Social ^Diseases
*Dr. ^. Jfcericourt
THE SOCIAL DISEASES
THE
SOCIAL DISEASES
TUBERCULOSIS, SYPHILIS,
ALCOHOLISM, STERILITY.
BY
DR. J. HERICOURT
Translated, and with a final Chapter,
BY
BERNARD MIALL
LONDON
GEORGE ROUTLEDGE & SONS LTD.
NEW YORK : E. P. DUTTON & CO.
1920
Annex
5018817
PREFACE
SOCIETIES have justly been likened to animal
organisms.
Like the animals, human societies possess the
functions of nutrition, relation, and reproduction ;
and the investigation of these functions, which may be
described as social physiology, was ingeniously
worked out, some fifty years ago, by Herbert Spencer.
On the other hand, just as the animals are prone
to various diseases, so human societies may suffer
from sickness, and as there is a social physiology
there is also a social pathology.
In the animals the malady of the individual con-
sists of a deterioration of the cells whose aggregation
forms the animal organism. Similarly a social
malady consists of the aggregate of the maladies of
the individuals the cells who make up a society.
It will therefore be understood that there can be no
social malady unless a large number of individuals
are afflicted with this malady, just as we cannot re-
gard an animal organism as diseased if only a few of
its cellular units are impaired.
The social maladies, then, are those which menace
the social units, both quantitatively and qualitatively,
and are thus capable of jeopardising the future of
societies.
These social or racial maladies, which have been
widely discussed during the last few years, we now
propose to describe. We shall consider their nature,
their gravity, and their therapeutic treatment.
From this last point of view the investigation of
social maladies, if we can judge by past experience,
is apt to be somewhat disappointing; for the public
authorities who are responsible for their extent and
r-rv
.
VI PREFACE
their gravity though their responsibility is quite
impersonal have not hitherto had the courage to
deliver a frontal attack upon them.
Why is this? As we shall see, all social thera-
peutics must involve the modification of habits, the
enforcement of regulations and restrictions. Such
matters are avoided by politicians as fire is avoided
by a burnt child ; for politicians are the slaves of their
electors.
Consequently no therapeutics worthv of the name
has so far been applied to the social diseases, which
run their course unhindered ; some, indeed, mav even
have been favoured by the somewhat incoherent
measures of which they have been the object.
It is possible that public opinion, being at last
more alive to the ills with which our European
societies are threatened, at a time when their vitalitv,
owing to the War, is in other ways so profoundly
impaired, may achieve a beneficent reaction against
this condition of affairs, and insist that the repre-
sentatives of the nation shall organize the struggle
against the plagues that threaten us.
Such a reaction is urgently needed ; and it will be
found that the social diseases which we are about to
consider are most prevalent in those States which are
most highly civilised ; as though those nations whose
civilisation is of oldest date might be likened to aged
and therefore exhausted organisms, which are conse-
quently liable to functional breakdowns, and to para-
sitic invasions of their organs.
History shows us that societies die and vanish from
the earth as individuals do. The pessimistic may
therefore regard the maladies of our societies as
presaging their inevitable dissolution. But we would
fain believe that there is still time to postpone the
final collapse.
*****#
The diseases to which animals are subject and
the same is true of human diseases originate in
PREFACE VI 1
three different ways. They may be due to the in-
vasion of the organism by vegetable or animal
parasites; to contamination by the absorption of
toxic substances; or to functional disturbances of
various kinds.
The diseases of societies, from the causative point
of view, may be classified in the same manner into
diseases whose origin is parasitic, diseases whose
origin is toxic, and functional disorders. As we have
already stated, they are identical with the diseases of
the individual, and if they are promoted to the rank
of social diseases it is only by reason of the large
number of individuals afflicted by them : whereby
they affect the future of races, and threaten the very
existence of societies.
The diseases which come under this heading, and
which we shall consider in the following pages, are
four in number. They are : Tuberculosis, Syphilis,
Alcoholism, and Sterility.
Tuberculosis and Syphilis are diseases of parasitic
origin. The first is due to a vegetable and the second
to an animal parasite.
Alcohol is a toxic malady a disease of intoxication,
using the word in its medical sense ; a poisoning of
the organism.
Sterility is a functional disorder or disturbance : it
may be deliberately induced.
Such are the four great scourges from which all
modern societies are suffering, but which threaten
more particularly the oldest civilisations. They are
more terrible than even the most terrible of wars; for
wars, even the most destructive, are passing accidents
from which societies recover fairly rapidly, as indi-
viduals recover from a serious loss of blood, while
their very lives appear to be seriously threatened b\
the advance of any one of the four plagues which
have stricken them.
It must be admitted, however, that a state of war
aggravates all social diseases, and that the conditions
Vlii PREFACE
of social hygiene to which we are at present subject
are peculiarly difficult.
On the one hand the privations and the fatigue
undergone by men of weakly constitution end by re-
awakening attenuated or torpid cases of tuberculosis
which might, under ordinary conditions, have been
completely cured ; on the other hand, for reasons
which it would be tedious to enlarge upon, syphilis,
in a state of war, finds conditions extremely favour-
able to its propagation. We shall show that the same
is true of alcoholism, but this more especially in
France, thanks to the culpable weakness of the public
authorities.
We propose to consider each of these maladies. In
the first place we shall study its causes; then its
different forms, which will enable us more surely to
realise its prevalence and its gravity ; then its re-
moter consequences, from the racial point of view.;
then the remedies which have been applied to it in
the past ; and lastly, the remedies which we ought to
employ in future.
It is interesting to note that of the four great social
diseases which we are about to examine, two are
strictly voluntary disorders. Man contracts these
two disorders because he wishes to do so ; and he can
abolish them by the mere exercise of his will. I am
speaking of Alcoholism and Sterility ; for the sterility
which we shall consider is of course a voluntary
sterility.
Syphilis is to a very great extent another voluntary
disorder, and it is certain that the intelligent educa-
tion of the young would quickly be followed by a
notable diminution of the ravages of this plague, the
most terrible of all the social diseases.
As these four diseases are responsible for the
greater part of the moral suffering to which man is
subject, it will be seen that it is only too true that
societies, like men, are the architects of their own
misfortunes.
CONTENTS
PAGE
PREFACE V
BOOK I
TUBERCULOSIS
CHAP.
I NATURE AND FORMS OF THE DISEASE; ITS
CONTAGIOUSNESS - 3
II WHY TUBERCULOSIS IS SO WIDESPREAD - 8
III THE SOIL FAVOURABLE TO TUBERCULOSIS - 13
IV THE CAMPAIGN AGAINST TUBERCULOSIS - 22
V SANATORIA AND DISPENSARIES - 27
VI INDIGENT CONSUMPTIVES IN AND OUT OF
HOSPITAL 33
VII THE ISOLATION OF CONTAGIOUS PATIENTS - 40
VIII THE COST OF THE CAMPAIGN AGAINST
TUBERCULOSIS 5O
BOOK II
SYPHILIS
I THE NATURE OF THE DISEASE AND ITS
PHASES 57
II HEREDITO-SYPHILIS AND THE SYPHILITIC
HEREDITY 68
III THE GRAVITY AND EXTENT OF THE EVIL - 82
IV THE CAMPAIGN AGAINST SYPHILIS. WHAT
HAS BEEN DONE - 87
V THE CAMPAIGN AGAINST SYPHILIS. WHAT
MUST BE DONE 96
X CONTENTS
BOOK III
ALCOHOLISM
CHAP. PAGE
I THE NATURE OF THE EVIL. THE DIS-
ORDERS RESULTING FROM IT - 113
II THE EXTENT OF THE EVIL. ITS SOCIAL
CONSEQUENCES - I2Q
III WHY AND HOW ONE BECOMES AN ALCOHOLIC 139
IV THE CAMPAIGN AGAINST ALCOHOL. WHAT
HAS BEEN DONE ; WHAT NEEDS TO BE
DONE; WHAT IS GOING TO BE DONE - 146
BOOK IV
STERILITY
I THE DEPOPULATION OF FRANCE - - 1 65
II THE CAUSES OF THE FALLING BIRTH-RATE - 173
III REMEDIES - IQO
IV THE CAMPAIGN AGAINST ABORTION - - 204
CONCLUSION - 215
THE SOCIAL MALADIES IN ENGLAND - - 217
BOOK I
TUBERCULOSIS
BOOK I
TUBERCULOSIS
CHAPTER I
NATURE AND FORMS OF THE DISEASE ITS
CONTAGIOUSNESS
Microbic in origin, tuberculosis is transmitted by con-
tagion. The most important point is to know whether
tubercular lesions are closed or open. Only the open
lesions permit the bacilli to escape, when they con-
taminate the surroundings and may be absorbed by
healthy organisms. These healthy organisms are thereby
infected, and may in turn become tuberculous. The
earliest reactions of the infected organism are usually
unperceived, and the malady progresses by stages with
intervals of repose between them. This is the period of
pre-tuberculosis, or latent tuberculosis. The organism
already infected may be infected anew by a fresh con-
tagion, and the reactions of an organism thus reinfected
are commonly very violent. Contagion is effected by the
absorption of bacilliferous dust arising from dried secre-
tions, or of the minute but virulently poisonous drops of
moisture expelled by a phthisical patient when coughing
or merely speaking.
TUBERCULOSIS is a parasitic disease of microbic
origin. It is caused by a bacillus which makes its
entry into the organism sometimes by way of the
4 SOCIAL DISEASES
respiratory tracts, and sometimes indeed most fre-
quently by way of the digestive organs. At the
outset it circulates in the blood, where it is seized
upon by special cells the phagocytes^- and conveyed
into the lymphatic glands, where it may remain
immobilised indefinitely. But, again, it may undergo
multiplication in these glands, and may migrate
therefrom, to localise itself in various organs, when
it causes, according to this localisation, broncho-
pneumonia, pleurisy, meningitis, peritonitis, osteitis,
etc.
The original contamination of the organism usually
takes place in very early youth, when the mucous
coats of the digestive organs absorb with peculiar
facility. For a time it may be for months, or even
for years the presence of the microbe in the or-
ganism is not betrayed by any very perceptible
disturbance. Its multiplication may be hindered by
certain unfavourable conditions, or the first centres
of colonisation may be tolerated by the contaminated
organism. This is the latent period of the disease,
and it may very well happen that this period is
never succeeded by the following phase ; moreover,
during this period the disease may be definitely
extinguished.
The bacillary disease does not become manifest
and accessible to medical diagnosis until it reaches
its later phases, and its symptoms are peculiarly
severe when an organism is re-infected ; for contrary
to the rule in certain other microbic diseases,
1 These cells are so called because, in a sense, they eat the para-
sites of the blood, often causing their disappearance by a sort of
digestion that is, when they themselves are not destroyed by para-
sites which are able to resist this intracellular digestive process.
FORMS OF TUBERCULOSIS 5
where the presence of the pathogenic or disease-
producing microbe excludes any further inoculation
by a microbe of the same nature, a tuberculous sys-
tem will readily accept a fresh inoculation. But it
reacts, at the point newly contaminated, by violent
inflammatory disturbances. This reaction to which
the name of allergy has been given is characterised
by local vascular disturbances of a very acute nature,
which apparently constitute an effort towards elim-
ination, as though the organism were giving proof
of a state of insufficient vaccination. 1
It is probable that the lesions of pulmonary
phthisis, among others, are reactionary lesions of
this character, due to a reinfection of the organism
by a fresh invasion of germs from the exterior, or
by the migration, from a centre where they were
tolerated, of virulent germs which proceed to colonise
a distant organ.
However this may be, the most important con-
ception from our point of view is the classic division
of tubercular lesions into closed and open lesions.
The tubercle bacillus may vegetate in the tissues
without provoking any reaction beyond an ordinary
trifling inflammation ; but it usually provokes the
1 On this phenomenon of allergy a method of diagnosis has been
based which is of the greatest service in doubtful cases of tuber-
culosis. This is the tuberculin reaction. Tuberculin is a toxin ex-
tracted from cultures of the tubercle bacillus. A small quantity
of tuberculin injected under the skin produces, if the subject is tuber-
culous, an acute inflammatory reaction, localised at the site of the
injection, with a variable degree of fever.
