instincts and impulses. The names of Rousseau, Basedow, Salz- mann, and Campe, are connected with this pedagogical study and their contributions have been considered in the preparation of this volume. For many reasons the subject has been greatly neglected among teachers until medical men alarmed the thoughtful with their dis- coveries of the ravages of venereal diseases, their prevalence among young men in large towns of Europe and America, and the dangers to women and families from this source. Since ignorance and neglect of proper training are part cause of these evils the pro- fessional duty of teachers has been made too plain to permit longer neglect. An extended treatment of sexual education may give to persons unfamiliar with the situation a wrong impression of the central purpose of the writer. It is the clear and decided conviction of the author that instruction in matters of sex should be a natural part of general education; that it should not be over-emphasized with pupils by calling special attention to it and by isolating it from other studies ; that the instruction should be brief, simple, and free from embarrassment. It may seem at a hasty glance that this present discussion violates these principles ; but in all fairness the reader must consider that this yearbook is for mature persons who are capable of following an objective and scientific argument without harm, and that it is no more intended for general reading than any professional medical book. The investigation was taken up and the treatise written at the earnest request of the Executive Committee of a society of responsible educators who had the conviction that they could not neglect the subject without failure in their official duty. The writer himself had for some years been compelled by his own university duties, by his position as president of the Chicago Society of Social Hygiene, and as trustee of schools for erring girls, and by his investigations of pauperism, crime, and industrial conditions in cities, to face this forbidding problem and seek light 12 THE EIGHTH YEARBOOK for its solution. With men and women who have come in contact practically with the evil consequences of sexual error and wrong, as confidential advisers of youth, no apology for this work will be needed. Neither completeness nor freedom from error is claimed ; but the writer has earnestly sought the best sources of information, has faithfully questioned many professional persons whose knowl- edge and character entitle them to consideration, has examined a large number of recent works of Europe and America, and, finally, has set down the results in plain, simple, direct speech, with the confident hope that all sensible and earnest teachers will appreciate the difficulty of the subject and weigh the argument without prejudice. On one side there has been much exaggeration and sensational overstatement, with unreasonable alarm, and not seldom, especially in certain novels, with an appeal to the salacious demands of their customers for pornographic stories. 3 Some story makers of "best sellers" find normal life too dull for spicy fiction, and are often inclined to select pathological and monstrous characters as types of modern society, forgetting that the freaks in side-shows on circus days are not specimens of normal and healthy men and women. But on the other hand men and women who have been brought up in sheltered homes and kept free from contact with the depraved, may rest in ignorance of the tragedies which threaten the inno- cent children in their schools and families, and so unwittingly neglect those measures of precaution which an instructed and con- scientious school official would take if he knew the facts. Young people who are secretly going astray rarely make confi- dants of teachers ; when trouble comes they seek a physician who, like any faithful father-confessor, buries their story under pro- fessional confidence. They are fortunate if they do not fall into the hands of some miserable charlatan who both corrupts and robs them. It is not surprising that many teachers, even of long experi- 3 Dr. Howard A. Kelly {Medical Gynecology, p. 292) uses a homely illus- tration to impress the danger of exaggeration : "On all sides of such questions one must beware of exaggeration. 'The diff'rence,' says the astute Dooley, 'between Christyan Scientists an' doctors is that Christyan Scientists think they-se no such thing as disease, an' doctors think there ain't annythin' else.' " PREFACE 13 ence, should be unacquainted with these hidden evils. In the course of preparation of these pages about 390 letters were sent to super- intendents of schools in towns and cities throughout the United States. Forty-two replies were received; neglect of the others is due to various causes. In answer to the question: "Do you per- sonally know of cases of illicit sexual intercourse by high-school pupils?" the replies indicated that 19 knew of 84 cases of boys and 44 cases of girls at some time within the past years of their experi- ence; 13 cases of illegitimate births were reported. The others did not personally know of any such cases. In reply to the question : "Do you personally know of cases of venereal diseases — gonorrhea, syphilis, or other?" the replies showed that 12 knew of 15 cases of boys and 3 cases of girls ; in all probability reported to them by physicians. The answers to the questions about the corruption of pupils by persons of vicious behavior and about the effects of secret vice were too vague to furnish any information of value. This imperfect response may be interpreted in various ways. Does it mean that superintendents are not acquainted with the facts ? When a superintendent of long experience in a renowned city declares that he never personally knew a single case of the kinds mentioned, is that proof that none or few occurred? Does it mean that super- intendents fear to offend their constituencies? Does it imply that they dislike to touch the subject? Does their silence or their testi- mony prove that high-school morality is what every patriotic Ameri- can would like to have it? One explanation is obvious enough: high-school pupils are from the better families and have care and breeding above the average youth. It is also true that lads of high- school age are not yet supplied with money to spend on harlots. The writer believes from considerable observation and inquiry that our youth in high schools are, generally speaking, under the sway of influences which protect them at this age from the baser forms of vice. This optimistic interpretation, however, is somewhat discounted by the suggestion of a high medical authority who was asked for an explanation: "That superintendents' claim that high schools do not offer a problem can be refuted by almost any broad-minded instructor in them; also by college physicians' experiences with entering freshmen." 14 THE EIGHTH YEARBOOK We must turn to physicians, dispensaries, and hospitals for our knowledge on this subject; and their evidence, so far as it is accessi- ble, will be presented. Most of the children leave public schools before the period of storm and stress. Vicious, enfeebled, and perverted children are expelled and deprived of education or sent to reform schools. Only the selected and ambitious youth from fairly cultivated families go through high school. It is not at all strange, therefore, that many superintendents and principals should be ignorant of the extent of the venereal peril and seem inclined to be incredulous when medical men reveal the facts. EXTRACTS FROM LETTERS BY SUPERINTENDENTS OF SCHOOLS I am sure that the evil is of sufficient importance to justify our thought on the matter. If there was general publicity and concerted action I am sure great good might be done. M. This is a delicate matter. With young children it must be attended to by parents. The influence of societies must be to arouse parents as to the seriousness of the subject, rather than to reach the children directly. Dis- creet teachers may co-operate, and with the consent of parents may give the necessary instruction. With children in the upper grades and high school the topic should be treated in books on physiology and hygiene, in a simple, clear, direct, and authoritative way. These portions of the book need not be taken up in class, but it is certain that all children will read them. I have had fairly authoritative information that there is great pre- valence of venereal disease among college students. N. H. Teaching should be through elementary biology or nature-study. Have straightforward talks to the girls by wholesome lady teachers — to the boys by a strong, clean male teacher, and lectures by physicians. P. I have no personal knowledge such as the inquiries suggest. B. I think facts should be taught in connection with science at high-school age, orally. P. I advise required biology for one year in all high schools ; nothing else. I went to medical school two years and have had my eye on this ever since. Sex teaching by celibate men and women is absurd, childish, and impossible. The subject is for parents only. Children, I think, must not be given books to read alone. It induces masturbation. God knows things are bad enough, but America is not yet like Europe. W. PREFACE 15 I am sorry to say we do not teach these important facts. A. The superintendent knows nothing wrong in this city and said he would not teach anything on the subject. E. Great care is necessary to avoid aggravating the evil in the case of chil- dren and early youth. The high-school teacher in physiology can give instruction to adolescents better than anyone else. He approves the cir- culars of the State Health Department of Indiana and thinks they could be handed to high-school students after a talk by the teacher of physiology. He knows a few cases of scandal. K. [To instruct children he knows of no way except by plain instruction by parents. In high school, botany, biology, and physiology are good means of teaching.] I am deeply interested in this study; we all need light on the subject. At present I think the whole subject of sexual hygiene is left to the home, where it is greatly neglected. In the high schools some- thing should be done where the homes neglect the matter. The question is how and what. R. Instruction of children should be by parents in the home. Instruction of youth should be in the science work in the high school where sexes can be segregated. [He approves the books: What a Boy Should Know and What a Girl Should Know. The subject is best taught early by parents or teachers of segregated pupils.] A. There are many suspicions floating around, but no accurate infor- mation. The outlook is to me as if much of this should be talked among parents ; first at mothers' meetings and fathers' meetings to prepare them for such sex teaching as this circular suggests. I have not seen anything printed which I thought suitable to put in the hands of the young. G. [He says that the subject is generally avoided by teachers and that he knows of no suitable publications for children and youth.] C. In this city we have separate high schools for boys and girls. Some years ago a teacher of physiology, who was a graduate in medicine pro- posed to give talks to the boys on the use and abuse of the sexual organs. Before doing so he wrote to the parents of the boys asking permission and explaining what he proposed to do. His request was met with a storm of indignant protest and he was forced to abandon his effort. [This super- intendent thinks that talks to the boys by the teacher who has the con- fidence of the pupils is the best method. For boys a male teacher — for girls a female teacher.] L. 16 THE EIGHTH YEARBOOK I am glad you have taken this matter up. I hope you will learn that the scare-heads of the press are unwarranted. Certainly among high-school boys and girls in New England these evils are almost unknown. Some principals have lectured to pupils on this abuse. I doubt the value of such work. All the books are of very doubtful value, I fear they excite lust. H. [Recommends talks to high-school boys by the principal of the school and to high-school girls by woman physicians and instructors in gymnasium.] S. In my opinion this work should reach the parents. The subject in the schools is attended by many and almost insuperable difficulties. The parent is the proper one to reveal these things to the children. F. I do not know. I am deeply ignorant on all these matters. S. [The superintendent has never known of a case of sexual immorality in his schools. The answers are based on considerable experience as high- school teacher and principal.] I am of the opinion that conditions are not so bad as many people attempt to show them. [He gives no suggestions for instruction, evidently thinking that none are necessary.] B. Children ought to be looked after by parents, Wise teachers can give enough instruction. For children at the age of puberty hygienic instruc- tion by occasional talks may be given. For youth more can be done than has yet been done, especially in connection with biology. We have had talks by physicians for boys. K. About puberty instruction should be general and can be given by the parent or one in a similar relation. S. Children are best taught by mothers, not teachers, by telling the stories, in a beautiful way before they get information in a gross way. Books should be used by parents or prescribed with the parents' consent. Do not try to get this done through schools ; let parents and the churches deal with it. Would you want a teacher to talk about this matter with your boy or girl and in the presence of man} - others? Parents are getting to be more negligent and your efforts should be toward educating parents in the manner of presenting these important matters to their young. Parents must not abdicate their parenthood entirely to teachers. We are drifting too much that way. The American Motherhood, the Ladies' Home Journal, and other publications are fast educating mothers on this subject. W. Instruction should be given by parents to children, especially by mothers to their daughters. Youth may be taught by lectures given to students, the girls and boys being in separate classes. I do not know any publications on PREFACE 17 the subject that do not need some expurgating. Should be glad to know of any that do not need this. I believe morality the strongest element in appealing to students, that is those we are trying to teach, next comes healthy bodies connected with happiness. M. Intelligent mothers can do more than all others. [He recommends the "Self and Sex Series."] A. Children cannot be taught in the schools. Private talks are used for youth. In cases of later adolescence there is no occasion for calling special attention to it. I should avoid suggestive books. Have little knowledge, but have used a few talks in some cases. E. We unfortunately give no instruction on sex questions. [As to books, replies : "Am not posted."] B. I have had so little contact with such evils that I have given little study to this subject. Sorry not to be able to suggest even one book on the subject. W. No doubt some of the evils mentioned here occur, but personally I have no knowledge of any of them. S. No direct reference to such subject has been made in any systematic way. I am not familiar with the publications. D. Your letter making inquiry in reference to certain diseases in our schools has been received. In reply I would say, that we do not get into contact with such cases as you describe. R. The usual sex books are poor indeed. Talks by the right person at the right time may do good. I do not know of any ideal book; wish I did. The one I like best is Burt Wilder's What Young People Ought To Knozv. T. On all these problems I am at sea. R. EXTRACTS FROM LETTERS OF PHYSICIANS In my private practice as a genito-urinary specialist I see very few cases of acute gonorrhoea. Boys and young men first go to a drug store or use some remedy suggested by a friend. Later they go to a general practitioner, and only the cases that they do not cure come to a specialist. I believe that boys and girls at the age of puberty should be carefully taught the anatomy or physiology of the sexual organs and the diseases that follow abuse or which may be contracted. I think this can best be done by talks illustrated by charts. I am much interested in the subject and have suggested such talks to some good people who think it ought to be 1 8 THE EIGHTH YEARBOOK done, but will not take the responsibility of starting the matter. They would regard such things as not proper. W. [Recommends segregation of prostitution and favors instruction. Thinks that boys should be taught by the father and girls by the mother under the direction of a physician.] The reading of properly prepared books of which I do not know any published entirely satisfactory. E. In my opinion father and mother should not permit children to go any- where after 8:00 or 9:00 p.m. After the fourteenth or fifteenth year parents should carefully explain sexual hygiene to their children. M. [Recommends publications of the Social Purity League.] G. [Recommends examination of the sanitary conditions of the houses of prostitution, because the prostitute is not as liable to be infected or to infect somebody else if she is clean and in good general health. Special attention should be paid to young girls who just start that kind of a life because their infections are worse and they attract more males. Forbid the owners of such houses to hire a physician to look after their girls. Recommends examination of children in schools and instruction of the mothers, because the mother needs instruction most and she stands nearest to her offspring.] B. A WOMAN PHYSICIAN, HEAD OF AN IMPORTANT HOSPITAL My practice is mostly in a maternity hospital and about 25 per cent of all cases handled have gonorrhoea either in acute or chronic state. We exclude acute cases when possible. We have at least half or more of mar- ried women from good respectable families nearly all unconscious of their malady. My opinion on the regulation of prostitution is similar to the regula- tion of saloons. Get rid of them as early as possible by the education of the young as to their evil results. While they exist make them as unprofita- ble as possible by expensive fines and removals. A business that moves its location frequently loses trade. No regulation that is not seeking for an extermination of these things is worth considering. Parents should be the first teachers of the young on sexual hygiene. It should come easily with the care of the body and the explanation made of the birth of babies and animals which they learn of in the course of family events. The teacher in school should take up the anatomy and physiology of reproduction as the child progresses at the twelfth or four- teenth year or even earlier when possible, by means of plants, etc. The high-school pupils should be taught something of venereal diseases by special lectures in separate classes and the story of human reproduction must be PREFACE 19 made clear, and the young mind may be impressed as in a religious appeal. Each high school should have such an instructor and in large cities one speaker can instruct all of the schools, the parents first being asked to listen to the talk and after hearing it shall decide whether or not they wish their children to sit for it All academies and young people's organ- izations should be presented with such a lecture The consequences of improper sexual relations should in all instances be made known to pupils of the high-school age and hinted at in the presence of younger children. In giving the lecture to parents first, they will be instructed often where they would be left ignorant, if they had not heard the talk, of the very things which their children need to know in order to fear the consequences in loose associations. A stricter chaperonage of both boys and girls in the high-school age should be urged upon American parents. D. [Thinks that prostitution should be under state supervision and segre- gation. Instruction should not be given to children in school or in groups, but by father and mother if the child is sensible, or by the family physician if the child is easily led or nervous.] I believe men should be as chaste as women and that this can be accomplished by education in respect to the moral obligation of high-school and college men. The condition of things in a reform school for girls may be shown by this statement: Of 1,305 girls admitted since 1895, 363, or 27 per cent, were immoral, but not diseased ; 47, or 3 per cent, had been mothers, when they were admitted ; 92 or 7.4 per cent had syphilis, and 50 of these had gonorrhoea also; 777 were admitted with gonorrhoea (51.4 per cent.); approximately 58.7 per cent, had venereal diseases when admitted. W. [Thinks that instruction should be given in the family by parent of the same sex as the child; and in school by special instruction of a physician in classes of one sex only.] B. [Thinks that prostitutes should be licensed and inspected and kept in a "red-light" district. As to method of instruction thinks no one method will do for all. There are as many good methods as there are men and women in the world.] W. I think a well-instructed mother should be the instructor of her chil- dren and the instruction should be given as early as the child mind expands and his curiosity is aroused. A. CHAPTER I SOCIAL LOSS FROM SEXUAL VICE. ECONOMIC ASPECTS The notorious indifference and neglect of this subject by other- wise earnest and thoughtful people who desire the common wel- fare must be largely due to the general ignorance of the damage which the nation suffers from the various forms of sexual vice. The attitude of the unclean is easily explained; they are ready to sacrifice others and themselves to appetite and lust, and they become deaf to argument and appeal in consequence of the debasing influ- ence of immoral indulgence and corrupting companionships. The present study seeks to present ascertained facts to a group of per- sons known to be devoted to public service and open to the influence of arguments drawn from careful and sober presentation of the real conditions. The volume is not intended for circulation except among mature and professional persons whose duties compel them to deal daily with young people who are exposed to temptation and peril. Plain speech, technical only when necessary, will be used throughout. We have used well-authenticated sources, and the conclusions stated are drawn up, so far as possible, in the exact language of medical authorities in responsible positions, and the whole carefully revised by physicians competent to discern and correct error in language or interpretation. It must be remembered that the contemporary judgments of competent physicians, specialists in the particular field, rest upon a wide observation of facts and are inductions from a vast ex- perience, as well as from laboratory and clinical experimentation. These physicians of scientific training would be the last men to affirm that investigation is closed, that all is known, and that noth- ing remains for study. But for the laity the consensus of opinion of the medical men at a given time is the most accurate statement of the facts which is accessible to them. And it is remarkable that, on our present subject, there is practical unanimity in regard to the physical facts with which we have to deal, much as men differ in 22 THE EIGHTH YEARBOOK regard to the more complicated and involved problems of social policy and methods of popular education. This is not a medical work and no more details will be given than are absolutely necessary to make teachers aware of the nature, causes, and effects of the principal venereal diseases which, in the opinion of the greatest physicians, threaten the welfare of the race. I. MEDICAL AUTHORITIES UPON THE NATURE OF THE SOCIAL DAMAGE FROM SEXUAL VICE The chief physical evils arising from ignorant or wilful per- version of the sexual functions are those of masturbation, excessive indulgence of the sexual appetite even in marriage, and the venereal diseases caused primarily and principally by prostitution. Of the comparatively rare pathological and abnormal cases little need here be said; they are to be treated by physicians rather than by teach- ers. Yet sexual perverts are occasionally discovered, not only in reform schools but also in ordinary public schools, and it is exceed- ingly important that medical inspectors find them out before they corrupt normal children. 1 Section i. Physical and psychical disturbances caused by mas- turbation 2 and by excessive indulgence of the sexual appetite, even in normal marital relations. — Here also may be mentioned the danger of precocious indulgence and illegitimacy, (a) Self-abuse is the cause of disorders when it is frequently repeated and long continued. But false and exaggerated statements are frequently made current by quack doctors who become rich by advertising their nostrums after exciting the terror of youth. Medical authority can be cited for a sober and reliable description of the facts, although there is a wide range of variation due to individual differences in constitution, vitality, occupation, and temperament, (b) Excessive indulgence in sexual appetite, without exposure to venereal diseases, may lead to physical and mental disorders of a grave character, both in illicit intercourse and in marriage. We exclude illicit intercourse 1 These inherited pathological conditions are discussed with authority by R. von. Krafft-Ebing, Psychopathia Sexualis, translated by F. J. Rebman from the 1 2th German ed. ; Forel, Die sexuelle Frage ; cf. G. F. Lydston, The Diseases of Society. 2 Dr. H. A. Kelly, Medical Gynecology, pp. 291 ff. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 23 from consideration as ethically rejected. The individual differences are so great that no rule can be laid down as to the measure of temperance in marital intercourse. Good sense in normal physical conditions is a fairly safe guide, and in morbid states of health a physician should be consulted. Precocious sexual intercourse and illegitimacy. — The sexual appetite awakens with puberty, especially in boys ; long before knowledge, experience, and reason provide the moral nature with motives for self-control and inhibition of impulse to gratification. The writer, as a member of the management of a refuge for young girls, is compelled to learn of frequent cases where the poor crea- tures become mothers without being aware of the dangers, miseries, and disgrace to which they expose themselves. It is incredible to a person reared wholly in a normal family life that there should be so many victims of ignorance and parental neglect. In a certain number of instances mothers deliberately corrupt their own daugh- ters and hire them out to vice before conscience has emerged. 3 Section 2. Venereal diseases, especially gonorrhea and syphi- lis. — It will be sufficient for our purpose to present medical authority in relation to the two most important and dangerous diseases which begin in the irregular and immoral relations of prostitution, but which are communicated also to innocent persons by various modes of contact. The two most distinctive of these diseases are gonorrhea and syphilis. Dr. William Osier, in a recent article on preventive medicine, describing the infectious diseases which are the greatest scourges to the human race, such as cholera, yellow fever, smallpox, pneu- monia, tuberculosis, leprosy, etc., says of the group of venereal diseases : These are in one respect the worst of all we have to mention, for they are the only ones transmitted in full virulence to innocent children to fill their lives with suffering, and which involve equally innocent wives in the misery and shame Physicians and the public have each solemn duties in this matter. 4 3 Antonio Marro, La pubcrte, chap. xxi. * Cf. Dr. Prince Morrow, in a pamphlet of the American Society of Sani- tary and Moral Prophylaxis. 24 THE EIGHTH YEARBOOK Gonorrheal — The cause of gonorrhea is a micro-organism dis- covered by Neisser in 1879. The modern period of our knowledge of gonorrhea dates from the dis- covery of the gonococcus. At the present day we recognize that the gono- coccus is the sole pathogenic agent of gonorrhea in men and women, and that the source of the infection is in the immense majority of cases a chronic or latent gonorrhea. 8 As to the effects of this disease we again quote from the same author (p. 83) : Instead of gonorrhea being limited to the genito-urinary tract, as was formerly supposed, its morbid action is now recognized as being much more extensive, not infrequently radiated to important visceral organs. As the result of modern investigations it may positively be affirmed that the gonococ- cus is susceptible of being taken up by the blood vessels and lymphatics and that it may affect almost every organ of the body. The premerential infection is directed to the serous structures of the body. Staining and culture experiments have demonstrated its presence not only in the ovaries, tubes, and peritoneal cavity, which it reaches through progressive invasion of the intermediate membranes, but also in the brain and cord, the endocardium, the pleura, the liver, spleen, kidneys, the joints and tendon sheaths, and periostea, to which it is carried by the blood vessels and through the peri- pheral capillaries to the skin. The number, variety, and gravity of these systemic localizations have led to the serious consideration of the question whether gonorrhea is not to be classed as a constitutional affection — whether these remote effects are to be considered as only occasional and exceptional metastatic complications, or whether there does not actually exist in all cases a latent infection which is only manifest by those systemic localizations in grave cases or in indi- viduals specially predisposed. As to the effects of gonorrhea on woman we quote from Morrow again (p. 172) : All observation shows that pregnancy is the worst thing that can happen to a woman suffering from cervical gonorrhea. It is equivalent to pre- paring the soil for the culture bed of dangerous seed which might not 6 We cite the important work of the distinguished physician, Dr. Prince Morrow, Social Disease and Marriage (1904). But several other important works have been consulted, among them . Medical Gynecology, by Dr. H. A. Kelly (1908). 8 Morrow, op. cit., p. 85. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 2$ otherwise find conditions favorable for their germination and growth. If the woman becomes pregnant, it may terminate in abortion or premature accouchement. At best she will probably produce but one child, which is fated to undergo during its passage into the world inoculation with gonococci which may destroy the eyes, and with what consequences to the mother? We have seen that gonorrheal germs become multiplied and exalted in virulence by their cultivation in the lochial fluid. They rapidly invade the body of the uterus, ascend to the annexial organs, with all the consequences of salpingitis, oophoritis, peritonitis, etc. The essential condition of cure is that it should be seen in the early stage, before infection of the uterus and annexial organs takes place. When it reaches the appendages the general opinion is that it is incurable except by radical operation. A German physician, Dr. Max Gruber, tells of a young woman known in his practice, who went on a wedding journey to Rome a blooming bride and returned broken and withered. The bride- groom had taken gonorrrhea and infected her. The doctor adds in justifiable wrath, "a man who consciously acts like that is a damned monster." He adds : But most men do not imagine that they are affected by gonorrhea, do not imagine that they are to blame when the wife quickly begins to grow ill and sink after marriage, and they believe they have had an invalid wife hung on their necks. The poor suffering woman must listen to reproaches and she grieves at heart that her sickness is a trouble to her dear spouse ! How are such terrible misfortunes, such errors possible?" 7 The offspring of the mother who suffers from gonorrhea is frequently infected and caused to suffer. Who that is capable of remorse or pity would refuse to be turned away from sexual vice by such a description of fact as that given by physicians ? The child in its passage through the maternal parts is compelled to undergo a veritable baptism of virulence. In the course of its passage the face of the child, and especially the eyes, are liable to be soiled with the uterine, vaginal, and vulvar liquids containing gonoccocci. The opening of the eyes of the infant, occurring as a rule when the child comes into the world, permits the penetration of the secretions into the conjunctival sac. The gonococci find in the delicate mucosa of the eyes a favorable soil for inoculation After birth the infectious secretion may be carried into the eyes through the intermediary of sponges, wash-cloths, or by the fingers 7 Die Prostitution vom Standpunkte der Sozialhygiene aus betrachtet, Vienna, 1905. 26 THE EIGHTH YEARBOOK of the accoucheur or nurse. When one eye remains uninfected, it may be inoculated with the purulent secretion of the other. It is estimated that from 10 to 30 per cent, of all blindness is caused by gonorrheic infection. Of all causes of blindness, purulent conjunctivitis is the most powerful factor. According to Neisser there are in Germany at the present time 30,000 blind persons whose loss of sight is due to gon- orrheal ophthalmia. In many institutions for the blind no fewer than 60 per cent, of the inmates have lost their sight from gonorrheal infection. In the institutions of Paris the percentage is estimated at 46, Jullien says 80 per cent.; in Switzerland, 20; in Breslau, 13; in this country, from 25 to 50. As to frequency of occurrence Morrow (p. 112) declares: In the report of the Committee of Seven, which records 1,941 cases of gonorrhea in women occurring in private practice in this city [New York] in one year, there were found 265 children with purulent ophthalmia. In the same year there were found in one of the eye hospitals of this city 136 cases of purulent ophthalmia. Various mitigating and preventive means are known and used by physicians, antiseptic washes, treatment of the eyes (Crede method) of the infant; yet even now many children suffer blindness from maternal infection. "At the present day in Germany gon- orrhea causes each year about 600 cases of blindness in the new- born." The dangers of purulent conjunctivitis from maternal infection are not limited to the child. Nothing is more infectious than ophthalmia neona- torum. It often happens that the attendants, the nurse, or the members of the family are infected, and it is to be observed that while the infection may be comparatively benign in the infant and yield readily to the Crede method, with complete conservation of the integrity of the sight, the infec- tion transmitted to the attendants most often results in a virulent inflamma- tion which may entirely destroy the eyes. 8 Further, we must consider the dangers of contact and diffusion of this dread disease even among the innocent. The virus of gonorrhea may be transferred by means of any indifferent object upon which it has been deposited and inoculated when brought into contact with a mucous surface susceptible to its action. Numerous well-authenticated cases of water-closet infection have been recorded. Rossolimos cites cases in which it was derived from the night- vase, towels, etc. 8 8 Morrow, op. cit., p. 116. ' Ibid. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 27 Douches, tubes, fingers, thermometers, towels, sponges may be the medium of transmitting the virus. One of these classes of con- tagion is called from its localization "vulvovaginitis." The inno- cent victims of this form of contagion are usually children from two to six years of age. It may be present in the newborn or at any age below puberty. In the report of the Committee of Seven there were found 218 cases of vulvovaginitis in private practice in New York City among 1,941 cases of gonorrhea in women. It [vulvovaginitis] has been found in hospitals for children to be one of the most insidious and persistent infections, and one of the most difficult to stamp out, with which physicians have to deal. 10 This statement is confirmed by facts furnished the writer by Dr. W. A. Evans, Commissioner of Health of the city of Chicago. The public bath may be the medium of communication. Various diseases and disorders may be caused by this form of the malady. In respect to the cure of gonorrhea, it is very important for the moral teacher to avoid all statements which are not confirmed by experience and by medical authority. The plain, unvarnished truth is most effective, and the educator who, for the sake of frightening his pupil from evil ways, resorts to falsehoods or even questionable assertions, loses his influence. For these reasons it seems wise to set down here the conclusions of experts in respect to the curability of this most common of venereal diseases. Taking the experience of the leading genito-urinary specialists in this country and Europe as developed by the results of the investigations of the Committee of the American Medical Association, six months may be accepted as the average duration of treatment of chronic gonorrhea. 11 The methods of cure do not belong here; that subject is in the hands of the medical adviser who should always be consulted and his counsels faithfully followed. Quacks should be avoided. The widely prevalent notion that gonorrhea is a trivial disease, not more serious than an ordinary cold, cannot be too strongly combated. Every young man and woman should know its serious character and terri- ble posibilities, and the vital importance of consulting a reputable physician at the earliest possible moment after gonorrheal infection is suspected. 12 10 Dr. J. M. Dodson. u Ibid. 12 Morrow, op. cit., p. 86. 2 8 THE EIGHTH YEARBOOK This judgment of a distinguished physician has been enforced and emphasized by numerous other medical men who have been con- 1 suited in the preparation of this chapter. Gonorrhea frequently unfits a young man for marriage and makes him a plague and a curse to wife and children. This is evi- dently a serious part of our problem. The danger of communi- cating a dreadful and destroying disease to an innocent bride is appalling to any man who has any sense of honor, moral responsi- bility, or religion remaining in him. Physicians insist upon extreme caution. Gonorrhea is sometimes cured, but the gonococci may survive in the system long after the cure seems to be complete. Morrow quotes the authority of Janet: I would demand an entire year without secondary infection. Even at the risk of being called a pessimist, I would impose this delay upon gonorrheics. The enormous number of matrimonial uterine affections shows that heretofore we have been too indulgent in this regard. Metritis, sal- pingitis, and grave operations are the future of these unfortunate wives who had hoped to find happiness in marriage. It is time to react, to consider gonorrhea as at least equal to syphilis from the point of view of conjugal relations. A quotation from Jullien (Blenorrragie et manage, cited by Morrow, op. cit., p. 169) is apt: When the responsibilities are well examined it is often to the negli- gence or ignorance of the doctor they must be ascribed. If he has made an insufficient examination, if he has been satisfied with a rapid inspection, or if deceived by false traditions, he has advised marriage in order to cure the gleet, he alone is guilty. To tabulate all the calamities which follow this fatal carelessness would be to write the endless martyrology of marriage, the saddest page I know. Most authorities maintain that the disease may be eradicated by per- sistent treatment conducted over a long period of time. Every individual who has once had gonorrhea should be assumed to be infected until the con- trary has been proved The poor, half-cured victims of gonococcus infection are a menace to the community and a stain on the fair name Oi the medical profession. 