It is this intense reaction which, in children affected by latent
tuberculosis, when they are vaccinated against smallpox with vac-
cine taken from calves which are also affected by latent tuberculosis,
gives rise to vaccinatory pustules complicated by a wide inflammatory
zone, indurated, and of a bright red colour, which is highly charac-
teristic.
6 SOCIAL DISEASES
formation around it of a small granulation, about
the size of a millet-seed (the tubercle properly
so-called) which represents a sort of nest full of
bacilli, an encysted nest, in which the parasite is
very little accessible to therapeutic or immunising
substances.
In this form the lesions of tuberculosis are closed
lesions, whence the bacillus cannot escape to con-
taminate the external environment.
But these granulations may multiply ; may become
confluent; may grow soft and suppurate ; and then
the pus formed is expelled from the organism, as
happens with all abscesses, and we then have to deal
with a case of open tuberculosis.
Such are the lesions of adenitis, and of suppurating
osteitis, and above all those of pulmonary phthisis.
The important thing to understand is that the
virulent microbe swarms in the pus of these open
tubercular lesions, and it is by these purulent secre-
tions that the external environment is contaminated
and becomes dangerous, as capable of conveying
the contagion.
The absorption by a healthy organism of tubercle
bacilli thus liberated constitutes the fact of con-
tagion.
Contagion does not occur in any mysterious and
inaccessible fashion, and contact with a tuberculous
subject is not of itself dangerous. In order that
contagion may be effected the healthy individual
must absorb, through the agency of his surround-
ings, the specific bacilli ejected by a diseased
organism.
This absorption most frequently takes place in
the form of particles of moisture or dry dust which
FORMS OF TUBERCULOSIS 7
are inbreathed or swallowed by the person exposed
to them.
Contamination by dry dust is not the most dan-
gerous form of contagion, for the bacilli of tuber-
culosis do not long resist the sterilising action of
sunlight and desiccation ; but the proximity of a
consumptive patient is dangerous for another reason
because of the tiny drops of saliva which he ex-
pels in coughing, and even in speaking. These
particles of moisture, rendered virulent by the passage
of the pulmonary secretions into the mouth, have
been collected within a radius of nearly seven feet
from the patient ; they may therefore be absorbed,
by persons living in proximity to such patients, in
the fresh state, that is, in possession of their
maximum degree of virulence.
These elementary facts concerning the nature of
tuberculosis, its lesions, and its modes of propaga-
tion, should be remembered before we inquire how
it is that the disease has been able to increase to
the point of becoming a social danger.
CHAPTER II
WHY TUBERCULOSIS IS SO WIDESPREAD
Contagion is the sole cause of the extensive spread of
the disease. It is favoured by the large number of semi-
invalid persons, who are still capable of active work, and
who go abroad like healthy persons, although they are
suffering from pulmonary lesions which exude infected
secretions full of tubercle bacilli. At the present time
half the death rate of our great cities may be regarded
as due to tuberculosis. As for the proportion of persons
affected by tuberculosis, this is difficult to estimate, as
persons who are only slightly affected are not registered,
nor are they under medical observation. We may safely
assert that only a very small number of town-dwellers
escape tubercular infection.
THE spread of tuberculosis has been so great of late
years that in certain large cities in Paris, more par-
ticularly we may take it that this disease is at present
responsible for a third and even for half of the deaths.
Official figures relating to the year 1913 the year
before the War attribute 18,552 deaths to the
epidemic diseases, tuberculosis being excepted ; while
tuberculosis alone was responsible for 84,443 deaths.
Between 1906 and 1913 in a period of eight years
the deaths from tuberculosis, in the whole of
France, were 689,846 ; while all the epidemic or
contagious diseases taken together killed only
165,518. 8
WHY TUBERCULOSIS IS WIDESPREAD 9
So we see that the losses due to the diseases de^
scribed as epidemic are very small compared with
the continual and increasing destruction of the popu-
lation by endemic tuberculosis.
During the same period, 1906-1913, the deaths from
tuberculosis rose to 44 per cent, of the general
mortality for persons between the ages of 20 and
40 years. That is, they amounted to nearly half
the death-rate.
But the mortality from tuberculosis fails to give
us an exact idea of the frequency of this disease,
and of the devastation which it causes. We must
not number only the fatal cases ; we must also count
those which are not fatal, but which cause a certain
amount of suffering, and which, taken in the mass,
diminish the social value of the sufferers.
Like all diseases, tuberculosis occurs in forms of
increasing seriousness, from the attenuated form
which leaves the individual the appearance and the
energies of almost normal health, to the extremely
serious form which may very quickly end in death.
Now, in the scale extending from the highly atten-
uated forms inaccessible to medical diagnosis to the
clearly confirmed cases there is a long tract, repre-
senting perhaps two-thirds of the whole, which
comprises persons who are, so to speak, on the
frontier of the disease, and whose moral and physical
value is more or less profoundly impaired.
If we may judge by the post-mortem examinations
made in the hospitals of the bodies of those who have
succumbed to various diseases, it is a very unusual
thing for the system to escape tubercular infection ;
just as it is very unusual, when we subject to
radioscopic examination persons who have all the
io SOCIAL DISEASES
appearance of health, to find the lungs perfectly
transparent, or unaccompanied by intra-thoracic
glands which are unduly enlarged.
This extreme frequency of tuberculosis is explained
by contagion. We must moreover reflect that the
most dangerous tuberculous patients are not those
who are most seriously ill, since these are kept more
or less isolated in their bedrooms, and are surrounded
by precautions calculated to diminish the risks of
contagion. The most dangerous patients are those
who are only semi-invalids, who move about freely,
going to their work, attending to their affairs, or
amusing themselves ; for these contaminate their
surroundings wherever they go, wherever they live.
It is these chronic sufferers from bronchitis, these
big, hearty-looking subjects of emphysema, these
people who are for ever coughing and spitting, who
sow their germ-bearing expectorations in every
corner.
We have seen that as regards the danger of con-
tagion we should distinguish between cases of open
and closed tuberculosis: that is, cases which do or
do not emit virulent secretions. Enlarged glands
and bones may be tuberculous, but unless they
undergo softening and suppuration they do not emit
bacilliferous secretions. Until recently the same
distinction was made between secretory and non-
secretory, or open and closed cases of pulmonary
tuberculosis. However, a more careful examination
of the pulmonary secretions in tuberculous patients
has revealed the constant presence of specific bacilli ;
in short, these secretions differ only in the smaller
or greater quantity of dangerous microbes which they
contain.
WHY TUBERCULOSIS IS WIDESPREAD 11
We must therefore abandon this division of pul-
monary bacillosis 1 into open and closed bacilloses,
and we must regard all sufferers from expectorating
pulmonary tuberculosis as dangerous. Now the
number of such sufferers is legion, above all if we
include in this class the sufferers from chronic em-
physematous bronchitis.
It is quite certain that pulmonary emphysema is
of tubercular origin. While the complete induration
of a portion of the lung is in reality a healing pro-
cess, constituting a sort of cicatrix which is the
vestige of a bygone lesion, and attests the absence
of danger as far as contagion is concerned, pul-
monary emphysema, on the other hand, is a process
of imperfect recovery ; it is a half-way house, so to
speak, and is always suspect as regards contagion.
As these attenuated forms of pulmonary tuberculosis
are observed in persons who offer a stout resistance
to the progress of the disease, they are compatible
with an apparently good state of general health, and
a good capacity for work ; the result being that those
who suffer from these forms lead the life of healthy
persons, and are therefore living under the most
favourable conditions for sowing the deadly seed on
every side.
It is indeed not unusual to see such persons losing,
from tuberculosis, in the course of their lives, several
wives and a number of children, while they them-
selves reach an advanced age, and are far from
suspecting that it is really they who have caused the
successive disappearance of all those who have lived
beside them. 3
1 Bacillosis : a state of harbouring bacilli.
2 See p. 224.
12 SOCIAL DISEASES
We now see that the innumerable opportunities to
which all town-dwellers are subject of absorbing, at
one time or another, a few tubercle bacilli, are quite
enough to explain the terrible increase of the spread
of this disease, from which very few inhabitants of
our large cities are absolutely free.
However, as the gravity of the disease is essentially
variable, and as the number of those who recover
from it is happily still considerable, although the
death-rate from tuberculosis is undoubtedly increas-
ing, there is reason to inquire whether some other
condition, as well as contagion, does not play its
part in the spread of the scourge.
In other words, as with all microbic diseases, we
must consider both the seed and the soil upon which
it falls, for the nature of this soil will be more or
less favourable to the development of the seed. We
must therefore inquire what are the conditions capable
of modifying the resistance of the organism to the
invasion of the disease ; and whether our populations
are not at present subjected to influences of a
peculiarly unfavourable kind as regards this re-
sistance.
This inquiry is all the more urgent in that the
tubercle bacillus is extremely sensitive to the nature
of its cultural media, so that it is permissible to
believe that it is also extremely sensitive to the
nature of the organic soil in which it has to develop.
CHAPTER III
THE SOIL FAVOURABLE TO TUBERCULOSIS
Bad hygienic conditions ; a sedentary life without suffi-
cient fresh air ; insufficient lighting- of inhabited premises ;
overwork; above all sexual excess and alcoholism, and
possibly vaccination against small-pox, are factors which
modify the organic environment, which render the latter
more or less favourable to the development of the tubercle
bacillus. The most obvious and most disastrous of these
factors is a syphilitic heredity. In all confirmed cases of
tuberculosis we shall find the stigmata of hereditary
syphilis. While contagion is the sole determining cause
of tuberculosis, the spread of syphilis must be regarded as
the prime adjuvant cause of tuberculosis considered as a
social disease.
IT has been said of tuberculosis that it is a disease
of darkness.
An investigation of the tuberculous homes of Paris
showed that there are tuberculous houses, and that
these houses are usually characterised by the im-
perfect lighting of the rooms. 1
1 The investigations of M. Juillerat have added an interesting cor.
tribution to the history of tuberculosis, and have enlightened us as
to the part which must be attributed to the domicile in the etiology
of this disease.
For example, the statistics of the Sanitary Bureau of Paris (Casier
sanitaire) reveal the fact that there are, in that city, a certain num-
ber of " death-houses," which go far to fill the dispensaries, sanatoria
and hospitals. 820 houses were identified which in n years have
furnished 11,500 deaths in a population of 106,300; or an average
of 98-34 per 10,000 inhabitants per annum, while the average mor-
tality is 49-5 per 10,000.
Another group of houses gives 81-2 per 10,000; a third, 75-2.
13
i 4 SOCIAL DISEASES
The defective illumination of inhabited premises
is of course accompanied by insufficient ventilation
and the comparative indigence of the inmates, which
means a hygiene defective in all its details.
But the great sensitiveness of the tubercle bacillus
to the direct rays of the sun, which destroys its
virulence in a few days, justifies us in attributing
to darkness a preponderating influence upon the
activity of contagion. The cure of superficial tuber-
culosis by heliotherapy (sun-baths) is a confirmatory
factor.
We know that in certain great cities, and above
all in Paris, there are not only very great numbers
of badly-lit houses, but also whole quarters, workers'
cities we might call them, entirely composed of such
houses. In these quarters the death-rate from tuber-
culosis is terrible, sometimes amounting to double
the rate observed in other parts of the same city.
Where the sunlight can find no entrance, there
disease makes its way, and above all tuberculosis.
The disappearance of badly-lit houses would un-
doubtedly be a great benefit, but it would be only
a local benefit, quite insufficient to effect any sensible
modification of the endemic tuberculosis from which
we are suffering.
It is often said that overwork favours the develop-
ment of tuberculosis. Intense and continuous labour,
of course, if it is aggravated by insufficient sleep
and an improper diet, which means that the repair
of cellular waste is defective, may result in a state
of physiological poverty which favours microbic in-
fection ; but whatever may be said of the conditions
of modern life, cases of serious overwork are not very
often met with ; when they do occur they are in-
SOIL AND TUBERCULOSIS 15
dividual cases which cannot be advanced as the
explanation of a social evil.
Premature sexual excess appears to be of greater
importance, as it is met with fairly often in young
men at an age when they have not ceased growing.
Now the exercise of the reproductive function seems
to be peculiarly dangerous to those who are pre-
disposed to tuberculosis. We know that pregnancy,
in a woman, may revive and stimulate a torpid or
latent tuberculosis ; while in man the exercise of the
genetic function, owing to the loss of precious sub-
stance and the nervous disturbance which it entails,
costs the system a large quantity of phosphates ; and
when the exercise of this function is exaggerated,
and above all premature, occurring at a time when
the organism still requires constructive material, the
result is an organic deficiency highly favourable to
the development of tuberculosis.
The ideas which are current with regard to the
exercise of the genetic function, according to which
it is a natural and indispensable necessity in all
young men, while its daily rhythm from one end of
the year to the other is accepted as a commonplace
(a rhythm which is not observed in any animal
species 1 ) are, from the point of view with which we
are occupied, extremely mischievous, and may pro-
duce disastrous results.
Those entrusted with the education of our youth
must not ignore these considerations, from which
young men in delicate health and how numerous
they are in our towns ! would derive great ad-
vantage.
1 But the function has a seasonal rhythm in most of the lower
animals. This seasonal rhythm is hardly perceptible in man. Trans.
16 SOCIAL DISEASES
Alcoholism also has been accused of favouring
tuberculosis. Alcohol, it has been said, makes the
consumptive's bed. In consideration of the gravity
of this other social disease, whose ravages we shall
presently investigate, if this accusation were justified
it would of itself be almost enough to explain the
devastations of tuberculosis.
But here we must draw a distinction. Does the
abuse of alcohol directly favour, in the individual,
the development of tuberculosis? It seems to us that
we can hardly assert that this is the case, for clinical
experience shows and pathological anatomy proves
that the action of alcohol upon the organic tissues
is betrayed by the development of a process of
sclerotic induration which would hardly seem calcu-
lated to favour the vegetation of the tubercle bacillus.
It is indeed by virtue of a process of this nature that
the lesions of tuberculosis are checked in their de-
velopment, becoming encysted, and finally healing.
Yet it is evident that alcoholism may exert an
indirect action, if it prevails in circles where the
imperfect cell-repair due to intensive labour is
prevalent, and if it absorbs the organic resources
which ought to be devoted to this process of repair.
While we must admit that alcoholism does not
favour a rapid and serious development of tuber-
culosis, we may consider that it does, under certain
conditions, favour the invasion of the disease ; more-
over, it is said to be one of the factors of the spread
of tuberculosis, since it favours the occurrence of
chronic forms of the infection, and thereby multiplies
the sources of contagion.
On the other hand, we must consider not merely
the effects of alcohol upon the individual, but we
SOIL AND TUBERCULOSIS 17
must also inquire into its effects upon posterity, that
is, upon the race. In other words, even if the al-
coholic does not become tuberculous, does he not
beget children predisposed to tuberculosis? In other
words again, does not heredito-alcoholism cause a
predisposition to tuberculosis ?
It is an indisputable fact that in certain classes of
society alcoholism is found to be of frequent
occurrence among the ascendants of tuberculous
persons.
There are industrial communities in which, despite
the habitual practice of voluntary restriction, the
birth-rate none the less remains fairly high. The
children, moreover, are sickly, and fall a prey to
tuberculosis. The mothers provide the key to this
problem in a couple of words. These children, they
say, are " Saturday's children." Saturday is pay-
day ; and on Saturday the husbands and wives come
home intoxicated, and the customary precautions are
forgotten. Hence pregnancy is of normal frequency,
but the condition of the offspring is lamentable.
Can we then say that a system prone to tuberculosis
is a stigma of heredito-alcoholism ? It is very difficult
to form a definite conclusion as to this point. It
would seem more probable that the usual form of
heredito-alcoholism is represented by arthritism, which
is, on the contrary, rather unfavourable to the de-
velopment of the tubercle bacillus.
Among the ascendants of epileptics too we often
discover alcoholism, yet it is much more probable
that epilepsy is a stigma of heredito-syphilis.
And this brings us to an hereditary influence which
has hitherto been disregarded as a factor of the
i8 SOCIAL DISEASES
predisposition to tuberculosis, yet which appears to
us to be its prime factor.
We refer to heredito-syphilis.
In speaking of heredito-syphilis we must make the
proviso that the term refers to two quite distinct
conditions. On the one hand, it denotes the trans-
mission of the infection, that is, of the microbe, from
parent to child, so that the child is born suffering
from the active form of syphilis. As a rule it dies.
This form of infective heredito-syphilis is compara-
tively rare. But on the other hand we very often
witness the transmission to the child of special
stigmata, morphological stigmata which affect prin-
cipally the cephalic skeleton and the organs de-
pendent thereupon, such as the teeth, but which
may affect all the tissues and all the organs, from
the heart to the brain.
For the syphilis of the parent is manifestly terato-
genic, that is, productive of abnormal forms, of
dystrophia (imperfect nutrition), of monstrosities,
more or less pronounced, in the offspring ; as though
the reproductive cells, ova and spermatozoa, had
suffered, owing to the presence of the parasite of
syphilis, or its toxins, a kind of parasitic castration,
resulting in the abnormal or incomplete development
of their products.
Now these stigmata major or minor of hereditary
syphilis are very easily detected. We shall describe
them later on, in one of the chapters dealing with
syphilis. But all that we have to say at the moment
is that they are almost invariably found in tuberculous
patients, and as a general rule they are more marked
in the more serious cases.
This fact is of capital importance. Logically it
SOIL AND TUBERCULOSIS 19
leads us to the indisputable conclusion that hereditary
syphilis provides a soil which is peculiarly favourable
to the development of the tubercle bacillus. We
shall return to this point when speaking of syphilis.
And since hereditary syphilis as we shall show in
another chapter is able to make itself felt through
several generations, giving rise to anatomical anoma-
lies and monstrosities or deformities which may
become fixed in the family, it may result in a morbid
condition which appears to be in close relation, to
the spread of tuberculosis.
Lastly, while examining the influences which may
modify the organic medium in a direction favourable
to tuberculosis, we must mention a hypothesis which
is of a somewhat disturbing nature. This hypothesis
refers to the possible influence of vaccination against
smallpox.
Many physicians assert that small-pox favours
tuberculosis ; and their opinion is based upon the
fact that persons who bear the marks of small-pox
are very frequently attacked by tuberculosis.
Now we must not shrink from a thorough con-
sideration of this fact and this hypothesis.
The virus of vaccine, if it is not identical with the
virus of small-pox, of which it is supposed to be
merely an attenuated variety, is at least very closely
related to it. If the one modifies the organic soil in
the sense described, it is probable that the other will
modify it in the same direction and almost in the
same degree.
Consequently, must we not regard the increasing
frequency of tuberculosis as resulting, to a certain
extent, from the regulations which have rendered
vaccination and re-vaccination compulsory ? At the
20 SOCIAL DISEASES
present moment there are no bounds to the demands
of the hygienists, and there are some who prescribe
re-vaccination every five years, and even every
second year !
After all, we find, as the explanation of the fact
that tuberculosis has been able to increase to the
point of becoming a social danger of the most
threatening kind, a whole complex of influences :
poverty, unhygienic homes, excessive and premature
sexual indulgence, hereditary alcoholism, inherited
syphilis, and vaccination ; all of which seem, in
different degrees, to make for the same morbid pre-
disposition, and each of which may claim its part in
the common disaster.
We have made no mention of tubercular heredity
as one of the factors of a soil favourable to tuber-
culosis. The direct transmission of the bacillus
from parent to child is comparatively very rare ; and
as for the transmission of a constitution especially
favourable to tuberculosis, as a result of actual
tuberculosis, it is very doubtful if such a thing is
possible.
While the children of tuberculous patients fre^-
quently become tuberculous themselves, this is be-
cause they live in contact with their parents amid
surroundings contaminated in a hundred different
ways, so that they cannot escape contagion.
But when the children are brought up apart from
their parents, amid favourable surroundings, they
develop normally and do not show any sort of taint
which could be attributed to their origin.
Unlike syphilis, which, as we shall see, affects the
whole race and sets its mark upon the offspring for
several generations, tuberculosis is chiefly destructive
SOIL AND TUBERCULOSIS 21
of the individual, without impairing his powers of
reproduction.
Thus the mischief done by tuberculosis is repre-
sented by the aggregate of individual deaths and
individual sickness ; but it is confined to these deaths
and this sickness ; and however great these are, they
are, taken as a whole, less compromising for the
future of a society than the mischief worked by
syphilis or alcoholism.
Undoubtedly tuberculosis is a great scourge ; but
it is perhaps the least formidable of those which
we have to investigate.
CHAPTER IV
THE CAMPAIGN AGAINST TUBERCULOSIS
The principle of the campaign against tuberculosis has
been bequeathed to us by our ancestors, who themselves
waged a successful war upon leprosy. It has found its
scientific proof in the experiments of Pasteur. The prin-
ciple of the campaign is to make war upon contagion by
isolating contagious sufferers.
Is it possible to wage war upon tuberculosis?
It is plainly evident that if we possessed an effi-
cacious remedy against the disease the war upon
tuberculosis, the social disease, would be an easy
matter ; it would consist of the treatment and cure
of the individual sufferers from tuberculosis.
But hitherto the search for a specific treatment has
had disappointing results, despite the numbers and
the efforts of the seekers ; and this is true of pre-
ventive treatment as well as of curative treatment.
The new methods of immunisation, and serotherapy,
which have proved so powerfully efficacious against
some diseases, have yielded no decisive results in
the therapeutics of human tuberculosis.
As it is at present practised, the method of sero-
therapy appears applicable only to acute infectious
diseases, in which the microbe circulates in the fluids
of the organism, or vegetates on the surface of its
CAMPAIGN AGAINST TUBERCULOSIS 23
mucous and serous membranes, as in plague, dip-
theria, cerebro-spinal meningitis, and cholera. But
in chronic diseases, in which lesions of the tissues
are produced, in the midst of which the parasites are
localised and isolated in a sort of protective cyst, the
immunising principles introduced into the blood with
the therapeutic sera prove to be absolutely ineffectual;
this is the case in syphilis, in cancer, and above all
in tuberculosis.
Similarly, the use of vaccines, at all events as it is
at present understood, would seem to be necessarily
ineffectual against a disease which becomes chronic
precisely because the efforts of the system to effect a
natural immunisation, such as is produced in acute
diseases, are insufficient. We have seen, moreover,
that the reinfection of tuberculous patients must be
regarded as a frequent occurrence, and that this re-
infection always aggravates the condition of the
sufferers. Now there cannot be any question of
employing vaccine against a disease which permits of
reinfection.
The manner in which tuberculosis must be attacked
by the new methods is therefore still to seek.
Remedies of a chemical nature, we must remind the
reader, have all proved equally ineffectual ; and as for
physiotherapy (treatment by sun-baths or sea-bath-
ing), its action is confined to local and external forms
of tuberculosis, which form only a very small propor-
tion of cases. Despite a passing hope, the enormous
bulk of cases of pulmonary tuberculosis have not been
touched by physical agencies, and it is precisely in
these cases that the social danger resides.
It remains, then, to attack the disease at its source,
before the individal is infected, and since tuberculosis
3
24 SOCIAL DISEASES
is a contagious malady we must make war not upon
the disease but upon contagion.
The principle of this campaign was taught us by
Pasteur, in his classic investigation of the diseases of
silk-worms. It is simple and radical.
Pasteur succeeded in stamping out the disease
(pebrine) which threatened to destroy his nurseries of
silkworms by selecting the eggs, setting aside and
isolating those which were invaded by the microbe
of pebrine, and ensuring that no contact was possible
between the healthy silkworms and the contaminated
larvae.
The result was speedily decisive : the batches of
larvae protected by this simple method all attained a
healthy maturity.