13 One branch of this investigation has special interest for all "Dr. H. A. Kelly, Medical Gynecology, pp. 362, 373- PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 2Q teachers, especially to those who give instruction in special classes and schools for the blind. 14 REPORTS FROM SCHOOLS FOR THE BLIND, 1907 Schools for the Blind No. of New Admissions No. Blind from Opth. Neonatorum Percentage New York State School for the Bind Penn Inst, for the Blind, Overbrook, Pa. Institute for the Blind, Austin, Tex 13 27 3°-7 33-33 (Not definite — -about 10.) Perkins Institute and Mass. School for the Blind Colorado School for the Blind, Colorado Springs Western Penn. Inst, for Blind, Pittsburg, Pa. , (Percentage of total number in school, 31.37.) Missouri School for the Blind, St. Louis State Board of Education for the Blind,, Hartford, Conn., (since creation of board in 1893, 34. 74.) State School for the Blind, Columbus, Ohio (Reduction of usual percentage and as low as at any time in last 12 years) Maryland School for the Blind (percentage of total number in school in 1905, 25.50) Ontario Inst, for Blind, Brantford, Ont. (Percentage of total number in school, 24. 7) 30.00 42.8 28.57 31-57 12.50 983 30-77 21.74 The average then of the new admissions in the fall of 1907 to the ten schools in which exact records were kept and representing eight states and the province of Ontario was 25.21 per cent., or one-quarter of the whole number, needlessly blind. That these are not unusual results is shown by the following report from the Pennsylvania School for the Blind for the past eight years. Per cent. Per cent. 1900 11 out of 25=44 1904 15 out of 56 = 25.00 1901 10 out of 26 = 35 1905 21 out of 42 = 50.00 1902 9 out of 39 = 23 1906 12 out of 38 = 31 .00 1903 14 out of 50 = 28 1907 9 out of 27 = 33.33 The average percentage of these eight years is 33.36 per cent, of the whole number admitted. As this enormously high proportion of blindness due to opthalmia neonatorum is found in states maintaining the highest standards of medical education and general sanitation, there is no doubt whatever that when exact statistics can be obtained at least as large a percentage due to this cause will be found elsewhere throughout the country. Widespread knowledge concerning ophthalmia neonatorum and its dangers is of vital social importance. Helen Keller voices a very proper public sentiment when she says: "The problem of prevention should be dealt with frankly. Physicians 14 See "Report of the Committee on Ophthalmia Neonatorum," Journal of the American Medical Association, May 23, 1908, Vol. I, pp. 1745-49 (Dr. F. Park Lewis, Chairman). 30 THE EIGHTH YEARBOOK should take pains to disseminate knowledge needful for a clear under- standing of the causes of blindness. The time for hinting at unpleasant truths is past. Let us insist that the states put into practice every known and approved method of prevention and that physicians and teachers open wide the doors of knowledge for the people to enter in. The facts are not agreeable reading. Often they are revolting. But it is better that our sensibilities should be shocked than that we should be ignorant of facts on which rest sight, hearing, intelligence, morals, and the life of the children of men. Let us do our best to rend the thick curtain with which society is hiding its eyes from the unpleasant but needful truths. Syphilis. — We must tread this via dolorosa still further in the interest of truth and humanity, and add a brief account of another pest of mankind, slayer of multitudes, itself primarily the issue of immorality. The source of this disease is a micro-organism, and the malady arises primarily from sexual intercourse with prosti- tutes, although it is also communicated to innocent persons. Let us mass our evidence in relation to the causes and effects of this disease of vice. While syphilis is a less prevalent disease than gonorrhea, it is much more prolific in sources and modes of contagion, and, in addition, is sus- ceptible of hereditary transmission. When syphilis is introduced into mar- riage it may become the origin of many innocent infections. Not only the wife and the children may be contaminated, but the syphilitic infant may infect the nurse or other members of the family, and the nurse may in turn infect her husband and her own children. Veritable endemics of syphilis have originated in this way. It is this quality of expansiveness, this capacity of morbid irradiation through family and social life, that gives to syphilis its superior significance as a social danger. 15 Syphilis sterilizes and so defeats the social purpose of marriage. The function of marriage is to create life ; the action of syphilis is to damage or destroy life. While syphilis may not materially affect the capacity for sexual intercourse nor impair the power of procreation, it renders the one dangerous by infection, the other deadly through inheritance. Even when syphilis does not destroy the product of conception it transmits to the offspring a defective organization — the infant comes into the world a blighted being, lacking in development and physical stamina and stamped with inferiority. Syphilis is thus not only a factor of depopula- tion, but a cause of degeneration of the race. 15 Morrow, op. cit., pp. 181, ff. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 31 Now, syphilis introduced into marriage often strikes the death knell of such hopes ; it is destructive of the mutual love and esteem which should form the basis of marriage. Syphilis distils a double venom; it poisons not only the health but the happiness of the household. It carries in its train not only physical woes, but social misery; often disunion and divorce. What husband can hope to retain the love and esteem of the wife whom he has dishonored with a shameful disease; of the mother in whose child he has infused the foul taint of the prostitute, which dies before being born, or comes into the world an object of disgust and horror? If he be a man of conscience and sensibility, what remorse he must suffer from his sense of guilty responsibility for the ruin he has wrought ! These pathological consequenecs and the social miseries they engender are by no means exceptional or uncommon. They are the natural expres- sion of the disease, the sequence of cause and effect, almost inevitable under I the conditions created by the marriage relation. Their frequency is far from being appreciated by the laity or even the general medical practitioner. Syphilis wears the protective mantle of shame, of secrecy, and silence, and its ravages, physical as well as social, are concealed from the public view. 16 The conclusions of a long and technical argument, fortified by citations from the highest European and American medical author- ities are thus summarized by Dr. Morrow : RESUME AND CONCLUSIONS (iN RESPECT TO SYPHILIS) From this study of prematrimonial syphilis the following conclusions may be formulated : 1. The two qualities of syphilis which emphasize its important relations with marriage are its contagiousness and susceptibilty of hereditary transmission. 2. These qualities are not impressed upon the syphilitic organism indefi- nitely; as syphilis advances in its evolution the virulent principle gradually becomes extinguished. 3. Specific treatment also exerts a marked attenuating and corrective influence upon the diathesis. 4. Syphilis does not therefore constitute an absolute permanent obstacle to marriage ; it is only a temporary bar which may be removed by time and treatment. 5. The decision of the question of the admissibility to marriage of a man with syphilis or with syphilitic antecedents imposes a grave responsi- bility upon the physician. 6. The physician should consider the proposed marriage solely as a sani- 16 Morrow, op. cit., pp. 182, 183. 32 THE EIGHTH YEARBOOK tary problem, the only correct solution of which is that the man should not marry so long as he is capable of infecting his wife or transmitting his disease to his children. 7. The elements which serve for the determination of this question are based partly upon our knowledge of the pathological laws of the disease and largely upon the results of clinical experience. 8. The division of syphilis into secondary and tertiary periods, or that based upon anatomical forms and processes, does not furnish a safe cri- terion for determining the contagious or non-contagious character of the lesions. 9. The chronological completion of the secondary stage does not always mark the definite disappearance of the virulent principle; clinical experience shows that the late lesion may be exceptionally, but none the less certainly, the source of contagion. 10. The precise date in the evolution of the diathesis when the syph- ilitic organism undergoes that radical transformation which marks the limit of its contagious or transmissive power does not admit of mathematical expression. 11. It is probable that this limit varies in different cases and that many circumstances contribute to advance or defer it. 12. The type of the disease, the constitutional peculiarities of the patient, the presence or absence of certain conditions which are recognized as factors of gravity in syphilis, the treatment employed, all exert a modi- fying influence. 13. All these elements should be taken into consideration in deciding upon the admissibility of a syphilitic man to marriage ; each case should be studied upon its individual merits. 14. The advanced age of the diathesis, a prolonged immunity from specific accidents and sufficient specific treatment are the surest guarantees of safety. 15. The arbitrary designation of a period of three or even four years as perfectly safe for a syphilitic man to marry, with or without treatment, and irrespective of the character of the diathesis is unwarranted by science or the teachings of experience. 16. While in the immense majority of cases the contagious activity of syphilis and its hereditary transmissibility cease after the third or fourth year, yet well-authenticated observations prove in the most positive man- ner that these qualities sometimes continue much longer, and may be mani- fest in the fifth or sixth year of the disease, and even later. 17. The aptitude of syphilitic parents to procreate diseased children may persist after the cessation of all specific manifestations ; the contagious state PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 33 of syphilis is not, therefore, the exact measure of the duration of hereditary influence ; this is especially true of maternal heredity. 18. The curative influence of specific treatment in causing to disappear the organic lesions as well as the functional disorders created by the syphilitic virus is well established. 19. While the preventive action of specific treatment is less pronounced than its curative action, it is hardly conceivable that a treatment which exhibits such incontestable virtue in causing the accidents of syphilis to disappear should not be capable of dominating and destroying the diathesis, if sufficiently prolonged. 20. The value of specific treatment in suppressing, holding in obeyance, and finally correcting the hereditary influence of syphilis may be accepted as well established by clinical experience. 21. Clinical observation shows that when there is a cessation of all specific manifestations after the completion of the secondary stage, and this exemption is prolonged during a period of twelve or eighteen months, they are not liable to recur. 22. When the syphilitic diathesis has been subjected to the double depurative action of time and treatment during a period of four years, in the vast majority of cases it is scientifically safe for the syphilitic to marry. 23. This rule is based upon a calculation of probabilities. Medical cer- tainty is not mathematical certainty, and a longer period of delay would afford additional guarantees of safety to the wife and prospective children. 24. In deciding upon the fitness of a syphilitic man for marriage the risks to the personal health of the prospective husband from his disease should always be considered. 25. A menacing character of the diathesis, and especially the existence and history of certain symptoms which point to the implication of the brain, nervous system, or other important organs constitute an express, permanent contraindication to marriage." To fortify the argument further the words of Dr. H. A. Kelly may here be cited and reference is made to his discussion: Two fundamental characters, contagiousness and susceptibility of heredi- tary transmission, give to syphilis an altogether special importance in rela- tion to marriage In addition, hereditary syphilis undoubtedly creates a terrain or soil favorable for the reception and germination of tubercle bacilli and perhaps other bacilli. It does this by impoverishing the organism and diminishing the capacity of resistance against microbic invasion. Syphilis is the only disease transmitted in full virulence to the off- 17 Morrow, op. cit., p. 258. 34 THE EIGHTH YEARBOOK spring, killing them outright or blighting their normal development. Fro the view-point of race perpetuation syphilis is antagonistic to all that th« family represents in our social system. The social aim of marriage is noi simply the procreation of children, but of children born in conditions ol vitality, health, and physical vigor. The effect of syphilis is so to vitiate the 1 procreative process as to produce abortions, or else a race of inferior beings j endowed with defects and infirmities and unfit for the struggle of life. Ill is this pernicious effect of syphilis upon the offspring which gives to the disease a dominant influence as a factor in the degeneration and depopula-i tion of the race. Apart from its hereditary risks, the important relations of syphilis with marriage are emphasized by its quality of contagiousness. Owing to its multitudinous modes of contagion, syphilis, introduced into marriage, often becomes the origin of numerous innocent infections which are communicated in the ordinary relations of family and social life Even after the dangers of syphilis, from the standpoint of its contagiousness and trans missibility by inheritance, have been silenced by time and treatment, a syphilitic man may be incapacitated for marriage by reason of his personal risks from the disease. Unfortunately, syphilis often yields a late harvest of tabes, general paralysis, and other lesions of the general nervous system — affections for the most part disabling and incurable — which may ruin the patient's health and entirely incapacitate him for the responsible position of the head and support of a family. The existence of such conditions constitutes an express permanent contraindication to marriage. 18 It is the fixed purpose of the author of this volume, as a layman, to set down no fact which does not come directly from a compe- tent medical man of high standing. The illustrations which fol- low are simply a reprint of Circular No. 3, on "Family Protection," prepared by Dr. W. T. Belfield, secretary of the Chicago Society of Social Hygiene, and an eminent authority in this field. 19 The cases were furnished him by several physicians. It requires no comment. Its laconic brevity brings out the tragedies implied without waste of words, and it fortifies the statements already made. The first step toward such protection is general enlightenment as to the actual frequency of such tragedies among the newly married. To this end the medical members of this society were requested to furnish instances of such disasters which they had personally observed. Only a few of the 18 Medical Gynecology, pp. 419 ff. 19 See also his Man and Woman, p. 87. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 35 many responses can be summarized in this leaflet. These illustrate the most frequent tragedies resulting from the contamination of the family through venereal disease, namely: a) The loss of motherhood, even of life itself. b) The mutilation of the wife by surgery to preserve her life. c) The loss of eyesight in the new-born infant. d) The loss of pecuniary support through the disability of the husband. 1. A girl twenty-two years old married a man of twenty-six. About a month after the wedding the bride was confined to her bed for several days with severe pains in the pelvic region, accompanied with fever (peritonitis) ; and she remained a semi-invalid from that time. On her return from their European trip five months later she was brought to me for examination. The cause of her illness was found in a gonorrhoeal abscess of each fallopian tube, which rendered her an invalid as well as sterile. Careful treatment produced but slight improvement. Finally a surgical operation was performed and the tubes removed. This greatly improved her health though she is, of course, permanently barren. The husband admitted that he had twice contracted a mild gonorrhoea while at college years before, but considered himself cured. Examination revealed the germs of this disease in him. 2. A bride eighteen years old came to my office with her mother two weeks after her wedding. She was suffering from newly acquired gon- orrhoea. After eight weeks of constant treatment, she was apparently well. Her husband had lived "like other men." 3. Several years ago there came under my care a case that I can never forget. The patient was a bride twenty-two years old, a beautiful woman of excellent family. She was suffering from gonorrhoea contracted from her husband, who had supposed himself cured before the wedding. An operation, which offered the only chance of saving her life, was performed. All went well for a few days. Her husband, who had been constantly with her, was called away on urgent business. The patient suddenly became worse and died before his return. 4. A man with gonorrhoea of fifteen months' duration, applied for treatment with the request to cure him in six weeks, as he was bound to get married at the end of that time. After examination the patient was warned that he could hardly expect to be cured by that time. At the end of six weeks permission to marry was refused. The patient disobeyed and married the heiress to a considerable estate. She became contaminated with his disease. Five months after the wedding she was taken to a hospi- tal, operated upon for gonorrhoeal abscess, and died two days after the operation. 36 THE EIGHTH YEARBOOK 5. I am at present attending the bride of a young man who thought he had recovered before his wedding from an attack of gonorrhoea. The young wife has gonorrhoeal peritonitis. She will doubtless recover but is probably permanently sterile. 