It must be admitted that while this method is
readily applied in the case of laboratory experiments,
or even in the raising of cattle for the market, it be-
comes terribly complicated, as we shall see, when we
have to deal with a human malady as widespread as
tuberculosis.
Yet the principle was applied, many centuries be-
fore Pasteur's time, by our ancestors, who, having to
fight against a horrible disease which in many ways
was analogous to tuberculosis, were successful in free-
ing themselves of the scourge and saving us from it.
We are referring to leprosy.
In certain forms of leprosy the sufferer is, as in
tuberculosis, afflicted with tubercles of varying
dimensions, which ulcerate and suppurate; but these
tubercles are external, situated on the unclothed por-
tion of the body, on the face and hands ; and these
ulcerating tubercles produce the hideous and terrify-
ing aspect of the leper, which was evidently largely
CAMPAIGN AGAINST TUBERCULOSIS 25
responsible for the adoption of the Draconian methods
employed in connection with the victims of the
disease.
The consumptive is no less afflicted, but the lesions
produced bv his complaint are usually internal; it is
his lungs, which are not visible, that ulcerate and
suppurate ; so that he is not an object of terror and
disgust, as is the leper. He continues to live among
his fellows, who do not suspect the danger with which
they are rubbing elbows.
Our ancestors, having to cope with a contagious
malady, did not hesitate to practice isolation of the
sufferers in order to prevent contagion. They estab-
lished leper-houses, and thus they succeeded in
extirpating leprosy.
It was a very pretty experiment, which long ante-
dated those of Pasteur, and it is thanks to this experi-
ment that we are not all of us more or less leprous
to-day.
It is true, on the other hand, that we are all more
or less tuberculous. Salvation is apparently to be
found in the isolation of tuberculous patients in
hospitals which would be the equivalent of the leper-
houses of our ancestors.
But times have altered ; science has cast its light
upon the dark and terrifying mystery of contagion ;
the agent of this contagion has been seen, isolated
and cultivated ; we know where it lurks and how to
avoid contact with it; so that while we accept the
principle of hospitals for the tuberculous we must at
once observe that they would not in any respect
resemble except in the principle which inspired them
the leper hospitals whose dismal fame has lingered
on into our own times.
26 SOCIAL DISEASES
The hospital for the tuberculous would no more
resemble the leper hospital of the Middle Ages than
a journey in an express train resembles a journey by
coach ; for it is obvious that the isolation of a tuber-
culous patient and it is of course understood that
only those would be isolated who were suffering from
open lesions, capable of conveying contagion an
isolation, moreover, which could under certain con-
ditions be observed in the patient's home would be
free of all the perfectly useless restrictions of the leper
hospital, which were in part devised to strike terror
into the minds of the heedless.
The hospitals for tuberculosis would be simply a
combination of hospital and hotel ; they would be pro-
vided with every modern comfort, and subjected only
to certain rules of internal discipline relating to the
intercourse of the patient with visitors from outside.
We shall now describe how the campaign against
tuberculosis is at present conducted in France by the
physicians of the Assistance Publique (Poor Law
Relief) and a few large administrations; and we shall
see how far this campaign falls short of providing
the effective defence of which we have just expounded
the principle.
CHAPTER V
SANATORIA AND DISPENSARIES
Sanatoria treat only patients in the early stages of the
disease: that is, patients who are not contagious. With
a few exceptions, the dispensaries merely distribute
miscellaneous medicines of doubtful efficacy. These
institutions are of questionable utility merely from the
philanthropical point of view ; they are useless as weapons
against contagion.
MANY conferences have been convoked for the pur-
pose of discussing the problem of tuberculosis.
Ministers, no less than physicians, have delivered
eloquent speeches. Beyond this nothing much has
been done ; above all nothing has been done which
could really be expected to check the increasing spread
of the disease.
A great to-do has been made of our sanatoria, which
were an importation from Germany, and also of our
anti-tubercular dispensaries. Let us see what these
institutions really count for in the campaign against
tuberculosis.
We are not speaking of private sanatoria, which
are merely nursing-homes, more or less luxurious
hotels, in which well-to-do patients are able to enjoy
a rest under special conditions of hygiene and dis-
cipline. Thev concern only a very small proportion
of the affected population ; consequently they cannot
to any great extent influence the public health.
27
28 SOCIAL DISEASES
The free sanatoria, those of the Assistance Pub-
lique, might, it would seem, be of greater utility.
But there are as yet only a few of these establish-
ments, with a total of a few thousand beds, while the
poor sufferers from tuberculosis are numbered by
hundreds of thousands.
These sanatoria are of course large establishments
built to last for centuries, so that the cost per bed is
extremely high ; and the numerous staff with which
they are provided makes the cost of daily mainten-
ance very heavy.
What is infinitely more serious is that these sana-
toria receive patients only in the early stages of the
complaint ; that is, patients who are suffering from
closed or non-contagious tuberculosis. The result is
that while the statistics of the cures obtained in these
sanatoria are undoubtedly highly creditable, their
effect in preventing contagion is absolutely null.
It will be said that those patients in the early stages
of the disease who are treated in these sanatoria under-
go improvement, and that a certain proportion of
them escape the phthisis which threatened them.
We grant that this is so, but what is the significance
of this mere drop withdrawn from the torrent of germ-
laden expectorations which continues to flow into our
public thoroughfares and finds its way into every
home?
The dispensaries, which are certainly less costly
than the sanatoria, are no less powerless against con-
tagion, if we except three or four dispensaries in
Paris which are well organized and which undertake
the education of the consumptive. These, after in-
vestigating the homes of the sufferers, endeavour as
far as possible to improve the hygienic conditions of
SANATORIA AND DISPENSARIES 29
these homes, disinfecting premises which are sus-
pected of contamination and providing patients with
nourishment.
These few establishments excepted, there are, as we
have said, only rudimentary establishments which
provide their patients with miscellaneous drugs. One
can only regard them as charitable institutions, which
are certainly useless in the campaign against tuber-
culosis.
In France a few private business concerns, and
even a Government department, that of the Posts and
Telegraphs, have tried to organize a logical campaign
against the contagion which used to decimate their
staff. In this department it has eventually been de-
cided to exclude employees suffering from open tuber-
culosis, while all suspect cases of chronic bronchitis
are obliged to use pocket spittoons. Those suffering
from pre-tuberculosis who are, as we know, merely
consumptives in the early stages of the disease are
given prolonged leave, their salary being continued.
Special attention has been directed to the hygiene of
business premises, from the standpoint of cleanliness,
lighting and ventilation, while common spittoons
have been abolished. Employees were of course
tempted to spit into or at these receptacles, which
were so many foci of contagious matter.
These efforts are very praiseworthy, and there is
no doubt that they have improved the sanitary con-
dition of the staff affected. But in the great campaign
against the social scourge of tuberculosis, as we con-
ceive that it should be waged, it must be recognised
that such measures represent only a negligible total of
results; moreover, these results even are probably
endangered or annulled by the dangers which
30 SOCIAL DISEASES
threaten the employees directly they quit the
premises where they are so carefully protected.
After the two first years of the great war the French
War Office (Administration militaire), in view of
the large numbers of tuberculous patients which it
was forced to return to civil life, and the large sums
of money which the Pensions Department was com-
pelled to provide, decided to create a number of
hospitals and sanitary stations where tuberculous
soldiers could be treated and if possible recover their
health before they were sent before the Boards of
Demobilisation (Commissions de reforme).
The war, indeed, owing to the exceptional fatigue
incurred, and the cruel vicissitudes of climate or
weather to which the combatants were exposed, has
been responsible for an extraordinary increase of
tuberculosis.
While a certain number of sufferers from pre-tuber-
culosis were able to benefit by the new open-air life
which was imposed upon them, it was more often the
case that torpid and attenuated forms of tuberculosis
were accelerated by the new conditions, so that they
rapidly developed into pulmonary phthisis.
These sufferers are now kept under observation and
sorted in the military hospitals; thence they are for
the most part sent to "sanitary stations," which are
really improvised sanatoria. There they remain for
an average period of three months, during which
time they receive a special training.
We must regard the creation of these sanatoria
there are twenty-four of them, comprising a total of
some two thousand beds as a laudable attempt to
make war upon tuberculosis; but we must not hesi-
tate to confess that it is absolutely insufficient from
SANATORIA AND DISPENSARIES 31
the standpoint of the universal and effective campaign
to which we must make up our minds if we wish to
achieve anything.
One institution has been created, however, which
is greatly superior to all those which we have de-
scribed, and which has really been inspired by a true
understanding of the danger to be fought and its
origin.
This is the (Euvre Cruncher, which removes
children from families in which they are in contact
with tuberculous parents and exposed to deadly con-
tagion and places them in the country with peasant
families, where they lead a healthy and industrious
life, in .the open air, until they are thirteen years of
age. Of course, the children with whom the (Euvre
Grancher concerns itself must not themselves be
suffering- from confirmed tuberculosis, while the
parents from whom they are propagated must, on the
other hand, be afflicted with open tuberculosis : that
is, must be dangerous. 1
The future of all these young creatures, who have
1 The Society known as the CEuvrc de Preservation de I'Enfance
centre la Tuberculose aims at removing, for as long as is considered
necessary, children who are still healthy from family surroundings
in which they are exposed to the contagion of tuberculosis, by plac-
ing them with healthy families in the country.
This work, as a means of fighting against tuberculosis, is above
all praise. It really attacks the origin of the evil, for there is no
doubt that contagion in the family is a frequent source of tuberculosis.
Their sojourn in the country terminates at the age of thirteen,
when the wards of the Society may be apprenticed. Children have
rarely been withdrawn by their parents before this age ; where they
are so withdrawn it is usually because the situation of the parents is
altered. If the father dies the mother feels lonely and takes back
her little ones to keep her company. Sometimes too, happily, the
parents' tuberculosis is cured, the material situation improves, and
the couple withdraw the wards whom they have entrusted to the
Society. Sometimes, again, if both the mother and the father die,
an aunt or uncle becomes the guardian of the children and adopts
them.
32 SOCIAL DISEASES
thus been saved from contagion, and whose excellent
health has been under observation for a number of
years, proves clearly that hereditary tuberculosis
exists only as an exceptional condition, and that cases
of "family" tuberculosis are almost always due to
contagion in the family circle.
The misfortune is that such an institution should
be, after all, only a private institution, whose means
of action, alas ! are extremely limited, so that its
benefits are destined to be lost in the ocean of public
disaster.
Let us add that since the beginning of the war the
(Euvre Grancher has been forced considerably to re-
lax its activities, confining them to the maintenance
of those children who were already its wards, without
recruiting any fresh beneficiaries.
There is no doubt that in a logical plan of campaign
against tuberculosis the extension of the CEuvre
Grancher, which should be made a State institution,
and of obligatory application, ought to be placed in
the front rank.
In all these cases the Society has achieved its object : it has pro-
tected the children from tubercular contamination.
But the greater number of its wards remain under the protection
of the Society. The majority, indeed, when removed to the fresh air
of the country, acquire a liking for the life of the fields and look back
with horror upon the dark, overcrowded city slum or tenement in
which they grew weak and emaciated. On reaching the age of
thirteen they no longer wish to return to the city ; it is then that
the Society endeavours to find them situations. Thanks to the
doctors of the colonisation centres, farmers, vine-growers and agri-
cultural labourers are found who are willing to take them as
assistants or apprentices and the work of salvage continues.
In 1908 the CEuvre Grancher placed 375 children in the country ;
their cost to the Society, in the preceding year, was .5,800. In
1913 the number of the Society's wards must have been nearly 500.
CHAPTER VI
INDIGENT CONSUMPTIVES IN AND OUT OF HOSPITAL
In the hospitals, where they are neither isolated nor
treated, consumptives, unless they are dying, make only
a temporary stay ; just long- enough to infect a few fellow-
patients. They are then restored to liberty, and employ
themselves in profusely sowing contagion in public places
and thoroughfares.
THE reader may be surprised to note that in speaking
of the various expedients directed against tuberculosis
we have not spoken of the French hospitals, where
so many consumptives are treated, if we may use the
term, that these establishments are always more or less
encumbered with them.
The reader should realise that the hospitals, which
are not intended to harbour chronic and incurable
patients, receive phthisical subjects only to the detri-
ment of patients suffering from acute diseases, who
should not be kept waiting for admittance, yet who
are thus left for a longer or shorter period without the
attention which they urgently require.
But since, as a matter of fact, it is admitted that
consumptives must be received by the Poor Law hos-
pitals, arrangements might have been made to give
these patients, during their stay, a certain amount of
treatment appropriate to their condition, and above
33
34 SOCIAL DISEASES
all to give them the special instruction which any
consumptive ought to receive before he can return to
a collective environment, in the midst of his family or
otherwise, in which he is liable unconsciously to sow
contagion.
Nothing of the kind is done in the hospitals, where
phthisical patients are not even given the pocket
spittoon so urgently recommended by all physicians.
Further, these are the terms in which Grancher,
speaking of the treatment which phthisical patients
receive in the hospitals, describes the adventures of a
consumptive in Paris :
"At the first onset of the disease tuberculous
patients are nursed at home and quickly exhaust the
few savings accumulated during many years of labour
and economy. Very often they even run into debt ;
then, their credit exhausted, they come to ask for
admission to the hospital. There they are nursed, or
rather they are allowed to rest, for a few weeks, after
which one is compelled to send them away, in order
to make room for fresh applicants. They return to
work, but can no longer gain their livelihood as be-
fore ; fatigue and lack of nourishment swiftly aggra-
vate their complaint, and force them to pay a further
visit to the hospital. This is repeated several times,
and the visits which they pay us are closer and closer
together.
"But there are often no vacant beds in our wards,
and the patients are sent to the Central Bureau.
There at most a dozen beds are available daily, and
one has to deal with more than a hundred applica-
tions for admission : the beds available are given to
fever-patients, and the phthisics are put off until the
following day. For a week or ten days in succession
INDIGENT CONSUMPTIVES 35
they repeat their fruitless applications, either at the
Central Bureau or the hospitals. During this time
they are not at work, and in consequence do not eat;
their malady advances rapidly. Finally they are
admitted to the hospital, and there they die, unless
they have died on the way thither.
" During each of his terms in hospital the phthisi-
cal patient is subjected to the most varied medical
treatment, as the therapeutic resources at our dis-
posal, for all that they are almost useless, are none
the less numerous.
"There is an absolute lack of hygiene that is, of
air, nourishment, clothing and rest in the treatment
of phthisics in the hospitals. There is no need to
prove the obvious namely, that the air of a hospital
ward is not fit for phthisical patients. The atmos-
phere is always vitiated by overcrowding, dust and
dejecta. Despite the employment of the best known
systems of ventilation, the air is insufficiently renewed,
and open windows are possible only to a limited ex-
tent if there are, as there alwavs are, cases of pneu-
monia or rheumatism in the wards.
"The food, excepting the bread and wine, is bad.
The supplementary cutlet reaches the patient only
after a long journey from the kitchen to his bedside,
cold and unappetising.
"The natural stimulants of the appetite, a certain
variety of seasonings, are absolutely wanting; and
nothing is absent, from the insufficiency of courses,
and the jumbling together upon one and the same
bed-table of plate and spittoon, urinal and tumbler,
to add to the consumptive's natural distaste for food.
"The clothing provided is as insufficient as the
nourishment. The hospital cloak does not give suf-
36 SOCIAL DISEASES
ficient protection against the draughts of the court-
yards and corridors. A special voucher from the
doctor is required to obtain a flannel vest, and
it is a favour which, once granted, is hardly ever re-
peated for the same patient. But what of the rest
so necessary to these poor patients, yet so rarely
obtained in hospital ? Every day, early in the morn-
ing, the process of cleaning begins and goes on all
day, except when the doctors or relatives are visiting
the wards. The nurses empty the spittoons and
chamber-utensils, polish, dust, sweep, make the beds,
roll them into the middle of the ward, pile up the
chairs and the bed-tables : in short, the patient is
routed out and put back again at least once a day.
During the night his neighbour coughs or groans or
cries out ; the male nurse goes to and fro in the ward,
and the sister makes her rounds. The unfortunate
consumptive, kept awake by all this commotion, and
by his own cough, gets hardly any sleep, and pre-
vents his neighbours from sleeping.
"With the present organisation," adds Grancher,
"all the phthisical patients are boarded at the rate
of three francs a day indiscriminately, and they all
die."
This, we may say, is not the most serious point :
for one thing is even more lamentable than the life,
or death, of the phthisical patient in hospital, and
that is his life outside the hospital, in the intervals
between his visits, during which he is not, after all,
very dangerous.
Incapable of labour which would assure them of
proper nourishment, indigent consumptives are, as a
matter of fact, reduced to mendicity. The Poor Law
Relief generously allows them three to five francs per
INDIGENT CONSUMPTIVES 37
month ; they wander from refuge to slum, from slum
to refuge, or in the summer they lie on the benches
or under the bridges ; the most fortunate, those who
are cared for by a hard-working family, abundantly
contaminate the premises of those who shelter them.
But all alike, wandering along the public thorough-
fares, in search of the light work that no one is will-
ing to give them, or some problematical assistance,
scatter their virulent expectorations wherever they
go ; and these, transformed into dust, are freely dis-
tributed by the next gust of wind, or perhaps by the
brooms of the municipal sweepers, over the passers-
by of all ages and either sex.
Not a spot of our most opulent cities escapes this
scattering of the seed of death ; from the wretchedest
alleys to the most stately avenues, to say nothing of
our pleasant public promenades and parks and
garden-squares where our children take their first
steps, or the sandy beaches on which they roll, which
no placards (like those which bid us be kind to
animals) warn us to regard with suspicion, by reason
of the tubercular sputa which may be mingled with
the sand.
It is an unspeakable scandal : a hygienic scandal
and a moral scandal.
In Paris particularly that wealthy city which
prides itself upon its elegance, and which has made
such costly and useless sacrifices in the cause of
hygiene the sight of these unhappy consumptives is
truly the living symbol of the expiation of a crime ;
the crime of disregarding human solidarity.
The Poor Law has provided for the acute con-
tagious diseases for scarlet fever and smallpox ; for
paralytics and lunatics; for the blind and the deaf;
38 SOCIAL DISEASES
for backward children ; for idiots and imbeciles ; but it
has not provided for consumptives without resources,
without a home, who are, one and all, unconscious
murderers, and who, as the price of the oblivion and
abandonment to which they are relegated, scatter
death around them in a continuous stream of poison.
Let us observe, to be just, that these unfortunate
people are not the only ones to contaminate public
places in this scandalous fashion. Semi-invalids,
rich or poor, still capable of an active life and their
name is legion do the same wherever they go, and
in all the premises which they enter, bent on work or
amusement.
The prohibition, under penalty of a fine, to expec-
torate in public places, might evidently provide a
partial remedy for this dangerous situation. We are
not aware of the weighty considerations which have
prevented the public authorities from issuing such a
prohibition. Perhaps they are afraid of a revolution !
The fate of the decree forbidding dog-owners to
allow their animals to defile the pavements is obvi-
ously not encouraging. Yet the prohibition to spit
in public places has been imposed on the inhabitants
of several cities of the United States, and no disorder
has resulted. This prohibition is the necessary corol-
lary of the request that consumptives shall employ a
pocket spittoon.
Under present conditions it is quite hopeless to
count on the general use of this protective appliance.
For the majority of patients it constitutes a sort of
dishonouring label, proclaiming their malady, which
they take very good care not to exhibit in public,
especially under the conditions which would indicate
its employment.
INDIGENT CONSUMPTIVES 39
It is an extraordinary fact that in collectivities in
offices, workshops, etc. the comrades of the sufferers
themselves oppose the latter's use of the protective
spittoon, as though the sight of an object intended to
avert a danger actually created that danger.
To sum up whatever the number of patients ex-
pectorating bacilli, the indigent sufferers form the
most dangerous section of such patients, by reason
of the abundance of their secretions ; for well-to-do
folk who have reached this stage of the disease usually
keep their room, either in their own homes or in
private sanatoria.
CHAPTER VII
THE ISOLATION OF CONTAGIOUS PATIENTS
The campaign against tuberculosis is essentially a
campaign against contagion. There is only one means
of abolishing contagion : the isolation of contagious suf-
ferers ; at home when such isolation can be assured, and
in other cases in special sanatoria. Isolation in sanatoria
should have nothing cruel or terrifying about it ; many
sufferers would be cured in these hospitals, the internal
system of which would not in any way recall that of the
leper-hospitals. On the one hand the well-being of the
patient should be considered ; on the other, the relief of
poor families, who ought to receive allowances when it
is the head of the family who is isolated. These con-
siderations provide an answer to the objections which
have been raised to the principle of compulsory notifica-
tion, which is a necessary corollary of isolation.
IF we wish to cope effectively, and in a decisive
manner, with the ravages of tubercular contagion,
which threatens to destroy the race, there is no choice
of means. The only means on which we can rely is
that which was employed by Pasteur to stamp out the
silkworm disease. Pasteur isolated the parasite-
ridden eggs; we must isolate the parasite-ridden
human beings. We must isolate contagious con-
sumptives who are suffering from open lesions.
40
ISOLATION OF CONTAGIOUS PATIENTS 41
By such means leprosy was vanquished, and tuber-
culosis may likewise be abolished.
When and how should this isolation be put into
practice ? This is a question which requires consider-
ation ; but it is permissible to argue that under certain
conditions isolation might be effected even in the
midst of the family, provided the protective measures
indicated were strictly observed, while any disregard
of them would lead to the removal of the patient.
As for the large tuberculous population, it would
be divided among the sanatoria, of which each depart-
ment or district would possess one or several. 1
How many sufferers from tuberculosis would have
to be isolated ? And what sort of buildings ought we
to have to receive them?
1 With regard to the sanatoria established in France during the
war, M. Kiiss, senior physician of the Angicourt Sanatorium, makes
the following remarks in the Bulletin medical for the J2th August,
1916 : " The fruitful conception which inspired the promoters (M.
Brisac, Director of the Assistance Publique, and M. Honnorat,
deputy) of the sanatoria was to undertake from now onwards
the organisation of the anti-tubercle campaign after the war and to
add in advance to the future dispensaries of social hygiene the
homes which they cannot dispense with if they are effectually to ful-
fil their function of preservation against tuberculosis. No one any
longer doubts that it will be necessary, after the war, to grapple
energetically and methodically and directly with the serious problem
of the social campaign against tuberculosis, in the solution of which
we have allowed ourselves to be outstripped by so many other
nations. The war having forced us to take immediate action in
respect of demobilised consumptives, we cannot allow these efforts,
which had only a sentimental value, to be condemned to sterility ;
it is absolutely essential than they should be linked up with the
application of plans for the future ; and here we have one of the
chief points of interest about the public sanatoria : attached to the
permanent organisation of the Assistance publique they could become
stable and permanent institutions, provided they exhibited the quali-
ties which are requisite in a true sanatorium. Now from this point
of view it is proved beyond dispute that many of these newly created
sanatoria have been established under conditions which lend horn-
selves admirably to the treatment of tuberculosis."
42 SOCIAL DISEASES
It is still rather difficult to reply to the first of these
questions. Judging by the number of tuberculous
patients with open lesions who have attended my
consultations at the Municipal Dispensary-Sanatorium
of Jouye-Rouve-Tanies, I estimate that there are
three thousand indigent consumptives in Paris. I
am considering only the incurable sufferers, who have
neither resources nor relatives able to look after them ;
unfortunates condemned to live, or rather to die, upon
an uncertain charity, wandering from door to door,
the unacknowledged guests of nameless lodging-
houses, refuges, night shelters and police stations,
and a danger wherever they go.
It seems to me that in order to act with the greatest
possible promptitude, without waiting for a law which
will order the internment of tubercular patients and
the construction of hospitals to receive them, it would
be easy and by no means costly to withdraw from
intercourse with their fellows those patients who are
particularly dangerous, and who certainly are re-
sponsible for the greater bulk of tubercular contagion
in Paris.