6. A family consists of a father, mother, and three children; the father is a mechanic, works at night and sleeps during the day. At night the mother and children occupy his bed without changing the bedding. The father contracts gonorrhoea, a druggist prescribes for him on his way home from work. In a few days the baby develops gonorrhoeal inflamma- tion in both eyes, and a girl of six shows the disease in the sexual organs. Both children became infected from the bed polluted by the father. 7. A married man while intoxicated contracted gonorrhoea. His little daughter seven years old, who slept in the same bed with him, developed the disease in both eyes. Careful treatment fortunately saved her eyesight. 8. A young bride was infected with gonorrhoea by her husband, who supposed himself cured before marriage. When her baby came its eyes were infected ; and it was saved from total blindness only by most pains- taking care by himself and a trained nurse, covering a period of three or four anxious weeks. During the treatment of the little one's eyes, in spite of care and warning, the mother's breast became infected, causing a pain- ful and tedious abscess. In another case, also of gonorrhoeal inflammation of the young mother, the babe's eyes were infected; within two weeks both were lost, and the child is totally blind. I am sure that the majority of these cases are due to lack of knowledge on the part of the husband, who is not told that the disease may lurk in his deeper parts long after it is outwardly cured. 9. We have in the children's department of the County Hospital numer- ous cases of gonorrhoea among the children, especially the little girls. The increase of this disease in our children's department has been alarming during the last two years, and we are sometimes unable to trace the source of infection. 10. I believe it very conservative to state that I see each week two cases of gonorrhoea in newly married women, the illness dating from marriage. 11. E. had been most carefully reared coming of ministerial stock for generations past; a young man to whom she had been engaged for three years betrayed her. She came to us two months before her child was born and had never shown any signs of syphilis. The little one, however, was diseased when born, suffered greatly during the four short months of its life, and then died, its little body gradually becoming decayed from the time of its birth. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 37 12. The most pitiful case of inherited syphilis I have known is a girl of eighteen who is just learning to spell "cat" and "dog." Her growth has been stunted and her vision practically destroyed by this inherited disease; and though she has been helped by proper treatment she will always be a loser in the fight of life. I know two childless women both of whom are disabled because of gonorrhoea contracted from their husbands. One of the men shares the grief of his wife because of the semi-invalidism that he has forced upon her. 13. A young wife gave birth to her first child, a credit to the parents. During her invalidism the husband met a former sweetheart, contracted syphilis from her, and before he became aware of his own infection, con- taminated his wife. She developed syphilitic sores in the mouth, and through her kisses infected the child with the disease contracted from her husband. 14. A young man married two years after he had contracted syphilis, Within a year his wife had a spontaneous miscarriage, her child having been destroyed by the taint inherited from the father. A year later she gave birth to a puny child which bore the marks of the same disease. Soon after the birth of this child the father, who had apparently enjoyed good health, awoke one morning to find his right arm and leg completely paralyzed and his ability to utter words abolished, his paralysis resulting from syphilitic disease of the blood vessels in the brain. He gradually regained his power of speech, and the use of his paralyzed limbs, though unable to earn a living for over a year. During this time the family was dependent for subsistence upon the charity of relatives. He will proba- bly have more trouble from the same cause. 15. A young man who was on kissing terms with several girls, acquired syphilis. Though warned that he could communicate the disease by a kiss, he failed to resist temptation, and implanted the disease on the lip of each of two girls of good family. 16. Six years after acquiring syphilis, during which time he had mar- ried and begotten a child, a young man developed locomotor ataxia. The physical and mental disability thereby entailed caused the loss of a good position and bright business prospects ; and the present financial outlook for his family is discouraging. The majority of cases of venereal disease acquired before marriage fortunately do not entail such disasters to wives and children. Instances like those just related constitute the exceptions rather than the rule; nevertheless, of the 60,000 blind people in this country, at least 12,000 lost their eyesight at birth through infection of the eyes with the venereal 38 THE EIGHTH YEARBOOK diseases of the parents. The cases of surgical mutilation and of perma- nent invalidism of wives; of the barrenness of marriage; of infant mor- tality before and after birth; of destitution through disease of the brain! and nervous system in the family bread-winner — all these also are appallingly | frequent results of venereal contamination. It is therefore apparent that no man who has ever acquired venereal disease should marry until he has secured the assurance of a competent! physician that such disease has been eradicated. The difference between! an apparent cure and a real cure can be determined only through expert! medical examination. It is equally apparent that the disasters to self, prospective bride, and j children which are entailed by the venereal diseases, constitute a risk | which no intelligent man should take merely to enjoy the animal pleasures, of promiscuous cohabitation — pleasures which are no more necessary to i bodily health than are the joys of drunkenness. 20 The illustrations of these evil consequences might be multiplied indefinitely, and physicians in almost any large town or city can furnish only too many examples in local experience. Is prostitution necessary to the protection of good women against the assaults of men? — The facts already presented reveal one aspect of the danger to which upright women, who are the vast majority of all women, are exposed in consequence of the exist- ence of the "social evil." Is there any countervailing advantage to them to set over against the demonstrated perils and sufferings ? Does not every prostitute by her very presence excite the sexual passion of many boys and men? Does she not win her bread by tempting youth? Is she not driven by the pangs of hunger to invent arts for breaking down moral restraints and the inhibitions of reason? How can the trade of the harlot protect purity? An article on "Education and the Social Evil" by Dr. A. W. Sterling of Atlanta, is summarized in the Journal of the American Medical Association, April 18, 1908, p. 1306: Sterling discusses this subject and arrives at the conclusion that con- tinence and pure monogamy are the western ideals. The assertion that prostitution has always existed and always will exist — is, in short, a neces- sary evil — he answers by pointing out that those who advance this view 20 That venereal diseases inflict injury on innocent wives and children may be seen in L. Duncan Bulkley, A.M., M.D., Syphilis in the Innocent, Bailey and Fairchild, New York. PATHOLOGICL, ECONOMIC, AND SOCIAL ASPECTS 39 would be as quick as their neighbors to resent the idea that any of their own people should embark in this necessary, and, according to themselves, saving profession Prostitution, if necessary, cannot be immoral, because it stands to reason that no necessary position in life is immoral. . ... If it is not necessary, enough has been said to show that its effects are so destructive, physically and morally, that it is high time something is done to demolish it. If we legalize this infamous business, where shall we look to recruit the ever-fading ranks of these poor creatures as they die yearly by the tens of thousands? Which of the little girls of our land shall we desig- nate for this traffic? Mark their sweet innocence today as they run about in our streets and parks, prattling and playing, ever busy about nothing, and earth's only memento of the angels in their guilelessness. Which of them shall we snatch as they approach maturity to supply the foul mart of the insatiable cravings of lust ? Perish the thought ! Again, we surely would not allow the daughters of our rich men to enter our legalized brothels. The poor man must suffer and be robbed of the flower or his family — the poor man who, Jacob Riis tells us, has no appeal beyond the policeman, and practically no rights in our courts. Sherman said "War is hell," but war is a sweet, a noble, and a choice calling compared with a life in this pit of iniquity. The only way out of the difficulty is to assert that the young girls naturally love this debauched life; but before I believe that you will have to rob me of my experience with women who, for the most part, began by being seduced. — Dr. H. A. Kelly. Prostitution cannot be called necessary or harmless. I must confess that I regard masturbation itself far a lesser evil, danger- ous and harmful as it is for youth and in excess also for adults. At most it harms only the sinner himself, while those who use prostitution bear also the blame of helping the physical ruin of thousands of unhappy women who are driven into incurable invalidism and early death. For almost all professional prostitutes are gonorrheic and syphilitic, and, even apart from that, most of them by their irregular mode of life, abuse of alcohol, and residence in prison are gradually ruined. In England, accord- ing to Tait, prostitutes reach on the average only twenty-five years of age. 21 "The sexual necessity." — A related question, on which there is considerable difference of opinion among physicians, is whether sexual intercourse is generally necessary to health. What is true 21 Dr. Max Gruber, Die Prostitution vom Standpunkte der Sozialhygiene aus betrachtet, p. 30. 40 THE EIGHTH YEARBOOK in this matter and what, therefore, should be the attitude of teach- ers and counselors of youth on this subject? That sexual inter- course is, for adults, normally desirable from the standpoint of indi- vidual health as well as for the existence and welfare of society may be at once frankly asserted. Celibacy could not be the regu- lar mode of life for adults, and marriage at a suitable age may be regarded as best physically and spiritually for the vast majority of healthy people. But this does not mean that sexual intercourse is necessary, as breathing and eating are necessary to life; nor is it fatal and inevitable as gravity, or as the involuntary movements of the heart muscles or the rhythmic secretion of the various glands of the body. Nature has provided a harmless outlet for the secre- tions of the reproductive system without either masturbation or illicit sexual intercourse. 22 The intercourse of the sexes is, apart from the pathological cases of the insane and idiotic, a voluntary act. Alcohol temporarily induces a pathological state when the control of reason and will is broken. That both men and women can abstain without serious injury to health is demonstrated by numerous examples and by the testi- mony of competent physicians; and this testimony is so strong that it leaves the arguments addressed to appetite rather than reason and conscience without a foundation. The same position is taken by the following competent medical authorities: Dr. Max Gruber, Die Prostitution, pp. 41, 42, and Hygiene des Geschlechtslebens; Hegar, Der Geschlechtstrieb ; Dr. W. S. Hall, Reproduction; Dr. W. T. Belfield, The Sexual Neces- sity; Robert N. Wilson, The Social Evil in University Life. Dr. G. F. Lydston (The Diseases of Society, p. 331) has a terrible arraignment of this notion of "sexual necessity" in his parable the "Lie of the Wild Oats," and he concludes : "Are not the wild oats of yesterday watered with the tears of today? .... Wherever immorality, vice, disease, crime, drunkenness, and insanity most thrive, there, if we dig down to the very roots of these evils, we find wild oats the thickest." Here speaks a man who recites facts 22 The seminal emissions which occur at intervals of from a few days to a few weeks, usually during sleep, in healthy continent men, are entirely normal and physiologic, and not evidence of "failing manhood" or "loss of virility," as is blatantly and falsely stated by the advertising quack. — Dr. J. M. Dodson. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 41 from his consulting-room ; he knows ; no wonder he is sometimes cynical in tone. II. ECONOMIC LOSS AND WASTE FROM SEXUAL EXCESS AND DISEASE It is impossible to secure statistical measurements of the extent and material consequences of the social evil in all its forms ; but the facts already exhibited carry with them direct proof that eco- nomic loss or ruin follows in its wake. The wage-earning power of working people depends on their industrial efficiency, and this efficiency is impaired by any habits or diseases which lower vitality, shorten life, or hinder the normal growth of a healthy population. Many of the feeble-minded, insane, blind, and deaf which have become a heavy burden upon the finances of modern states have fallen into a state of dependence through inheritance of the effects of vicious indulgence and ven- ereal disease in their parents and more remote ancestors. The cost of medical treatment by physicians, hospitals, and unscrupulous "specialists" must be enormous. To our national shame be it said, much of this expenditure goes to paid advertise- ments of the lowest type of doctors in newspapers which are taken into respectable families and supported by the advertisements of great merchants. Some idea of the economic loss from venereal diseases may be gained by using such statistics as we have. In the Prussian- German army during the years 1873-93 the average annual sick- ness from these causes was 33.2 per cent, of the active soldiery; in the French army of 1883-93, 43.6 per cent, to 58.9 per cent. ; in the army of Austria-Hungary in the period 1869-93, 53-° P er cent, to 81.4 per cent.; in the Italian army 1883-93, 79 per cent, to 104 per cent. In the German navy there were sick in the years 1875-76 to 1888-89, on the average, 127.9 P er cent - ^ n tne English army it was worse, and in the Dutch army, the ratios rising to 224.5 anc ^ 294.1 per cent. If we take all the European armies together we may say that each day seventy to eighty thousand soldiers are treated for venereal diseases and more or less unfitted for duty. What a loss to the power of an army or navy this implies ! In the civil population it is bad enough. Only a part of those affected enter hospitals, yet the figures for these are startling enough. In 42 THE EIGHTH YEARBOOK Prussian hospitals in 1877-99 about 240,000 persons, or 58 per cent, of all patients were treated for venereal disorders. In more northern lands, because greater care is taken, a larger ratio obtains : in Norway in 1859-70 annually 0.86 per cent of the entire popu- lation, in Sweden 1.24 per cent., in Denmark 2.03 per cent., in Fin- land 2.27 per cent. An official inquiry in Prussia, answered by only 63 per cent, of the physicians, showed that on one day, April 30, 1900, about 41,000 persons were treated. It is thought that in all Germany 100,000 were under care of physicians that day. Kirchner estimated the economic loss to Prussia alone from this cause at 90,000,000 marks annually. In the great cities the situation is worse. In Christiana the aver- age sick in 1859-70 were 7.66 per cent, of population ; in Stock- holm, 16.04 P er cent; in Copenhagen, 25.5 per cent. In Russia where these maladies are rife, it is estimated that 13 to 2^ per cent of the population is infected and in some provinces almost all are syphilitic. In Berlin the number of new cases of syphilis is estimated to be 5,000 each year, in Paris 8,000 to 10,000. On April 30, 1900, the cases of venereal patients reported by physicians were 10 per cent. of the entire population of Berlin. In Copenhagen, where the records are unusually complete, the number of new cases of gonor- rhea reported annually is 56,000, or about one-half the population. Of 8,500,000 persons insured in the sickness funds of Germany 6 per cent., or more than 500,000 are annually afflicted with venereal diseases. In Berlin 3.6 per cent, of the soldiers, 8 per cent, of workmen, 13.5 per cent, of female waiters, 16.4 per cent, of young salesmen, and 25 per cent, of students in the sickness insurance associations were treated for venereal diseases. 23 The frequency of venereal diseases varies with nations, with districts, and especially, with density of population. For example, in Germany, these diseases are more frequent in northern than in southern districts ; more prevalent in the northeast than in the west, in cities, than in rural regions. Of the male population of Prussia on April 30, 1900, 28 in 1,000 were infected; in Berlin 142 in 1,000; in cities with over 100,000 inhabitants, 100 in 1,000; in 23 From Dr. Max Gruber, op. cit. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 43 cities of over 30,000 inhabitants, 45 in 1,000; in the army, 15 in 1,000. The frequency of these maladies varies also with the social classes. Thus in Berlin, of soldiers in the garrison, 4 to 5 per cent, are annually affected; of wage earners in the central sickness insurance association, 8 per cent. ; of female waiters regis- tered in the local sickness insurance association 13.5 per cent. ; but the police records show 30 per cent, of same class; salesmen 16.5 per cent. ; students in the sickness insurance association 25 per cent. The figures for students reveal a very discouraging condition. Of 12,000,000 persons in the German workingmen's insurance associations about 6 per cent., or 750,000 persons require medical treatment and hospital care at an annual cost of at least six to seven million marks (about $1,500,000 to $1,750,000). To this loss must be added the loss of wages and productive labor caused by sick- ness, weakness, and the physical consequences of the attacks. 24 Economic loss implies diminution of the opportunities of cul- ture ; and so venereal excesses and diseases both directly and indi- rectly affect adversely the educational process. No less than 344 persons were admitted, on an average, for each of the four years, to the asylums in England and Ireland, the predisposing or exciting cause of their insanity being venereal disease. It is impossible to supply accurate statistics relating to venereal diseases in the United Kingdom, as there is an immense organized hypocrisy and a well-understood conspiracy of silence regarding the subject. If the committees of our voluntary hospitals ceased misleading the public, and would publish the actual causes of the diseases which the patients suffer from, full particulars could be obtained ; but it is stated that if they did so, the public would withdraw their subscriptions. It is unfortunate that at present all medical statistics relating to deaths and diseases due to alco- holism and venereal diseases are a source of joke, and are absolutely unre- liable and wilfully misleading. Fournier states that of all hospital patients in Paris 15 to 19 per cent, were of venereal origin. Morrow places the per- centage at the New York hospitals at 10 per cent, of the total; Lane in London at 33 per cent, of the out-patients ; while in continental hospitals the percentage of women suffering from gonorrhoea is from 20 to 25. Prostitution and venereal diseases are interchangeable terms, for there is always venereal disease where there is prostitution. A reference to the annual reports of the surgeons-general of the British M Dr. A. Blaschko, Die Geschlechts-Krankheiten, Berlin, 1907. 