I have therefore proposed the erection, on the out-
skirts of Paris, of suitable huts, such as would be
quite sufficiently comfortable, to shelter these unfor-
tunates during the last months of their lives.
Estimating their number at 3,000, and the term of
their survival at three months, ten huts containing
each loo beds (capable of receiving 300 to 400 patients
during the year) would suffice to receive them all, and
thus Paris would be rid of one of the chief sources of
contagion, while an end would be made of the scandal
we have described.
And in order to obtain such a benefit what would
ISOLATION OF CONTAGIOUS PATIENTS 4 3 -
the City of Light have to pay? A truly ridiculous
sum : ;6o,ooo for the construction of ten hospital
huts and ^40,000 annually for their upkeep. 1
Thus, for the sum of ; 100,000, a mere drop
in the ocean of its budget, the city of Paris could have
installed and set going for the first year a scheme of
effective protection against tubercular contagion. It
might have disinfected itself morally and physically,
and it would have initiated a true campaign against
tuberculosis.
No doubt there are certain objections which may
be made to the realisation of such a plan.
To begin with, the criticism has been advanced that
such temporary hospitals would speedily acquire the
most sinister reputation, and that as the patients
would be perfectly aware that they would enter them
only to die, no one would be willing to enter them.
Those who think thus do not know the patients of
1 These figures are in accordance with an estimate made by an
architect, M. Tavernier, for a projected hospital, but containing 100
beds, with two annexes, providing accommodation for a housekeeper,
a caretaker, a cook, two male and two female nurses. The cost of
such a temporary hospital should not exceed ;6,ooo.
It should be noted that each of the patients in the large common
ward would be partially isolated in a cubicle composed of a partition
six feet eight inches in height ; thus patients would be spared the
sight of death-bed scenes, which would obviously be numerous and
frequent.
It remains to estimate the working expenses of one of these tem-
porary hospitals.
Now according to the experience acquired as Director of the
Jouye-Rouve-Tanies Dispensary-Sanatorium, where the meals of the
patients copious and physiologically therapeutic cost only a franc
apiece in ordinary times, the nourishment of the patients, together
with the salaries of the staff, ought not to exceed .4,000 per hut
per annum.
At the same time the Municipal Council of Paris voted a sum
of .400,000 for the erection, at Vaucresson, of a hospital for con-
sumptives, capable of receiving only a few hundred patients.
44 SOCIAL DISEASES
whom they speak. To the latter the hospital is a
place where they go to die, yet they would be only
too happy to gain admission and to pass the remnant
of their days there. What do they ask of us, those un-
fortunates who apply to the doctors of the dispensaries
when they are discharged from hospital? For a
refuge, any sort of refuge where they would be
allowed to rest, where they would get something to
eat, and where they would be allowed, without further
anxiety, to let the days go by. They would perhaps
say that it spelt death; but what they fear, like all
human beings, for that matter, is a painful death,
aggravated by cold and hunger. In comparatively
comfortable surroundings, even in the midst of the
dying, they would no longer think of death, for such
is the mentality of the consumptive : he always
cherishes indestructible hopes.
To those for whom they would be intended, there-
fore, these temporary hospitals would not be the place
where they would die ; they would be the haven where
they might cease from wandering, where they would
be warm, where they would obtain food and sleep.
It has also been said that such temporary hospitals
would be, for the adjacent districts, accursed spots,
centres of contagion which would spread danger for
miles around. No commune would accept their
proximity without vehement protests.
We know that during great epidemics, in time of
plague or cholera, the peasants still accuse the doctors
of spreading the disease by poisoning the wells. But
are we to compromise with such a delusion ? There
is no place where contagion is less to be feared than
in a sanatorium or dispensary conducted according to
the rules of modern hygiene. Where the clothes and
ISOLATION OF CONTAGIOUS PATIENTS 45
the linen of the patients are disinfected, where every
patient has his private spittoon, and where no expec-
toration contaminates the ground, there is not the
slightest danger of contagion. It is on leaving such
establishments, on returning to even the most care-
fully scavenged public thoroughfare, that we run the
risk of contagion.
The fears of those who would live in the neigh-
bourhood of such temporary hospitals would there-
fore be chimerical, survivals of a bygone age; and
the establishment of such institutions would enable
the local hygienic authorities mayors, officers of
public health, etc. to educate the public, and to
teach it how one contracts tuberculosis and how one
avoids it.
The plan which we have just briefly described was
submitted without the least hope, however, that it
would be seriously considered to the Municipal
Council of Paris, as a means of starting a decisive
campaign against tuberculosis.
It should be noted that there was no question of
important architectural undertakings, such as the
erection of thousands of cubic yards of hewn stone or
bricks and mortar, and that the scheme could have
been carried out with a very small staff. These, we
admit, are not the qualities desirable in public works. 1
I may add that the initial cost per bed and the cost of
1 The members of municipal councils do not always, alas ! seek
election from disinterested motives. Hence an inclination to adopt
such proposals as involve the award of costly contracts to persons
who are sometimes not unrelated to councillors, or are at least of a
grateful disposition. The only remedy is to cease to elect tradesmen
or business men of doubtful character to municipal bodies. Trans.
46 SOCIAL DISEASES
the patient's maintenance were almost scandalous in
their moderation.
As a matter of fact no one paid the least attention
to the scheme, with the exception of M. Ambrose
Rendu, who was good enough to bring it forward.
If I have recalled this scheme it is because it seems
to me that its low cost would permit of its extension
throughout the country if ever our legislators were to
introduce a measure of safety enforcing the isolation
of contagious cases of tuberculosis.
In any case this scheme would dispose of the pre-
liminary argument, with which one has so often had
to contend, that the expense entailed by such a
measure would be excessive, amounting to tens of
millions of pounds, and there is no doubt that this
argument would be more decisive now than it might
have been before the war.
The hospitals or sanatoria for tuberculous patients
might, at least provisionally, be no more than pretty
and healthy bungalow buildings, erected on pic-
turesque sites, in the midst of parks or gardens, in
the upkeep of which the patients themselves would
occupy themselves.
Set free from all anxiety, the patients would be
free to receive visits from relatives and friends, such
visits being subject only to a few precautions relating
to contagion due to conversation between persons
dangerously near one another.
And as in reality a good proportion of such patients
would recover, or at least improve, under the hygienic
influence of their new life, to the point of passing
from the stage of open lesions to that of closed lesions,
so that it would be possible for them to return to the
world outside the hospital, the sanatoria of the future
ISOLATION OF CONTAGIOUS PATIENTS 47
would assuredly very soon acquire the best of repu-
tations, which they would enjoy until the day when
their existence would become superflous, and there
would be nothing left to do but to burn them.
The isolation of tuberculous patients would of
course involve, as a corollary, the compulsory notifi-
cation of tuberculosis, which would thenceforth be
included in the schedule of contagious diseases.
This principle of notification is unassailable, for
tuberculosis that is, with open lesions is one of the
most contagious of diseases; and although it does
not manifest itself a few days after the absorption of
the germ, as smallpox and scarlet fever do, it is none
the less equally contagious with these diseases, and in
a sense more dangerous, since in the majority of
cases it is not possible to discover the source of con-
tagion and take defensive measures.
In practice it must be admitted that this peculiarity
may be used as the basis of arguments highly un-
favourable to the principle of notification ; for we
tend to deny a danger that we cannot see.
It has been objected, on the other hand, that it
would be cruel to inform patients that they are tuber-
culous, and would result in many tragedies of despair.
It does not seem to us that this argument is valid :
the consumptive, whose treatment is a matter of
general hygiene rather than of medical therapeutics,
has every reason for requiring to know what ails him
if he wishes to recover, for he must in that case adopt
a mode of life to which he would never constrain him-
self if he did not know himself to be seriously
threatened. No doubt the physician's verdict may
cause some considerable distress for a few hours or
days, but the consumptive quickly becomes hopeful
48 SOCIAL DISEASES
again, above all when he is assured that his malady
is curable. As we have said, optimism, and optimism
of an indestructible kind, is in the great majority of
cases the characteristic of the tuberculous patient.
Lastly, it has been objected that the compulsory
notification of tuberculosis would directly militate
against the accomplishment of the object in view,
since the sufferer, dreading isolation or internment,
would refuse to be medically examined and would not
take proper care of himself.
This, however, is begging the question, for suf-
ferers never or hardly ever believe themselves to be
tuberculous, and it is only when the physician has
informed them of the nature of their complaint that
they declare themselves to be consumptive.
But, finally, let us suppose that dangerous patients
do actually refuse to see the doctor ; ideas concerning
the danger of contagion are at present general enough
and they will become more and more so for the
members of the threatened family to bring sufficient
pressure to bear upon the patient to make him respect
the law ; the more so as it would be legitimate to in-
flict penalties on families which, should conceal their
invalid members.
If poor families tolerate the presence of a consump-
tive to-day, it is only when the consumptive is still
capable of working. Directly the family is indemni-
fied for the removal of their consumptive members
they will become absolutely pitiless, as they are now
when it is a matter of driving an invalid who is no
longer anything but a burden upon them to enter a
hospital.
Compulsory notification would therefore, in all
probability, very quickly become a habit; and the
ISOLATION OF CONTAGIOUS PATIENTS 49
result would be so profitable to all, to the diseased
and the healthy alike, that there would be more
reason to dread its abuse than to fear its omission.
CHAPTER VIII
THE COST OF THE CAMPAIGN AGAINST TUBERCULOSIS
The expense of isolating the victims of tuberculosis
would undoubtedly be very heavy, since it would be
necessary to compensate the families deprived of their
support. We hiave already entered upon this policy of
costly compensation. In the Army, which in France
comprises nearly a quarter of the adult nation, pensions
are granted to soldiers discharged on account of tuber-
culosis, and in the near future tuberculosis will be regarded
as an industrial accident. Thus half the population will
be working to support the other half. Cost for cost, it
would be better to incur a certain amount of ruinous
expense in order to avoid becoming tuberculous than to
ruin ourselves completely by maintaining the victims of
tuberculosis.
The cost of the campaign against tuberculosis, even
if the latter be economically conceived, in accordance
with the indications already given, would still be very
heavy, for the establishment of sanatoria and the
maintenance of patients would absorb only a portion,
and no doubt the lesser portion, of the money which
would have to be devoted to it.
It would, in fact, be necessary to indemnify every
family from which a wage-earning member had been
taken the father, the mother, or a child of an age
to earn his living.
50
THE COST OF THE CAMPAIGN 51
However greatly diminished the capacity for work
may be in the victims of tuberculosis, and even when
they are seriously ill, it is nevertheless true that the
great majority of them continue to work, impelled by
the necessity of gaining a livelihood for the family. I
have seen clerks refusing to stay at home, even when
spitting blood by the mouthful several times a day ;
I have known them to die pen in hand. The intern-
ment of poor consumptives would therefore be admis-
sible only on the condition of indemnifying their
families. Let us note, to begin with, that we have
already largely adopted this policy of pecuniary com-
pensation. In France, indeed, since the war tuber-
culosis is regarded as a disease contracted on military
service, or aggravated by the conditions of service,
so that the consumptive is entitled to Discharge
No. i : that is to a pension, or a gratuity renewable
annually.
And this is mere justice, for it is impossible to
raise the objection that the disease was possibly
anterior to military service. If the man was sus-
pected of tuberculosis before his enlistment, he ought
not to have been accepted. Since he was passed as
fit for service by the tribunal (Conseil de Revision)
the State is undoubtedly responsible for the aggra-
vation of his malady.
The men thus discharged because of tuberculosis
are more numerous every day ; and the physicians of
the sanitary stations to which they are sent for a few
months in the hope of improving their condition
sufficiently to avoid discharging them have observed
that many patients undergo treatment very unwill-
ingly, fearing precisely lest their precious Discharge
52 SOCIAL DISEASES
No. i, on which they count so eagerly, escape them !