44 THE EIGHTH YEARBOOK army and navy give us some idea of the terrible amount of venereal diseases there present. During the year 1901, of 100,811 troops (army) stationed in the United Kingdom, there were 1,936 admissions for primary syphilis; 988, for soft chancre; 1,907, for secondary syphilis; 5,794 for gonorrhoea. That is, 10,625 "admissions" in twelve months. Of the British army in India and of 60,838 troops, there were admitted to hospital 2,021 for primary syphilis; 3,921, for soft chancre; 3,544, for secondary syphilis; 7,303, for gonorrhoea. That is, 16,789 admissions in twelve months. Of European troops stationed in other parts of the Empire (fifteen stations) there were admitted to hospital 655 for primary syphilis; 1,488 for soft chancre; 842 for secondary syphilis; 3,258 for gonorrhoea. In the Royal Navy, with 98,410 afloat, there were 3,293 persons treated for primary syphilis; 2,110 for secondary syphilis, 5,790 for gonorrhoea. That is 11,193 persons. It is calculated that the army lost 514,855 days' active duty owing to venereal diseases among the troops, the sick rate being about 1 12.2 per 1,000 men in one year. Supposing these sailors and soldiers had been suffering from plague, cholera, or smallpox, the daily papers would have spread such facts broad- cast, and questions would have been asked in Parliament. But such ques- tions are not asked about venereal diseases, chiefly because we are cowards; we do not wish to save thousands of children from death and disease, and are afraid of Mrs. Grundy. We know that very few of these men are really cured, and that they come home, go ashore, and wander about spreading the disease broadcast, and, by giving it to nursemaids and others, are the means of carrying venereal disease to children in private families. The Registrar-General, in his Sixty-sixth Annual Report, states that in one year, in England and Wales, 986 males and 843 females died from syphilis, and 12 males and 13 females from gonorrhoea, a total of 2,755. These statistics are much below the mark. What of the 19,081 children who died because they were born before full time? These figures refer only to those who die ; but what of the immense total who are alive but suffering from the effects of venereal disease? It is interesting to note the amount of venereal diseases which came to light, for the year 1902, in the French army. There were 485,207 officers, non-commissioned officers, and men in the home service, and 77,185 in the foreign. The following are the statistics: Home Service: syphilis, 3,024, or 6.2 per 1,000; soft chancre, 1,071, or 2.2 per 1,000; gonorrhoea, 8,722, or 17.9 per 1,000, a total of 26.3 per 1,000. Foreign Service: syphilis, 1,219, or 15.8 per 1,000; soft chancre, 1,209, or 15.7 per 1,000; gonorrhoea, 2,986, or 38.7 per 1,000, a total of 70.2 per 1,000. If reference be made to the Fifty-ninth Report of the Commissioners PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 45 in Lunacy (1905), Table XXII shows the influence of venereal diseases in causing insanity. In the yearly average for five years the condition of unsound mind in 489 persons was due to venereal diseases. Again Table XIV refers to deaths of lunatics from general paralysis of the' insane (G. P. I.) 1 and points out that of a total of 9,288 deaths in asylums, no less than 1,665 deaths were due to general paralysis of the insane. It is now held that the chief cause of general paralysis of the insane is syphilis. Mott, I think, states that from 25 to 40 per cent, of insanity is due to syphilis. As bearing upon the devastating action of venereal disease upon chil- dren, Fournier says: "Syphilis is the essential murderer of those young in years; it is the veritable tomb of infants; it is the cause of death before birth, at the moment of birth, after birth, within the first week of birth, or it may await the first year. Syphilis, alcoholism, and tuberculosis con- stitute the triad of contemporaries." He gives the following facts : Of 28 mothers who had syphilis 1 child survived and 27 died. LeFileur's statistics show that of 414 syphilitic wives — who were pregnant when suffering from syphilis — who had among them 260 children, no less than 141 of these died within one month after birth. Of the 414 pregnancies 295 infants died, or about three deaths in every four births. When both parents are infected with syphilis the infant mortality is 68 per cent, in hospital practice, and 60 per cent, in private practice. Fournier terms the first year of the infant's life 'Tannee terrible," when speaking of the devastating influences of syphilis. This is a fearful death-rate, much higher than that following small- pox, scarlet fever, or typhoid, and shows that the human animal is some- what of a glut in the market. If other diseases of infancy, and especially gonorrhoeal ophthalmia in infants — a disease which sends many to insti- tutions for the blind, makes many more become a charge to the Poor Law, and prevents others from earning a livelihood — were considered faithfully, the widespreading results of venereal disease would be more carefully studied. In New York in one year, of 1,941 mothers with gonorrhoea, 265 of their babies suffered from gonorrhoeal ophthalmia. In Switerland one in every five cases of blindness is due to gonorrhoea. In New York of the 1,941 cases of maternal gonorrhoea, 218 female children suffered from vulvo-vaginitis. In all the discussions bearing upon the falling birth-rate, I have seen no notice given to venereal diseases and operations upon the uterine organs as causes of this fall. I contend that they are very serious causes. How can venereal disease be stamped out? — No practical person holds that the registration of prostitutes on the Continent, or in England when 46 THE EIGHTH YEARBOOK the Contagious Diseases Acts were in force, has been, or can be, of any service. I would, however, suggest that notification of venereal diseases to the health authority, or to some central body in London, Edinburgh, and Dublin, be adopted, and that hospitals, supported by the municipalities, be established at which all poor venereals can obtain free treatment. Bearing upon the above suggestions, I would point out that we now have compulsory notification of infectious diseases. Why not have notifi- cation of contagious diseases — especially as contagious diseases cause more widespread evils? 20 Dr. Fournier, one of the highest French authorities says: Syphilis causes certain forms of insanity. Of 4,700 patients, 2,009, or 42.7 per cent, had nervous disorders. All the body is affected; general paralysis, locomotor ataxia, cancer of the tongue. Collective damage: (1) Wives are infected. Twenty per cent, of women who have syphilis take it from their husbands; (2) Venereal diseases given by husbands drive women to divorce ; the family is ruined ; a great source of neglected and delinquent children, so costly and danger- ous to the state. Heredity : Syphilis slays infants by hecatombs ; 60 per cent, in the city at large, 84.86 per cent, in hospitals, of infants of syphilitic mothers die. Idiocy, insanity, abortion, still-births result. 28 If it is said that the foregoing statistics apply only to European countries, and that in the United States the situation is not so alarming, we must reply by adducing the results of investigations by American physicians. In a communication from Dr. Prince A. Morrow the economic consequences of venereal diseases are dis- cussed : While the enormous prevalence of venereal infection is undeniable, and its dangers, both individual and social, are scientifically demonstrated, yet any estimate of the money loss to the community or nation must be purely conjectural and lacking in scientific accuracy. Such an estimate must include as items: (1) invalidism, often permanent; (2) loss of wage- earning capacity; (3) the cost of treatment, incalculable but enormous; (4) the cost of educating and caring for blind children, the idiots, deaf 25 Robert R. Rentoul, Race Culture, chap. xvii. 28 M. F. Hennequin, Rapport general sur les travaux de la Commission Extra-parlementaire du Regime des Mams. Melun, 1908; 2 vols. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 47 mutes, the insane, and other defectives ; (5) the loss of citizens to the state from the sterilizing influence of gonorrhea In the report of the surgeon-general of the U. S. army for 1904, it is stated that of every 1,000 soldiers stationed in the United States, 167 were admitted to the hospital for gonorrhea or syphilis. This was more than double the morbidity of tonsilitis, the next most common of the diseases to which the troop men were subject In the troops stationed in the Philippines, the venereal mor- bidity was 297 per 1,000, largely exceeding the morbidity from malarial fevers and diarrhea; 22 out of every 1,000 soldiers were constantly in- effective from venereal diseases — four times as many as from any other disease The statistics of the Navy Department show during the same year that venereal disease was chargeable with a percentage of 25.2 per cent, of the total number of sick days in the hospital from all causes combined. In four years 949 men were discharged from the navy for disability from venereal diseases. The most extended investigation ever made in this country was that of the "Committee of Seven on the Prophylaxis of Venereal Disease in New York City" in 1901. The committee was composed of medical men of recognized standing. A circular letter of ques- tions was sent to 4,750 physicians resident in Greater New York, of whom 886 replied, but only 678 furnished statistics. These reported 23,196 cases (15,969 gonorrhea and 7,200 syphilis). From this the committee estimated that about 162,372 cases were treated in that year in the city. To these must be added the large number treated by druggists and quacks. The records of hospitals and dis- pensaries furnished further cases in great number. In public and private practice they thought 225,000 cases were treated. If we compare the morbidity of venereal diseases with that of other infec- tious diseases we find a startling contrast; for in 1900 the records showed that of measles there were only 12,530 cases; diphtheria, 11,001 cases; scarlet fever, 7,387 cases; chicken-pox, 1,251 cases; smallpox, 99 cases ; tuberculosis, 8,877 cases. Tuberculosis is not adequately reported ; the others are approximately correct ; and against these we have a venereal morbidity of 225,000 cases. Yet, officially, venereal diseases do not exist in New York City, says the report. There is a conspiracy of hypocrisy to conceal the pres- ence of these plagues and pretend that they do not exist. 48 THE EIGHTH YEARBOOK Another valuable investigation was made by the "Committee on Sanitary and Moral Prophylaxis" in Baltimore: A circular letter was drafted, asking for detailed reports of venereal cases, and a copy was sent to each of the 1,200 physicians resident in Baltimore. Permission to inspect their records was also asked from the superintendents of the various dispensaries and public institutions in Balti- more, in which this class of cases is received. To the circular letters sent to the members of the medical profession relating to the statistics of pri- vate practice, 224 replies were received, about 18 per cent. The statistics obtained from physicians in private practice consist entirely of the reports handed in by the 151 physicians whose returns were appar- ently careful and accurate. The total number of cases reported by them for the year 1906 is 3,090 — 2,195 cases of gonorrhoea and 895 cases of syphilis. These reports have been tabulated and preserved in a permanent form for reference. It is to be understood that no cases of chancroid are included in these figures. While the frequency of chancroid is variable, being less in private than in public practice, the statistics of all authors in all countries estimate it at from 9 to 35 per cent, of the total venereal morbidity. Taking this aggregate of 3,090 cases and knowing that the 151 phy- sicians who reported them represent only one-eighth of the total number of practicing physicians in Baltimore, it becomes evident that the num- ber of cases here reported represents only a small fraction of the total number of cases actually treated in private practice during the year of 1906. More- over, when account is taken of the quack doctors and advertising "special- ists" who treat venereal patients it is obvious that the number of venereal cases here recorded must fall far short of the actual number of cases treated. It is only necessary to glance at the advertisements in the daily papers or to visit the expensive offices of the advertising quacks to reap assurance of the fact that venereal patients bring in large returns to the irregular practitioner. The amount of literature which the charlatans cir- culate is itself conclusive evidence of the thriving practice that they drive. On account of the shame and secrecy associated with the social diseases, the venereal patient is particularly prone to be duped by the fakir. It is well known that many drug stores in this city owe a large part of their revenue to this class of practice and the many "sure cures" and blood purifiers which may be found upon their shelves bear witness to this fact. In addition to the patients who are treated by the irregular prac- titioner, are those who remain untreated or who use prescriptions given them by friends, and although it is impossible to estimate the number of PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 49 these cases any fairminded physician must admit that the number is large. The testimony of European physicians is that from 25 to 50 per cent, of all venereals are treated by charlatans. On further analysis of those statistics it was found that 1,328 cases of gonorrhoea occurred in men, 542 cases in women, and 114 cases in children. Of the infections in women 202 were particularly noted as marital infections. The proportion of women and children to men in the statistics regarding syphilis is remarkably high. In men 489 cases occurred, 303 in women, and 103 in children. Of the cases occurring in children 93 were classified as hereditary infections. Notes as to the source of the infection were, public prostitutes 678, clandestine prostitutes 625, extra- genital infection 184, and "source unknown" 3y6. In examining the dispensary and hospital records, the Committee recorded only those cases where a definite diagnosis of gonorrhoea or syphilis was made. In some of the hospitals and dispensaries it was impossible to obtain any reliable statistics owing to the insufficiencies in the histories. In many of the cases no diagnosis was put down, and in some dispensaries no available histories were to be had. In one promi- nent dispensary, for example, 7,593 patients were listed for the year 1906, but the histories were so incomplete that it was impossible to obtain any reliable information from them. Only 17 of the 41 hospitals in Baltimore afforded any opportunities for statistical research, so the figures which follow represent only the cases treated in those 17 institutions during the year 1906. The total number of cases recorded was 6,360. Of these 4,553 were diagnosed as gonorrhoea and 1,807 as syphilis. Owing to the lack of available information in over one-half of our hospitals and dispensaries these figures represent most inadequately the number of venereal patients actually treated in our public institutions in the year 1906. Despite the fact, however, the extent of venereal morbidity embodied in this report far exceeds the morbidity resulting from the other contagious diseases in the year 1906, as officially recorded by the Board of Health. In the year 1906, 575 cases of measles were reported; 1,172 cases of diphtheria; 577 cases of scarlet fever; 175 cases of chicken-pox; 58 cases of smallpox; 1,215 cases of typhoid fever; 465 cases of whooping cough; 57 cases of mumps, and 733 cases of tuberculosis, making a grand total of 5,047. The number of cases of tuberculosis reported is of course absurdly small, but since the tuberculosis campaign began the number of notifications has been considerably increased. This illustrates again the signal advantage of educating the general public in any effort to make preventive medicine efficacious. Taking now the number of cases of contagious disease reported at the 50 THE EIGHTH YEARBOOK Health Bureau, let us compare with it the number of cases of venereal disease reported by the committee. There were reported 3,090 cases in private practice and 6,360 cases were recorded in the hospitals and dis- pensaries investigated, making a grand total of 9,450 cases of venereal disease. Opposed to this morbidity we have the sum total of 5,047 cases representing the collective morbidity resulting from the other contagious diseases in the year 1906. When we notice that only 58 cases of smallpox were reported in 1906 and then realize that even the wholly inadequate figures of the committee show 2,706 cases of great pox in the same year, the thought must occur to us that the medical profession might for a time at least advantageously turn its attention to the greater evil. 27 No doubt similar results would be found in other cities. We may add fragmentary illustrations which indicate that New York and Baltimore are by no means exceptional. So prevalent are these [venereal diseases] in our large cities that at least half the adult male population of all social grades, according to con- servative estimates, contract one or both of them. 28 It is well known that insanity is one of the heaviest burdens on the financial resources of our states. The cause of insanity, even when known to be venereal disease, is often covered up under some other name. Yet we discover some facts in reports of asylums. In the Ninth Annual Report of the State Board of Insanity of Massachusetts for the year ending November 30, 1907, p. 15, we find the following: First cases received 2,414. One insane person came under care for the first time from every 1,291 of the estimated population of the state. No causes of insanity were assigned by the physicians of the hospital Congenital causes were assigned in 5.47 per cent. ; heredity alone in 5.26 per cent., with other causes 14.13 per cent Alcoholic intemperance alone in 16.65 per cent., with other causes 5.35 per cent., making alcohol a causa- tive factor in 22 per cent., senility in 13.79 per cent. ; coarse brain lesions in 5.30 per cent.; syphilis in 3.19 per cent. In the insane ward of the State Hospital the average rate for three years (1905-7) was 5.93 per cent.; in Worcester Hospital the highest. 6.13 per cent. 27 Reported by D. R. Hooker, M.D., Maryland Medical Journal, February, 1908. 28 W. T. Belfield, Man and Woman, p. 86. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 51 The economic loss due to venereal diseases is indicated in this citation from a circular of the Chicago Society of Social Hygiene : Gonorrhoea, while usually cured without apparent loss of health, has always serious possibilities : it kills about one in two hundred ; it perma- nently maims one in a hundred ; it impairs the sexual power and fertility of a much larger number ; it often produces urethral stricture, which later may cause loss of health and even of life ; and in many cases it causes chronic pain and distress in the sexual organs with severe mental depres- sion. The loss of health, time, and money entailed by these sequels and their treatment may far exceed that occasioned by the original disease. The disaster to the individual wrought by syphilis is shown in the atti- tude of the leading insurance companies toward those so infected — a purely business proposition devoid of all sentimental considerations. They refuse to insure the life of a syphilitic person for four or five years after the disease was contracted, and then only upon special terms. For their records prove that syphilis shortens life. 29 One of the highest authorities on pauperism, Amos G. Warner {American Charities, pp. 66-71, ed. of 1894), has given us the result of a prolonged expert study of degenerate persons in Ameri- can cities: Careful observers believe it [licentiousness] to be a more constant and fundamental cause of degeneration than intemperance No boy among boys, or man among men, can have failed to have evidence thrust upon him showing that a very great amount of vitality is burnt out by the fires of lust Personal acquaintance with railroad day laborers, and others of a similar class, convinces the writer that they are commonly kept from rising in the industrial scale by their sensuality, and that it is this and the resulting degeneration that finally converts them into lazy vagabonds. The inherent uncleanness of their minds prevents them from rising above the rank of day laborers, and finally incapacitates them even for that position. It may also be suggested that the modern man has a stronger imagination than the man of a few hundred years ago, and that sensuality destroys him the more rapidly. To this testimony might be added that of Dugdale in his re- markable story of the Jukes, and McCulloch's story of the Ishmaels. Venereal diseases are spread even to innocent persons by the float- ing class of irresponsible vagrants. 30 ■ Cf. W. T. Belfield, Man and Woman, p. 90. 30 See Report of the Departmental Committee on Vagrancy (British), Vol. II, pp. 105, 203. 52 THE EIGHTH YEARBOOK III. MORAL LOSS CAUSED BY THE SOCIAL EVIL AND SEXUAL VICES This subject does not lend itself to precise statistical treatment, yet the argument does not lack cogency. In the extreme form we discern the spiritual ruin wrought by wicked indulgence, in the wrecks of humanity inclosed in prisons and cared for in asylums and hospitals. A curious and somber aspect of this matter is that men who indulge in base vice lose the fine quality of conscience without knowing it. First goes the power to blush; then comes the levity, the coarseness, the positive delight in obscenity which shocks the right minded. The roue loses faith in the purity of women and of men, and judges the world by himself. It is simply inconceivable to him that anyone can be other than the debased and polluted creature which he has voluntarily made himself. 31 31 A. Marro, La puberte, pp. 517 ff. ; G. F. Lydston, The Diseases of Society. CHAPTER II METHODS OF SOCIAL CONTROL AND MOVEMENTS FOR AMELIORATION It is true that this Handbook is primarily for teachers and that its chief object is to discuss the best educational methods of dealing with the problems connected with the sexual life. But a considera- tion of various policies of regulation and control is necessary at this point for at least three good reasons; first, because many teachers are among the leaders of thought in their communities, and their attitude is a large factor in shaping a sound public opinion; second, because a critical examination of all proposed methods of police regulation must reveal their partial failure and show the necessity for an educational campaign ; third, because many of the arguments used for certain methods of regulation tend to poison the moral nature and undo the work of faithful teachers. No scheme of external police regulation can ever take the place of a sound moral training and that rational self-control which is the only ultimate guaranty of good citizenship. Yet police and sani- tary control of some kind is necessary. While vice and crime exist, and until education in morality and religion has done its per- fect work, society must employ its police powers as far as these are available to diminish disease, protect the innocent, and guard the ignorant against temptation. Teachers, like all other thought- ful and responsible formers of opinion and character, should be acquainted with the actual and proposed measures of governments. I. THE SANITARY POINT OF VIEW, AND "REGLEMENTATION" Physicians very properly regard it as their social duty to guard in all possible ways against the communication of infectious diseases of all kinds. They lead the civilized world in advocating and organizing measures for diminishing typhoid fever, tuberculosis, scarlet fever, and other communicable maladies ; and for this they deserve our praise and our support. Now, medical practitioners are compelled in their daily rounds of duty to come into contact with the loathsome and dangerous diseases already discussed. Naturally 53 54 THE EIGHTH YEARBOOK they inquire what society can do to diminish the spread of these infectious diseases which, for the most part, originate with prosti- tutes and their male clients. Policy of state (or municipal) license or toleration, on the basis of inspection, control, and certificates of physicians. — This policy has many advocates, and it is followed in France, Germany and other nations. It is claimed that it is the duty of the state to prevent or at least to diminish all diseases, no matter what their nature, and so protect the public. To carry out a system of effective regulation it would be necessary ( I ) to distinguish and separate the diseased from the healthy prostitutes; (2) to bring all harlots into special quarters and houses where they can be supervised; (3) to discover and send to hospitals every harlot as soon as she is diseased and so capable of infecting men; (4) also to examine every man who enters a house of ill fame to be sure that he is not diseased. Is such a policy capable of being carried out? An examination of the facts shows what might be expected, that not one part of this scheme can be carried out thoroughly. Of course infection may be prevented in a certain number of cases; the liability to infect may be reduced in particular instances ; and it would be dishonest to deny that something has been achieved by systems of regulation and toleration. We cite the argument of Professor Fournier in favor of the system of reglementation. 1 Dr. Fournier first gives evidence in support of the assertion that syphilis and gonorrhea are social plagues, ranking along with alcoholism and tuberculosis as agents of destruction. The evil is fourfold: these diseases inflict injuries on the diseased person; they are a source of misery to the wife and children; both occasion grave hereditary harm; and thus through injury to persons and families the nation suffers. The illustrations of this argument we have given elsewhere in this discussion. Next Dr. Fournier takes up the objections to medical super- vision of prostitution, which is the source of these venereal diseases : that such medical supervision is injurious, inadequate, and useless. He examines the assertion of the "abolitionists" that it is injurious 1 M. F. Hennequin, Rapport general sur les travaux de la Commission Extra- parlementaire du Regime des Mccurs, 1908. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 55 to public health on account of the false security which it promises and by the terror which it inspires in prostitutes. In reply he says : The state has never corrupted anyone, nor advised anyone to resort by preference to the women registered for medical control; and the guarantees offered by sanitary control are not very attractive, as is shown by the fact that the public houses, which are most secure, have long declined in num- bers, notably at Paris, where, in a period of sixty years their number has fallen from 235 to 48 in 1901. To the objection that reglementation inspires the women with fear and keeps them from registration and control, he says : The objection is valid, so far as Paris is concerned, since the women dread Saint-Lazare because it is rather a prison than a hospital. Apathy, indolence, carelessness, vague fear of remedies and physicians, and often the prohibition of their employers who do not permit them to interrupt their occupation act as a deterrent to registration. Another objection is that reglementation is inadequate. Dr. Fournier says : The complaint is just, but reglementation has of necessity a limited field, and reaches only the lower levels. But even if it restricts disease a little it should be used. Private charity is good, although it leaves many poor without relief; and the police force is useful though it does not detect all criminals. It is claimed by "abolitionists" that reglementation is useless. Dr. Fournier here enters upon an examination of the results of the Contagious Diseases Acts in England and similar legislation in Italy. This dispute is too complicated to repeat here and leads to no conclusive result for either side. Dr. Fournier then states the programme which he claims com- mands the support of the majority of medical men. The object of this programme of action is to reduce the physical evils of prosti- tution (I'assainement de la prostitution). It demands all that is advantageous to public health and takes no' thought of anything further. It demands a medical inspection of prostitutes at fixed intervals, and, when they are found to be diseased, their incarcera- tion in a special asylum. The programme is summed up in these words : medical supervision of prostitution, a supervision which shall be legal, humane, and reformatory. By legal supervision, he means the substitution, in place of the arbitrary, omnipotent, and 56 THE EIGHTH YEARBOOK capricious power of the police, of a system in which the law pro- vides, defines, and limits all the measures which are to be used for the defense of public morals and health, such as the arrest of women for public solicitation, or their sequestration when they have con- tagious diseases. This supervision must be humane; that is, must be free from the persecutions of an intolerant discipline, and from all punishment; in a word, from all requirements which simply exasperate women and compel them to shake off an odious yoke, to the great detriment of the public health. The women under re- straint by reason of contagious disease should be treated as sick and not as criminal persons, with all the kindness which is due any sick person. They should not be kept in a prison but in a special asylum, until a certificate of health is given. Moral influences should be used during the stay in the asylum; a trade should be taught by which the woman can earn an honest living, and she should then be encouraged and helped to lead a better life. Per- haps a more authoritative and competent representation of the sys- tem of reglementation could not be furnished. In another plea for public regulation according to the French method, Dr. Fournier says: Do not accuse us hygienists and physicians of not having done our best to safeguard the public health, for we have struggled a long time to realize a better condition, but our counsel and our adjurations have simply been heard in high places. Still public opinion is energetically urged to abolish all medical supervision of prostitution by a powerful society called the Federation for Abolition. We count on the good sense of the French people to resist such doctrines, the result of which would be to multiply the venereal peril tenfold. 2 This passage is cited simply to show the point of view of some French physicians and some in America also. On the other hand, the arguments of the abolitionists in France are presented by Dr. Angagneur who, in his reply to Dr. Fournier, reached the following conclusions : i. Venereal diseases have not the serious importance ascribed to them by the public and above all by specialists. Syphilis, the most important of all, has little influence on general morality and on the increase of population. 2 Dr. Alfred Fournier, Pour nos fils, p. 46. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 57 2. The variations in the rate of venereal morbidity are about the same throughout Europe. Venereal disease is decreasing in all the armies of Europe. The presence or absence of a system of reglementation has no appreciable influence on the amount of such disease. 3. The introduction of reglementation in a community which has not had such a system does not affect the rate of morbidity; if any effect is produced the rate increases. 4. The suppression of reglementation in any community does not affect the rate of venereal morbidity, but this rate often diminishes after the suspension of reglementation. 5. Prostitution necessarily brings the prostitutes to syphilis. Reglemen- tation has no power to prevent this contamination. 6. It cannot be proved that the women subjected to inspection are more free from infection than those not under supervision. Older prostitutes in any case are more immune than the younger. 7. Reglementation does not tend to free prostitution from disease; it renders it more dangerous by keeping women from seeking treatment. 8. Those infected with venereal diseases are the more inclined to seek treatment the less vigorous is the supervision, and the more humane and accessible are the hospitals. 9. Reglementation has not had a favorable influence on venereal mor- bidity; on the contrary it aggravates it. Some of these positions were sharply contested by medical men, especially the attempt to minimize the disastrous results of venereal diseases. 3 Attempts at control are made by France, Belgium, Ger- many, Russia, Sweden, Denmark, Austria, Hungary, Roumania, Spain, and Portugal. In the United States, England, Norway, Holland (except Rotterdam), Switzerland (except Geneva), this policy is not pursued. 4 Can prostitutes be brought under control? In all places and especially in the great cities attempts to suppress secret prostitution have come to a miserable fiasco. Thus in Paris with its approximately 4,000 registered prostitutes, estimates of secret prostitutes run from 10,000 to 120,000. In Berlin there are only 3,500 public and 10,000 to 50,000 secret harlots. In Vienna there are 1,700 to 2,000 registered and from 20,000 to 60,000 secret harlots. 5 3 M. F. Hennequin, Rapport general sur les travaux de la Commission Extra- parlementaire du Regime des Masurs, 1908. 4 Gruber, op. cit. 5 Ibid., p. 16. 58 THE EIGHTH YEARBOOK What is really promised by the advocates of the German license system? Not much. S. Bettman, an advocate of this systern, will say no more than this : "Surely no greater security should be promised than control can afford." 6 He follows Jadassohn in advising this information for male "clients" of the inspected har- lots, in places where the tolerance and inspection system obtains : 1. Every prostitute, i. e., every woman who engages in sexual inter- course for pay, is under obligation to submit herself regularly to police investigation, in order to determine, as well as possible, whether she is suffering from a contagious disease. 2. Every prostitute is under obligation always to have and to show on request a card with her photograph similar to the one in the control book. 3. Every prostitute who has not this evidence is in the highest degree suspicious, and intercourse with her is particularly dangerous. 4. The card contains the certificate of the last police examination ; and may not be more than four days old. 5. But even prostitutes who are regularly examined by the police phy- sicians may be sick, since there are contagious maladies which the exami- nations cannot disclose. 6. The examination gives no security against infection with venereal diseases, but can merely diminish the danger of infection by exclusion of those who are affected certainly and in a high degree. Regulations of this character are not an invitation to men to engage in immorality ; they operate rather as a deterrent, and also indicate satisfac- torily the still greater risk to health of intercourse with prostitutes who are not examined by police physicians. To one who is really sane and knows all the facts this informa- tion would exclude all but men sex mad, insane from lust and drink. But fools will heed nothing. The most that Bettman claims is a reduction of the probability of infection for a certain case; he knows well that any man who persists will be infected some time. The question is whether this is worth what it costs ; whether there are disadvantages over against advantages ; and whether the same results cannot be obtained without a semblance of license by some better method? The effort to make the control, examination, and treatment thorough drives many of the wretched women to avoid the registration and conceal their condition. Men are tempted all the more to vicious and dangerous indulgence when 6 Die aerztliche Ueberwachimg der Prostitution, S. Bettman, p. 162. 163. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 59 the official certificate of health is exhibited by the temptress. Fear is allayed, but danger is by no means removed. There is no safe way to sin. Dr. Gruber declares : The one who is prostituted or who has intercourse with prostitutes must be informed that he will soon or late become infected with venereal disease, even with the dangerous diseases of gonorrhea and syphilis." 7 On the basis of a local investigation in the city of Mannheim, Germany, where the policy of inspection prevails, it has been affirmed that the number of the infected is still so great that the best possible control offers no secure protection against infection. 6 As for myself, and I trust I speak for all in this professedly Christian land, I would declare : "We cannot consent to sanction of evil that good may come from it." .... We will fight evil wherever we see it, and under all circumstances we will oppose the debasement of the public standards of right and morality. This we will do in entire confidence that in spite of all appearance the right so upheld will in the end prove victorious." * The venereal diseases belong to the worst accompaniments of the sexual impulse Medicine, in connection with men's eagerness for pleasure, has hit upon the most absurd and debasing arrangements that one can imagine, i. e., state toleration, organization, and attempted cleansing of prostitution. Under the pretext of a sanitary regulation, they compel prostitutes to enrol themselves in houses of ill-fame and subject them there to regular medical inspections which are designed to remove the infected from circulation and require them to submit to treatment in the hospital. It is evident that the more or less unsavory service of a prostitute's phy- sician on the whole (there are exceptions) is likely to be followed by physicians of inferior grade. We shall see later that the whole system fails of its purpose. The value of treatment of venereal diseases has been greatly overestimated The only adequate treatment of venereal infec- 7 Gruber : op. cit., p. 30. Proof of the inefficiency and failure of all methods of government regulation are given by Dr. Max Gruber, Die Prostitution vom Standpunkte der Soaialhygiene aus betrachtet, Vienna, 1905 ; Dr. Howard A. Kelly, "What Is the Right Attitude of the Medical Profession Toward the Social Evil?" paper read before the American Medical Association, 1904, and re- printed from the Journal of the American Medical Association, March 4, 1905, citing an article by Frederick Griffith, in the New York Medical Record, April 23, 1904, on the status in Paris; James Foster Scott, The Sexual Instinct. 1908 (2d ed.) ; G. F. Lydston, Diseases of Society. * Drs. Lion and Loeb, in Sexualpddagogik , D. G. B. G., p. 296. * Dr. Howard A. Kelly, op. cit., p. 6. 60 THE EIGHTH YEARBOOK tion is to avoid it. It is beyond belief that honorable women, with the idea of protecting their daughters from the lust of men, will continue to defend such barbaric institutions as licensed prostitution and regulation. Nothing but suggestion of men, to which women are often exposed, can make this comprehensible. That many men and physicians defend this system arises from a mixture of blind conservatism, faith in authority, and incapacity for forming a judgment, together with a concealed, often unconscious eroticism. 10 What must be the influence of the system of inspection and control on members of the medical profession? It would not be true to assert of all the physicians who administer this system in Europe that they are unworthy of their high profession. If the system on the whole were the best for society men of character would be found to carry it out, repulsive as it might be in certain aspects. The treatment of disease cannot fairly be judged by aesthetic standards. From the outside we can sympathize with the expression of disgust with which even physicians repel the propo- sition to introduce Parisian methods in American cities. Thus a high-minded medical man says : The necessity for examining women licensed to carry on their business will create in our midst a vile and odious specialty, akin and closely allied to the professional abortionist, degrading to our profession and partly bringing it into contempt by making it thus pander to vice Read Griffith's article, and see how many of the Paris medical men are employed with two tables examining prostitutes at the rate of about 450 an hour ! What a lowering of our standards when we come to that ! ! u But this praiseworthy repugnance to a vile task does not meet all the difficulties. Can the medical profession and the public authorities leave the whole matter alone and do nothing to cure and mitigate the ravages of the diseases in question? This society has been criticized by some physicians for the adoption of a policy which excludes reglementation from its scheme of work. The failure of this system abroad in materially decreasing the spread of disease, apart from objections on moral grounds, and the hostility of public senti- ment in this country, led to its rejection. It would seem a gross incon- sistency for a society which holds that monogamy is the only sure basis of 10 Dr Forel, Die esexuelle Frage, pp. 230, 231. 11 Dr. Howard A. Kelly. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 6l the social order, the normal productivity and progress of the race, to sanction the legal recognition of a class of women set apart for polygamous practices. A society that recommends continence as the surest preventive of venereal infection cannot consistently favor a legalized provision for incontinence. We cannot afford to lower the standard of morality. The supremacy of morals in private or public life can never be established unless we hold fast to those immutable principles of right based upon the "moral code," which is diametrically opposed to the "conventional code of morals." "Physicians," declares Dr. Osier, "should be the apostles of continence." Whether or not the individual lives of its members conform to this standard, the medical profession in its corporate capacity, in societies and associations, should proclaim the doctrine, based upon sound physiology and experience, that continence is not prejudicial to health. The almost uni- versal infection of the minds of young men with the converse of this doc- trine — the so-called "sexual necessity" — is in my opinion, the most powerful determining cause of masculine immorality. 12 II. THE POLICY OF REPRESSION : THE "ABOLITIONISTS" This policy aims at the absolute suppression of all illicit sexual intercourse. It requires, in order to be effective, that every harlot and every male frequenter of rooms or houses of ill fame be arrested and severely punished by fine and prolonged imprison- ment. It is true that professional prostitutes can be driven out of rural districts and villages where there is an overwhelming public opinion in favor of this policy. But when the attempt is made in cities the evil is scattered but not exterminated. Policemen fre- quently accept bribes from the houses of ill fame as "hush money," and in return protect the outcasts from interruption. It is practi- cally impossible to secure witnesses for prosecution. What man will testify, since his testimony incriminates himself? What woman of ill repute can be brought to testify? It is very easy to declaim against sexual vice and demand that the authorities exterminate it root and branch; but such declama- tion seldom takes account of all the facts. Does any person who is acquainted with our great cities really mean to propose to imprison as criminals the unknown thousands of miserable women who sell body and soul for a living? Have such zealous and worthy orators 12 Dr. Prince A. Morrow, Sanitary and Moral Prophylaxis. 62 THE EIGHTH YEARBOOK even figured out how many prisons would have to be built and maintained to carry out their policy? Have they taken pains to learn, as they should before speaking, how impossible it would be to ferret out the secret prostitutes which the most vigilant detectives in European cities are unable to discover? Have they carefully studied the effects of attempts to treat prostitutes as criminals already made in obedience to occasional moral spasms of public interest in American cities? Have they ever duly thought out the demoralizing tendency on courts and police? Do they not know what a deeply rooted vice will do to pay hush money to those who are given power to imprison the offenders? Have they duly con- sidered the revolting injustice of a policy of imprisoning women for an offense and permitting men, their accomplices and tempters, to go free or to escape with a fine ? Frankly we must give up the policy of repression, for it can be nothing more than a sham policy, full of hypocrisy and corrup- tion, not at all effective for its purpose. A slower but more funda- mental policy must be found ; a policy which will not recognize the profession of the prostitute as legal or pretend to guarantee the lustful against disease, and yet will work steadily toward the cure and prevention of disease, and the removal of the causes. III. THE POLICY OF MORAL REGULATION OF VICE The essential features of this policy are : i. Repressive features. — It is possible for the police force of government supported by wise laws and enlightened public opinion, in a reasonable degree, to prevent the open and public solicitation of the temptress. The street walker can be arrested ; those who sit at open windows may be required to hide; red lights and other advertising methods may be suppressed ; saloons, dancing-halls, and places of amusement can be cleared of vicious persons. 2. Preventive features. — Children must be rescued from the control and influence of vicious parents or guardians. The respecta- ble tenants of tenement houses may be protected against the inva- sion of women of depraved habits. The crowding of living and sleeping-rooms, promiscuous and intimate association of persons of both sexes, especially of boarders, must be brought under munici- pal control. Still wider measures are the industrial education of PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 63 girls, vigorous action of juvenile courts to prevent the prostitution of girls, raising of wages of girls to a decent standard, super- vision of work places and mercantile establishments. 3. A system of moral regulation must recognize the demands of the medical profession, and include practical measures of dealing with infected persons. Physicians should be trained for this task. Quacks should be rooted out and newspapers punished for insert- ing their advertisements, if not by law at least by withdrawal of patronage of subscribers and advertisers. Dispensaries and hospi- tals should admit patients suffering from these maladies, and the cost of treatment should not be in the way of .the admission of anyone. District nurses should be taught to discover and know how to advise the ignorant and poor. Physicians paid by the public should be ready to treat poor persons who come to them. The sacred and responsible relations of marriage should be guarded before the portal by a state law requiring a medical certificate of an official physician of freedom from communicable disease as a condition of receiving a license to marry. These points are argued at length in the report of the Commit- tee of Fifteen in the volume called The Social Evil. 13 The writer of this Handbook looks upon this Report as the most sane, high- minded, and practical statement which has come to his notice. It is customary to speak as though there were but three possible ways of dealing with prostitution, absolute laissez-faire, absolute prohibition of vice, and rcglementation. It is very cogently argued that laissez-faire is an inadmissible policy. Not only does venereal disease extend its ravages unchecked, but every sort of moral iniquity thrives wherever vice is a law unto itself. With equal cogency it is argued that no human legislator can make vicious men or women virtuous, or preserve so close a surveillance over them as to pre- vent the exercise of their evil propensities. Thus, by a process of exclu- sion, rcglementation is arrived at as the only rational policy for govern- ment to pursue. It is difficult to understand how such naive reasoning can still be enter- tained by thinking men. Regulative and repressive systems differ in empha- sis, rather than in essence. The first aim of the reglementationist is to check disease ; he recognizes, however, the gravity of vice in itself, and 13 Committee of Fifteen, The Social Evil, chap, xi (1902). 64 THE EIGHTH YEARBOOK admits that no measures that may limit its volume are to be disregarded. The opponent of reglementation, while believing that vice itself is an evil that completely overshadows any hygienic effects that result from it, will generally admit that all means for combating venereal disease should be adopted, provided that they are not directly antagonistic to moral ends. Accordingly, we find many elements, both moral and sanitary, upon which both parties agree. A system of control based upon such common elements and supplemented somewhat as common-sense suggests, would escape the serious charge, now brought against reglementation, of making itself auxili- ary to prostitution, and would at the same time be free from the moral and hygienic futility of violent repression. Such a system would abandon the task of effecting the impossible, in either morals or hygiene, and would reserve the powers at its command for the bringing about of such ameliora- tions as experience and reason have shown to be possible. Such a system we may term the Moral Regulation of Vice, since it would never lose sight of the fact that moral considerations are of paramount importance. Repressive features in moral control. — The first point upon which all are agreed is the necessity of suppressing, so far as possible, flagrant incitement to debauch. Solicitation upon the street and in public places should be restrained ; haunts of vice should be compelled to assume the appearance of decency; in short, every method of conspicuous advertising of vice should be done away with. It is admitted that this can only ap- proximately be accomplished. The prostitute will always continue to make her presence known. But much would be gained if vice could be made relatively inconspicuous except to its votaries. The constant presence of women known to be immoral serves to recruit each year the patronage of prostitution by inciting to vice many who would not of themselves have sought illicit pleasures. From this point of view, it is far better that prosti- tutes should be clandestine in fact as well as in name than that they should appear in their true colors. A system which places moral ends before sani- tary would be just as capable of dealing with this part of the problem as one which regards sanitary ends as paramount. As a practical fact, the former system would encounter less difficulty than the latter, since the exigencies of sanitary control require that a certain latitude of flagrancy should be given to the licensed prostitute. Reuss, p. 87, is cited : "From the moment that by inscription a semi-official seal is placed upon prosti- tution, one is morally bound to grant the women upon whom obligations are imposed the right to exercise their trade. For the great majority of public women, solicitation upon the street is the only kind that can be employed. The street where they elbow the passers-by, furnishes them the means of their existence ; forbid it them, and they die of hunger." PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 65 The pernicious effect of a league between vice and legitimate pleasures has been mentioned above. Especially dangerous is vice in public drinking- places. Women are engaged to persuade men to drink alcoholic liquors to excess; the effects of alcohol, in turn, lend service to vice It will doubtless be impossible to keep the saloon absolutely free from the presence of prostitution, and to prohibit absolutely the sale of intoxicants in brothels. But a policy which should revoke the license of a saloonkeeper who permits unattended women to frequent his premises in the evening and night would assist in driving vice from the saloonkeeper. A supplemental policy of discouraging the sale of liquors in so-called hotels would be needed to make the plan effective. In like manner, the dancing-hall or music-hall which lends itself to the purposes of vice is a public nuisance and could be reached by the police whenever immorality becomes flagrantly conspicuous. Vice will naturally take refuge in private houses if denied the use of public places. It would still require regulation to keep it within the bounds of decency. It is in vain that it is driven into privacy if by conspicuous lights or signs or by noisy music it is permitted to make its presence noto- rious. An English law of the present day makes it possible to close a house if it is shown by the testimony of two responsible citizens to be used for immoral purposes. While it is doubtful whether such a law would have any other effect than that of breaking up the house of ill fame and compelling prostitutes to resort to solicitation upon the street, an analogous measure which should permit aggrieved neighbors to close a house which is obtrusively devoted to immorality would be a most efficient form in com- pelling such establishments to conceal their true character. We may here consider whether moral ends are best subserved by rele- gating vice to a single quarter of the city. It is a serious question whether the house of ill fame, situated in a respectable locality and compelled to preserve an outward air of decency, is as dangerous to the community at large as a similar establishment surrounded by others of a like character and hence not under compulsion to refrain from flagrant devices for increasing its patronage. Preventive features. — A second point upon which all parties will agree, is the desirability of keeping growing children free from contact with pro- fessional vice. The child who knows all evil is almost destined to share in it. No child over three years of age should be permitted in a house where prostitution is carried on. In tenements and flat-houses parents of children should be able to bring complaint against tenants of tenements or flats in the same building when suspicion is created that prostitution is carried on in such tenements and if the suspicion is found to be based 66 THE EIGHTH YEARBOOK upon reasonable grounds, the courts should require the landlord to evict the suspected parties. The evil is one of such gravity that it would seem to justify a measure which interfered, to a certain extent, with the principle of inviolability of domicile. Even where the children of the poor are not in immediate contact with professional vice, their surroundings are frequently highly inimical to virtue. When a whole family, adults and children of both sexes, is crowded together in a single room, moral degradation is almost inevitable The problem is one of the most intricate with which society has to deal, since the incomes of the poor and the rents which they have to pay are almost entirely fixed by laws over which government has little control. Nevertheless, the question may be raised whether it is not possible by means of restrictions upon the building and letting of houses, to discourage the formation of quarters that inevitably entail upon the community a most serious burden of vice and disease 14 The report further suggests : industrial education of girls, to help them to be self-supporting by honest industry; the prevention of the prostitution of minors by the care of neglected children, and, we may add, juvenile courts. General practitioners should be required to possess a high degree of knowledge in the treatment of venereal maladies The quack phy- sician who practically fosters disease for his own ends should be eliminated. Treatment for venereal disease should be within the reach of all. The cost of adequate treatment for the more serious forms of venereal maladies is so great that the vast majority of patients cannot be treated at all except at public hospitals and dispensaries. These should, accordingly, be numer- ous enough to furnish gratuitous treatment to all who desire it. Patients should be encouraged to appear for treatment ; every care should be taken to insure them against exposure, since many would rather endure their maladies in secret than permit it to be known that they suffer from a shameful disease." If publicity cannot be avoided at public dispensaries, it would be for the general welfare to designate officially private physicians in each quarter of the city, who should treat such patients free of charge, receiving their compensation from the public treasury. Dr. Morrow says that facilities for such treatment in New York City are inadequate; probably this is true in most if not all our cities. Objection will doubtless be raised that such measures would mini- mize the deterrent effect that is exercised by venereal disease upon those 14 The Social Evil. PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 67 who wish to indulge in vice. It is a sufficient answer that the chronic results of disease are frequently even more disastrous to innocent parties than to the sufferer himself. Moreover, the immediate consequences of disease are sufficiently grave to act as deterrent for those who can be deterred from vice by fear of disease. It is doubtful whether the distantly remote consequences are weighed at all. Finally, a system of moral control cannot overlook the fact that venereal disease is frequently transmitted to innocent persons. It is difficult to see how this evil can be