And here a novel and somewhat unexpected aspect
of the question presents itself : the conflict with the
patient himself, who, in his own interests, does not
wish to be cured !
This new military law has created a very important
precedent, whose consequences will be felt before
long. Hitherto employers and the law have abso-
lutely refused to regard sickness in general, and tuber-
culosis in particular, as accidents of occupation.
There is no doubt whatever that under the pressure
of the trades unions Parliament will be compelled to
revise and expand the law, and, before all else, to
make it cover tuberculosis ; for since the latter is re-
garded as a consequence of military service, on what
principle would it be possible to refuse any longer to
regard it as a consequence of industrial or commer-
cial employment?
And then, the cases of tuberculosis becoming more
and more numerous, we shall be confronted by this
unexpected situation : half the population will be
working to keep the other half.
And this new law will undoubtedly affect the
workers in a manner which it will be well to realise
beforehand; for its incidence, as almost always
happens, will aggravate the lot of those whom it pro-
fesses to assist : since the employers will soon refuse to
engage any worker who has not been duly declared,
after a medical examination, to be free of the slightest
tubercular taint. And as this taint is all but general
in the workers of our great cities, we can hardly see
where such measures will lead us ! There is reason
to fear that we have here the seed of labour crises both
numerous and varied.
THE COST OF THE CAMPAIGN 53
The wisest and most economical course would be
to prevent the mischief going any further, and to
adopt a logical and radical policy : that is, to isolate
tuberculous patients.
The tuberculous members of the working classes,
and all poor or indigent tuberculous patients, would
be interned in sanatoria.
Tuberculous patients of the well-to-do classes would
be isolated either in their homes, if the circumstances
lent themselves to this course, or in private sanatoria
similar To those which already exist. But in all cases
the character of this more luxurious form of isolation
would be closely inspected, and would be replaced
by a stricter form if it were considered insufficient.
Such is the only solution of the problem of the
campaign against tuberculosis, the social malady. It
is a solution which many have approached, without
daring to propose it; and a host of remedies have
been formulated which are only unreliable palliatives
intended to produce the illusion that the evil is really
being attacked.
We ought to-day to be well aware of the value of
all these remedies. In seeking to spare the suscepti-
bilities of the patients we have merely dealt gently
with the disease, which is now threatening to destroy
us.
Tuberculosis is transmitted by means of the secre-
tions of patients who are suffering from open lesions.
Let us isolate all consumptives with open lesions,
and in order to make sure that there shall be no flaw
in the system, let us prohibit spitting upon the
ground in public places and thoroughfares.
54 SOCIAL DISEASES
Without these definite and radical measures all
other efforts are doomed to certain failure. 1
1 In the foregoing chapters we have spoken only of inter-human
contagion. There is no longer any need to reckon with tuberculosis
of bovine origin due to the absorption of germ-laden milk.
The bacteriologists have learned to distinguish between the bovine
bacillus and the human bacillus, and the first is very seldom found
in man.
The employment of boiled or sterilised milk is now so general that
all danger would seem to have disappeared in this quarter ; and as
for the flesh of tuberculous animals, this does not appear to be very
dangerous ; firstly, because cooking destroys the bacilli with which
it might be contaminated, and secondly because the tubercle bacillus
is hardly ever found in the muscles of animals.
Raw meat, then, need not be regarded as suspect unless the car-
case reveals a condition of general cachexia ; but in such cases it is
hardly likely that the butchers would buy.
BOOK II
SYPHILIS
BOOK II
SYPHILIS
CHAPTER I
THE NATURE OF THE DISEASE AND ITS PHASES
Syphilis is caused by a microbe of an animal character,
the treponema. Its transference from one organism to
another is most commonly effected by direct contact, but
it requires a slight traumatism, an abrasion of the skin
or the mucous membranes, which serves as a gate of
entry. Once the organism is infected the malady evolves
through several phases. It gives rise, after the initial
indurated chancre, the lesion of inoculation, to the super-
ficial manifestations of secondary syphilis roseola and
mucous patches ; and then to the profound and varied
lesions of tertiary syphilis, which may affect the kidneys,
the liver, the heart, the arteries, or the nervous system.
For a long time the syphilitic nature of a large number
of diseases was not realised. This was notably the case
with tabes and general paralysis, which are now referred
to their true cause, thanks principally to a method of
investigation known as sero-reaction, which enables us
to recognise with absolute certainty those cases which
are due to syphilis.
SYPHILIS, like tuberculosis, is a disease caused by a
microbe. This microbe, which for a long time eluded
microscopic investigation, was discovered some ten
57
58 SOCIAL DISEASES
years ago. It is a microbe of an animal nature, not
a vegetable microbe like that of tuberculosis. It was
given the name of Spirochaeta pallida, and is now
more generally known as Treponema pallidum.
It belongs, as a matter of fact, to the family of
Trypanosomes, which have already furnished the
parasite of dourine, a disease of horses which is in
many respects analogous to syphilis. This parasite,
Trypanosoma equiperdum, usually assumes the form
of a spirillum.
Although certain of the lesions of syphilis are
rather like those of tuberculosis, the two diseases are
very different from an epidemiological point of view,
and also as regards their modes of infection and
contagion.
As regards infection it should be noted that the
point of entrance of the trypanosome is external, and
requires a solution of continuity, a small wound, a
rent in the integuments, either of the skin or the
mucous membranes, while the absorption of the
tubercle bacillus almost invariably takes place in the
interior of the organism, probably through the
healthy mucous membranes of the respiratory or
digestive tracts.
While the system has to absorb a fairly large
quantity of bacilli in order to become infected with
tuberculosis, it seems that the smallest quantity of
virulent material is sufficient to infect it with syphilis;
and an extremely brief period of contact enables the
trypanosome to establish itself upon the tissue con-
taminated, whether that of the mucous membrane of
the genital organs, or the mouth, or of some
cutaneous fissure, however small. Cases have been
cited of physicians who, after exploring syphilitic
NATURE AND PHASES OF SYPHILIS 59
lesions, and noticing a trifling scratch upon a finger,
have immediately washed and cauterised the wound;
yet in spite of this prompt disinfection they were
unable to escape infection.
Consequently, where sexual intercourse takes
place, and one of the subjects is afflicted with virulent
lesions, the contagion of the other is humanly speak-
ing inevitable, since connection can hardly be effected
without a certain slight erosion of the mucous mem-
branes.
But whereas the microbe of tuberculosis is most
frequently absorbed through the medium of the ex-
ternal environment, in the form of dust or moist
particles, in syphilis contagion is almost invariably
effected directly, by immediate contact, as the trypano-
some can only live a few moments outside the living
organism. While one hears of cases of contagion
effected through the medium of a glass which has
been used by a syphilitic patient afflicted with lesions
of the lips, it should be remembered that in such
instances the person infected must have used the
contaminated glass very shortly after the syphilitic.
So the fact that the tubercle bacillus is able to sur-
vive in the external environment, while the trypano-
some of syphilis does not resist this environment,
together with the fact that syphilitic lesions are com-
paratively dry, while tubercular lesions discharge
abundant secretions, produce very different conditions
of contagion in the case of the two diseases.
The initial lesions of tuberculosis assume the form
of adenitis (glandular inflammation), for the bacillus
is able to penetrate the mucous membranes without
provoking a reaction in the tissues, and it is only in
the lymphatic glands, to which it has been conveyed
6o
by the phagocytes, that it provokes, as it vegetates,
an inflammatory reaction characterised by swelling
and fever.
The treponema, on the other hand, always pro-
vokes an acute reaction of the tissues in the locality
of the minute wound which has served as the place
of entry ; a characteristic reaction, which makes it
possible to diagnose the complaint. This reaction
constitutes what is known as primary syphilis : it
takes the form of the indurated chancre.
This local syphilis is quickly followed by symptoms
which mark the infection of the whole organism.
The glands in connection with the chancre swell and
grow hard (the indolent bubo); then an eruption of
rose-coloured spots appears on the trunk (roseola
syphilitica, the roseola of syphilis); then ulcerations
of the mucous membranes occur, more especially in
the mucous membrane of the mouth (these are the
mucous patches), whose secretions, like those of the
chancre, are extremely virulent. These symptoms con-
stitute one phase of secondary syphilis, and appear
some weeks after the chancre. The roseola appears
only once during the course of the disease, but the
mucous patches, even when the syphilis is under
treatment, are extremely liable to recur. These are
in reality, with the initial chancre, the true contagious
lesions, the more so as in the woman the indurated
chancre of the genital parts is very often unper-
ceived.
A capital point which differentiates the natural
history of tuberculosis from that of syphilis is that
tuberculosis, during the stage of infection, does not
protect the organism against a reinfection ; and we
NATURE AND PHASES OF SYPHILIS 61
have seen that this reinfection is accompanied by
very serious disorders ; while once the organism is
contaminated by syphilis reinfection is absolutely
impossible; thus, by inoculating a patient with the
secretions of his own indurated chancre we cannot
produce, in any part of the body, a further indurated
chancre. A syphilitic organism can no longer be
inoculated from the outside with the microbe of
syphilis ; but this does not prevent microbes resulting
from the initial infection from multiplying in the
interior of the organism, where they produce a great
variety of lesions, according to the organs affected.
At this stage the humours of the organism are pro-
foundly modified, and on this modification the method
of sero-reaction has been based, which enables us to
affirm, when the reaction is positive, that the patient
under suspicion is indeed a victim to syphilis. It is
true that a negative sero-reaction does not prove that
the patient is not syphilitic, for the treatment of the
disease may cause a temporary disappearance of the
sero-reaction, although it may not for that reason pre-
vent the ulterior symptoms from appearing. 1
1 The syphilitic sero-reaction, or " sigma reaction," commonly
known as Wassermann's Test, though it should be known as Bordet's,
from the name of the French physiologist who discovered the prin-
ciple of the test, is not, as was at first believed, a specific reaction ;
that is, it is not caused by the presence in the blood-serum of the
patient of the toxins elaborated by the treponema.
According to the recent investigations of M. L. Bory, this reaction
is apparently due to a quantitative modification of the albumins of
the serum, a modification probably characteristic of the physiology of
organisms intoxicated by the treponema.
This readily explains the fact, which at first appeared somewhat
paradoxical, that positive reactions have been observed in cases of
hereditary dystrophy (faulty nutrition) which could not be suspected
of active syphilis.
In those cases it is enough to admit that the humoral alteration.
62 SOCIAL DISEASES
After the intermediate series of secondary symp-
toms, appearing in succession, but sometimes with-
out passing through this intermediate series (adeno-
pathy, papulo-squamous syphilids of the skin, mucous
patches in the mouth) the disease may manifest itself
in the tertiary lesions.
These lesions are extremely varied, for they may,
as a matter "of fact, affect all the systems and all the
organs. They mark the advance of the parasite into
the depths of the organism, and its random localisa-
tion in those parts that offer the least resistance.
Like the secondary symptoms, the tertiary symp-
toms also may affect the integuments, that is, the
skin or the mucous membranes. These lesions are
known as tuberculo-ulcerous, owing to their external
aspect, in the mouth, and in the tongue, they take
the form of those white pearly patches known as
smokers-' patches, although tobacco has nothing
whatever to do with their origin. These lesions must
be regarded as contagious; but generally speaking
the tertiary lesions of syphilis, by the very fact that
they affect the deep-lying organs, are not contagious.
The kidneys, the liver, the lungs, even the eyes
may be the seat of syphilitic processes of an inflam-
matory nature, or actual growths, of a tuberculous
appearance, which are known as gummae. Very
often, too, we observe manifestations of periostitis
and exostosis, which are readily cured, however, by
which occurred under the influence of the infectious malady is
capable of hereditary transmission, just as are the morphological
stigmata.
In other words, the sigma-reaction is a simple morbid reaction,
not a phenomenon of immunity. In practice it is none the less a
reflex of great utility, as it enables us to affirm the existence of the
disease, and to follow and measure its development.
NATURE AND PHASES OF SYPHILIS 63
the specific treatment. The most serious lesions are
those which affect the heart and the arterial system,
or the nervous system : spinal cord, meninges, and
brain.