remedied except by the requirement, as a preliminary condition to the issuing of a marriage license, of a certificate from an official physician showing the present state of health of each of the con- tracting parties. Such a requirement would work no real hardship to any- one, since few persons who suspected the existence of a disease of this kind would apply for an official examination' before health had been re- stored. It will be admitted that many difficulties would arise in the adminis- tration of such a law, and that it could only diminish somewhat the evil which it is designed to meet. The evil in question is, however, one of so revolting a nature that any amelioration would be worth a heavy cost. The report urges the appointment of a special body of police agents for the administration of the system. For the introduction of a system of control embodying the above fea- tures several state laws would be needed. But whereas reglementation would with difficulty find a place under the Constitution, a system of moral control would be open to no objections on the score of constitutional law. What is of greater importance, any good that might result from regie- mentation is fatally tainted with evil ; whatever good might result from moral control is good unmixed. Reglementation would arouse the uncom- promising hostility of a great part of the community; intelligent moral control would meet with the approval of all, excepting of those who are not satisfied with a plan which would only gradually bring about moral and sanitary improvement, and who dream that there is some royal road to the instant abolition of either moral or sanitary evil. The Detroit method may — with some misgivings — be mentioned under the plans for the mitigation of evils. Some think it only license under a new name. Dr. Guy L. Kiefer, health officer of Detroit, says : The following method as practiced here has been in use about two months The keepers of all houses of prostitution known to the police have been notified that certificates of health will no longer be required nor accepted by the board of health. The board does not care about cer- 68 THE EIGHTH YEARBOOK tificates, but does care about health. It is its duty to prevent, so far as possible, the spread of all contagious diseases, and venereal diseases are contagious." w Therefore on and after January i the health officer, or some phy- sician delegated by him, will visit these houses at unannounced and irregular intervals and examine the inmates. If any are found with a contagious disease (gonorrhea or syphilis) they will be quarantined. The placard used on these houses is a large yellow card with the one word "quarantined" printed on it in conspicuous, heavy, black letters. The keeper of the house then agrees to send the woman to a hospital for treatment at her own expense. "There, after a thorough examination, clinical and bacteriologic, by a phy- sician of the board of health, when found recovered, she was allowed to go." The houses are not licensed, but these diseases are treated like other contagious diseases. An officer must be con- stantly at work. The plan is merely partial and palliative : many of the women will escape notice and go on infecting men ; and in inter- vals of visits will infect many. Educational methods of the state of Indiana. — In the year 1905 the legislature of Indiana passed a law, which was designed to prevent the issuance of licenses to marry in cases of unfit persons. The Board of Health of Indiana caused to be distributed a large number of cards on which were printed "facts about tuberculosis, gonorrhea, and syphilis." New French Bill — We here insert a summary of the chief points of a bill recommended to the French parliament as a result of an in- vestigation covering the experience of more than a century and a dis- cussion of some of the most competent men in France during a period of three years. 10 This bill (Projet de loi concernant la prostitution et la prophylaxie des maladies veneriennes) aims to take from the police the power of arbitrary arrest on suspicion, the power to punish without trial and all forms of legal tolerance, enforced inscription and medical inspection, with certificates of health which were condemned by a majority of the commission, not without 15 Journal of the American Medical Association, March 21, 1908, p. 97. 18 Rapport general sur les travaux de la Commission Extra-parlementaire du Regime des Maurs, presente par M. F. FIcrinequin. Melun, 1908. 2 vols., pp. 285, 534- PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 69 protest from strong medical authorities. This bill aims positively to prevent public solicitation and temptation, the seduction and ruin of girls, and to provide all possible means of healing diseases and limiting the spread of venereal poisons. 1. Among the general provisions of the bill are (Titre I) : Prostitutes shall not be deprived of liberty except by due process of law; they shall not be compelled to register on a list of prosti- tutes and be subject to enforced inspection. 2. Minors are protected from moral peril (Titre II) : if under the age of eighteen, and habitually immoral, they may be brought before a civil court and placed under the care of an institution for reformatory education up to majority or marriage. A useful in- dustry is taught and money for a start in life furnished out of the earnings upon discharge. 3. Public solicitation to sexual immorality is brought under the law (Titre III), and the penal code is modified to provide fine and imprisonment for the offense. 4. The attempt to incite to evil conduct, notorious cohabitation for debauch, and the renting of a dwelling knowingly to prosti- tutes are brought under the Penal Code (Titre IV). The police are forbidden to enter a domicile, however, except in case of tumult or where a person's safety is in danger. 5. Preventive measures (Titre V). Prostitutes arrested under the law and found to be infected may be required to take medical treatment, if they do not submit to it voluntarily. On complaint any man or woman guilty of communicating a contagious venereal disease may be punished. Quack advertisements are brought under control. Hospitals are required to accept venereal cases for treat- ment. Dispensaries and consultations by physicians are provided for and exposure is forbidden. In all medical schools the young physicians must have instruction in venereal diseases. Mutual benefit societies must not refuse aid to members requiring medical aid for those maladies. Mention may be made here of the problem of isolating the houses of ill fame with a view to removing them as far as possible from contact with children and youth. This involves, on the part of the police, a certain kind of silent toleration and the suspension of laws making it criminal to rent houses to be used for immoral 70 THE EIGHTH YEARBOOK purposes. On this knotty subject opinions of thoughtful people differ widely. In some degree this is the actual policy followed in American cities, with spasmodic arrests — sometimes more in the interest of fees and bribes to policemen than with any real good to the community. On segregation we have the views of Dr. E. Lesser (Verhiitung und Bekdmpfung, etc.) : On the restriction of prostitutes to certain houses. — I may say at the very beginning that from a hygienic standpoint I do not ascribe to this question a very great importance, although there can be no doubt that it would be very much easier to control the conditions of health with harlots in the houses and to bring medical treatment to those who are sick. Still on the other hand it is very certain that at present under no conditions is it possible to shut up all the prostitutes of a great city or even the greater part of them in such houses. The hygienic conditions of the prostitutes outside of the houses would naturally in no way be touched by this arrangement, and therefore we must, even along with the existence of tolerated houses with the greater number of prostitutes who live where they please, employ the means we have before described and some others in order to secure sanitary conditions. But in an entirely different relation, by partial restriction to certain places, that is by a partial compulsion to live in certain localities and streets, an advantage might be gained. This is not too much to say when for the majority of the largest cities the claim is made that in them prostitution is almost ubiquitous. I am satisfied that, for example here in Berlin, there are not many streets in which there are no prostitutes, and that on the other hand there are streets in which one or more prostitutes live in almost every house, and when we consider that by far the greatest number of prostitutes dwell in the quarters occupied by the poor families in the great tenement houses it is apparent without anything further that there is a I very great demoralizing influence which is exercised by this universal presence of prostitution among the population. Even if in the dwellings where prostitutes dwell there are no children, yet on the same floor or in the house there may be children and growing youths and maidens who day by day have before them the shameless conduct of these prostitutes. It appears self-evident that the sense of modesty is dulled by this means and that moral self-control is disturbed and that those who are in danger are easily brought to the steep places of vice. To set aside this demoralizing influence of prostitution altogether naturally is something that can never be done, but even by a partial sequestration of prostitution at least a partial improvement of the situation can be made and also in PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 71 another direction the restriction of a number of prostitutes to several civic localities would make an improvement possible. I mean the diminution of the solicitation by prostitutes on the open streets. The conditions in a great number of the great streets of the larger cities and those also in Berlin are in fact greatly to be deplored. It is almost incredible with what openness the majority of the prostitutes conduct their solicitation on the streets, and how in consequence certain streets have been taken posses- sion of by the prostitutes to such an extent that in the evening or at night decent women or girls cannot pass through these streets because they are considered prostitutes and are assailed by men in the most disagreeable way. Ability to resist temptation, especially on the streets, is a serious factor, as can easily be understood. The man who is going on his way quietly without sexual intentions, finally, after he has been again and again attacked and the sexual nature disturbed, yields and follows the last of the prostitutes who speaks to him. The same man would under no conditions go to a house of ill fame, because this would imply a previous sexual purpose. That the incitements on the street have a great influence on the increase of sexual intercourse with prostitutes there can be no doubt, and for this reason restriction or segregation of a number of prostitutes would offer an immediate improvement, although of course a complete suppression of provocation on the street cannot be regarded as possible. The control of employment bureaus. — The connection between the social evil and bureaus of employment in our large cities is described with painful accuracy from direct personal observation by Frances A. Kellor in her book Out of Work, Putnams (1904). She says: But the .... business methods and the frauds pale into insignificance beside conscious deliberate immorality of many offices and the traps they set for their unwary and helpless victims. Of these the honest employer knows but little and the employee recalls many escapes. The bare fact is that while advertising honest work and while furnishing it to some, many also degrade, debase, and ruin others and later cast them out moral and physical wrecks. Not only are they robbed of their small savings, hoarded like animals, and subjected to many indignities by proprietors, but they must submit to association with and temptation by street walkers and immoral men. Not only must they lodge under conditions which rob them of their self-respect, but unsuspectingly they are sold into disreputa- ble houses and held as prisoners. Not all offices are engaged in this work, though with few exceptions 72 THE EIGHTH YEARBOOK they are careless in making inquiries where girls are sent. Figures can only be approximate, but it is no exaggeration to say, that in New York, Philadelphia, and Chicago, about 75 per cent, are not averse to sending women as employees to questionable places, and from 40 to 60 per cent, send them as inmates, obtaining their consent when possible. The details given by Miss Kellor are painful and startling in the extreme but must be read in her interesting volume. This chapter is in no sense of the word intended as a contribution to the extent of dealing with the social evil, whether it shall be regulated, exterminated, licensed, tolerated, or whether it is necessary or otherwise. Its sole purpose is to show one source of supply — places where unwilling recruits are secured ; and to insist that some methods are unfair and that some offices are sailing under false colors. Even granting that neither regulation nor segregation will affect the demand, one thing is certain: increase the risk and the majority of such offices will retrench their work or go out of business, for they will do nothing that will not pay — and honest, igno- rant, and helpless girls will be much better protected ; for disreputable houses cannot so readily reach women who are penniless, friendless, and discouraged — the time when such proposals are most favorably received. Associations for combating the social evil. — Teachers should be acquainted with the more important organizations working on behalf of social purity. These organizations have grown rapidly in numbers and in power during the past decade as the public is becoming more intelligent An article in the new Encyclopedia of Social Reform, by Dr. Bliss, p. 1127, gives some information: In Europe there is a National Federation for the Abolition of State Regulation of Vice. Its headquarters are at Geneva, Switzerland, and it has committees in various countries. This federation publishes sixteen different periodicals in seven different languages. The British Committee has its office at 17 Tothill Street, Westminister, S. W., London, England. The secretary is Mr. Maurice Gregory and the organ of that office is called The Shield. The International Bureau for the Suppression of the White Slave Taffic has for its secretary Mr. William Alexander Cotte, with offices at St. Mary's Chambers, 161-A Strand, London, W. C. This bureau has a committee known as a National Vigilance Committee with a branch in the United States. Dr. O. Edward Janney of Baltimore is the chair- man of this committee in this country, and state associations have been formed. The White Cross Society, established by the Bishop of Durham, England, in 1883, an d taken up in this country by Rev. B. F. DeCosta, PATHOLOGICAL, ECONOMIC, AND SOCIAL ASPECTS 73 D.D. should be mentioned. The principal purposes of this organization are. First, to urge upon men the obligation of personal purity; second, to raise the level of public opinion upon public morality ; third, to secure proper legislation in connection with morality. The New England Watch and Ward Society, having as its secretary Mr. J. Frank Chase, Boston, Mass., is one of the oldest societies in this country. It combats obscene literature, gambling, and vice. The New York Association for the Suppression of Vice, led by Mr. Anthony Comstock, devotes its efforts chiefly against obscene literature and degrading instruments of vice. The American Society of Sanitary and Moral Prophylaxis seeks to limit the spread of dis- eases which have their origin in social evil. It was founded by the emi- nent physician, Dr. Prince A. Morrow of New York City. A society with similar purposes is established in Chicago — The Chicago Society of Social Hygiene — and the Milwaukee Society for Sanitary and Moral Education. There are others. All work largely through publications. The Women's Christian Temperance Union ; the Young Women's and Young Men's Christian Associations ; the King's Daughters ; the National Council of Women ; the Congress of Mothers ; many women's clubs and various law and order societies in our cities have all undertaken this crusade. In most of the large cities may be found the rescue missions of the Catholic church and of other denominations of Christians, and the Florence Crittenden missions. The Health Education League at 113 Devonshire Street, Boston, Mass., publishes as No. 16 in the "Health Education Series" a little cir- cular on Sexual Hygiene, by a member of the Massachusetts medical society This league is doing excellent work. Origin of the Society of Sanitary and Moral Prophylaxis in this country. — The first gun fired in this movement was a paper on "The Prophylaxis of Venereal Diseases in New York City," read before the Medical Society of the County of New York, February, 1901. This was followed by the report of the Committee of Seven, New York, in December, 1901. An effort was then made to organize a society for the study and prevention of venereal diseases in this country, but it met with neither medical nor lay support. Social Diseases and Marriage was written in 1903 largely with a view of creating a professional sentiment in favor of this work. This was followed by a "Plea for the Organization of a Society of Sanitary and Moral Prophylaxis" read before the New York County Medical Society in May, 1904. Finally after months of personal solicitation the following named gentlemen united with me in a call for a meeting, February 8, 1905, to discuss the wisdom and expediency of forming a society for the prevention of social diseases : Dr. Stephen Smith, Dr. Edward L. Keyes, 74 THE EIGHTH YEARBOOK Dr. George B. Fowler, Dr. L. Bolton Bangs, Dr. Edward L. Janeway, and Dr. Abraham Jacobi. 17 Conclusion. — The sexual appetite is natural and universal ; it serves a purpose. But it must be regarded from the social stand- point, in connection with the duty of having and caring for chil- dren, not from the selfish standpoint, as a mere means of fleshly gratification, with no moral or social object. This is the essential evil. 18 The state must tolerate and control; it ought not to recog- nize prostitution in any way as legitimate. At best, law, police, government can do little more than affect the external conduct; they do not reach the springs of action, the habitual incentives, the active ideas, the personal motives, the spiritual valuations of satis- factions. Admitting all that may properly be claimed for the favorable reaction of even compulsory observance of decent require- ments on the inner life, we must look to some influence far deeper and more pervasive for the ultimate self-regulation of life in accord- ance with the laws of social welfare and of the noblest life. This influence is education, and therefore we now turn from the medical profession and from the statesmen to that profession which deals with the character, the will, the moral nature in the most direct and persuasive way; we make our appeal to the school teachers, the parents, the spiritual counselors of children and youth. This will be the theme of the other part of this Handbook. 17 From letter of Dr. Prince A. Morrow to the writer. 18 Cf. Max Gruber, Die Prostitution, p. 33. ■■• : ■ ' iaffl ■' : '-"' V.: :■■))■:■■: IHBi sW