Cases of syphilitic myocarditis are comparatively
frequent, and when the lesions are localised in a cer-
tain region, intermediate between the right auricle
and ventricle, a region known as His's Bundle, rich
in nervous ganglia, we observe disorders characterised
by a slow permanent pulse which may fall to thirty
or forty beats per minute with a condition of vertigo
which is often very serious.
At other times it is the aorta, at its cardiac origin,
which is affected, presenting a degeneration of its
walls, which most frequently results in its dilatation
and the formation of an aneurismal pouch.
All lesions affecting simultaneously the origin of
the aorta and the mitral valve should be regarded as
being of a syphilitic nature.
The arterial system, moreover, may be affected
throughout its whole extent, and its lesions produce
the greatest number and variety of functional dis-
orders. Thus the obliteration of a muscular artery
gives rise to intermittent lameness, and that of the
branches which irrigate the upper extremities pro-
vokes the asphyxia of the extremities, or Raynaud's
disease. The cerebral haemorrhages which result
from an arterial lesion of the central nervous system
provoke those hemiplegias which are commonly
described as attacks of apoplexy.
If the nervous system is invaded by the treponema
the disorders produced are extremely serious and with
very few exceptions fatal.
6 4 SOCIAL DISEASES
Syphilitic myelitis, tabes, meningitis, and general
paralysis are of this order.
Tabes or locomotor ataxia and general paralysis
have only recently been referred to syphilis. These
disorders were formerly regarded as parasyphilitic :
that is, physicians were inclined to believe that they
were favoured by a previous attack of syphilis, but
that they were not a direct manifestation of the
infection.
The discovery of the treponema was fatal to this
theory of parasyphilitic disorders. In the charac-
teristic lesions of these diseases the microscope has
succeeded in proving the existence of the specific
parasite; and sero- reaction, applied to the blood of
the victims of tabes and general paralysis, confirms
the testimony of the microscope in almost every case.
Tabes and general paralysis are therefore true
syphilitic disorders. Perhaps in certain cases their
origin is only heredito-syphilitic, for these disorders
occasionally make their appearance in subjects who
really do not appear ever to have had any previous
syphilitic symptoms. Still, this origin may be only
apparent, for in the case of syphilis one should be
extremely sceptical in the face of the most energetic
denials, since the primary symptoms may occur un-
perceived even in individuals who observe themselves
most attentively.
Moreover, the hypothesis has been put forward
based upon careful microbiological observations that
there is a special race of treponema which has a
special predilection for nerve-tissue. Upon infection
by this variety of treponema the initial chancre is
supposed to be insignificant, and the secondary symp-
toms very fugitive.
NATURE AND PHASES OF SYPHILIS 65
This would explain why syphilis may be energetic-
ally repudiated by victims of tabes and general
paralysis, even when the sero-reaction contradicts
their statements.
It would also explain certain curious instances of
several subjects contaminated by one and the same
woman, all of whom have succumbed to general
paralysis. Such instances have been noted in the
case of medical students, who recalled very clearly
under what circumstances they contracted syphilis,
and whom it was possible to follow to the end of their
career.
The syphilitic disorders which we have just
enumerated and briefly described for we are not
writing a work on pathology, but a study of a social
malady affect the individual, diminishing his physi-
cal and moral value to a greater or less extent, and
may immediately or remotely endanger his life. But
they do not represent all the mischief done by the
treponema ; they are only its less serious manifesta-
tions from the standpoint of the life of societies, a
standpoint which is the only one that interests us here.
Here is a list of tertiary complications drawn up by
Professor Fournier, from a total number of 4,700
patients afflicted by the tertiary phase of syphilis.
Cases
Complications involving the skin (tertiary
syphilids) - - 1518
Gummatous tumours (subcutaneous gummae) 220
Tertiary lesions of the genital organs - 285
,, ,, ,, tongue - 277
,, ,, ,, palate - - 218
,, ,, ,, throat and pharynx - 118
i >i Ups - - 45
66 SOCIAL DISEASES
Cases
Tertiary lesions of the tonsils - 12
,, ,, ,, mucous membrane of
the nose - 10
,, bones - - 556
,, ,, ,, bones of the nose and
the bony palate - 241
if n joints - - 22
,, ,, ,, muscular system - 23
,, ,, ,, digestive canal - 22
,, ,, ,, larynx and trachea 36
>i n n lungs - 23
,, heart - 23
,, aorta 14
,, ,, liver 71
n n n kidneys 39
,, testicles - - 255
,, eye - in
n n n ear .... 28
,, ,, ,, veins and arteries - 17
Syphilis of the brain and spinal cord, tabes,
general paralysis, etc. - 2009
The toxins secreted by the treponema appear to
have a predilection for the reproductive elements
ova and spermatozoa destroying, either partially or
completely, their reproductive faculty.
As a result of this species of parasitical castration,
analogous to that observed in a number of animal
and vegetable species, sterility is of frequent occur-
rence in syphilitics, above all when the disease is not
subjected to treatment.
Treatment seems to improve the situation, and
syphilitics who undergo treatment are often fertile.
Still, this improvement is only apparent, for although
NATURE AND PHASES OF SYPHILIS 67
treatment attenuates the piecemeal destruction of the
generative cells, it does not completely prevent it,
and the individuals proceeding from these cells are
still marked in some degree by the syphilitic taint;
they are more or less seriously blemished ; they bear,
more or less profoundly, the brand of the stigmata;
they suffer a diminution of their vital energies, and
of their resistance to disease; their external forms are
affected, and their faculties are imperfectly balanced.
They are heredito-syphilitics.
And the syphilitic heredity, from the standpoint of
the future of the race, is the most disastrous of all the
diseases to which the individual may fall a victim.
CHAPTER II
HEREDITOSYPHILIS AND THE SYPHILITIC HEREDITY
By heredito-syphilis we mean the transmission of the
infective microbe from one of the parents to the child
this is heredito-syphilis properly so-called and also the
morphological modification of the offspring, which in
this case present degenerative changes of a dystrophic
order, not of an infectious nature. Properly speaking,
these degenerative changes constitute the stigmata of the
syphilitic heredity. These stigmata may manifest them-
selves through several 'generations. They are varied and
numerous, and may affect any part of the system, at the
hazard of the degenerative changes which the syphilitic
toxin has produced in this or the other portion of the
reproductive cells. The most serious of these hereditary
taints is the production of an organic soil favourable to
the development of tuberculosis. Syphilis thus provides
the soil for tuberculosis ; and the hereditary influence
which is most disastrous from this point of view is that
transmitted by the mother.
The hereditary manifestation of an infectious
disease may assume two different forms.
The microbe of the disease may pass from the pro-
creator into the offspring, through the infection of
one of the reproductive cells, ovum or spermatozoon ;
or when the inheritance is of maternal origin, the
microbe may pass through the placenta, which, it
appears, is not a perfect filter in respect of the
68
HEREDITO-SYPHILIS 69
elements existing in the mother's blood; and in this
case the child enters the world suffering from the
same disease as its infected parent. This is heredito-
syphilis properly so-called.
Or there may be developed, in the child, a degener-
ative change of the constitution, or modifications of
structure or function, due to humoral changes, them-
selves due to intoxication, caused, in the parents, by
the progress of the disease with which they are in-
fected. It would be better to apply to this condition
the term syphilitic heredity.
We have seen that tuberculosis is very rarely
hereditary in the first of these senses ; that the children
of tuberculous parents are seldom born infected
with the bacillus. The hereditary character of pre-
disposition to tuberculosis is also disputable, and we
shall presently see in what sense predisposition is
capable of transmission.
Tuberculosis is therefore more particularly an indi-
vidual disease, which is to be regarded as a social
malady only by reason of the great number of
individuals who are afflicted by it.
It is otherwise with syphilis. On the one hand, its
transmission from the mother or the father to the
foetus is of frequent occurrence ; and if children
suffering from heredito-syphilis in the infectious
state are comparatively rare this is because they
usually die in the womb. Miscarriages are indeed
extremely frequent in women who are infected or
merely fecundated by a syphilitic man.
In any case the children born syphilitic are almost
all doomed to an early death.
This all but universal mortality, and these numer-
ous miscarriages, must therefore be added to the loss
7 o SOCIAL DISEASES
due to complete sterility, which is frequent in
syphilitics, and which plays an important part among
the causes of the low birth-rate or the actual depopu-
lation from which France and other countries are
suffering.
On the other hand, the syphilitic influence, even
apart from any active infection, always makes itself
felt in the offspring, and is betrayed by the more or
less profound disorders which constitute the stigmata
of the syphilitic heredity.
The syphilitic influence, that is, the syphilitic in-
toxication of the parents, causes, in the offspring,
dystrophias, disorders of development, which are re-
vealed by a degenerative change of the normal struc-
tures, sometimes sufficiently marked to constitute
actual monstrosities.
In other words, the syphilitic influence of the
parents is above all teratogenic, productive of
monstrosities, great or small.
It seems as though certain portions of the repro-
ductive cells must have been destroyed by the parasite
or the toxin secreted by the parasite, and that these
cells, in their development, are no longer capable of
producing complete individuals and normal structure-
forms.
These changes are, as we have said, the result of a
sort of incomplete parasitical castration. The
humoral changes in the parents, which may be de
tected by the sero-reaction, may themselves be trans-
mitted to the offspring, and for this reason the posi-
tive sero-reaction observed in the latter has thrown
a vivid light on the nature of the numerous dystro-
phias which have always been noted, but whose
nature and significance were completely unknown.
HEREDITO-SYPHILIS 71
First of the minor stigmata of heredito-syphilis in
the order of frequency we must note the morphologi-
cal blemishes of the cephalic skeleton and its
adjuncts : the exaggeration of the frontal bosses, the
ogival hollow of the palatal vault, and above all the
vices of dentition : notched teeth, stunted teeth, absent
teeth, improperly planted teeth, separation of the
upper median incisors, and the presence of tubercles
(known as Carabelli's tubercles) on the internal sur-
face of the molars. These tubercles are in reality
supplementary cuspids. 1
The face also is the seat of some of the minor stig-
mata of heredito-syphilis : malformation of the ears,
squinting, perhaps myopia; the tongue scrotal, fis-
sured, slit, or notched ; and above adl hare-lip, a
major stigma, of which the separation of the incisors
is in a sense the prophecy.
The circulatory system is often modified by here-
dito-svphilis; tachycardia (frequent pulse), exophthal-
mic goitre, and the asphyxia of the extremities are
due to this influence; and certain orificial disorders
of the heart; pure mitral retraction and mitro-aortic
lesions are regarded as being most frequently mal-
formations of syphilitic origin. 2
The nervous system could hardly escape the
1 The significance of these tubercles as stigmata of heredito-
syphilis has been disputed.
2 Mitral retraction, a heredito-syphilitic malformation, is extremely
frequent, but it is easily overlooked when it is not exaggerated, as
it is then manifested only by very slight functional disorders, which
always draw attention to the respiratory system.
M. Denis, in 90 patients, discovered it 40 times ; in 50 cardiac suf-
ferers, taken at random, 21 times; in another series of 31 cardiac
patients, 19 times.
Lastly, of 600 patients suffering from cardiac affections, the same
observer found that in no the cardiac rhythm betrayed a slight re-
traction of the mitral orifice.
7 2 SOCIAL DISEASES
syphilitic influence, and there is no doubt that certain
forms of entero-neurosis, with neurasthenia, idiocy,
imbecility, dementia praecox and epilepsy are the
major stigmata of heredito-syphilis. 1
It seems to us that hysteria itself must be attributed
to the same influence, considering it essentially as a
retraction of the field of consciousness, a disorder
which probably originates in some anatomical de-
generation of the weft of the cerebral tissue. Suf-
ferers from the severer forms of hysteria frequently
display numerous stigmata of heredito-syphilis.
Lastly, rachitism (rickets) is undoubtedly a major
stigma of a specifically hereditary character, and has
long been regarded as such.
The same is true of infantile and juvenile obesity,
and also the familiar coxa vara, a deformity consist-
ing of an abnormal inward curve of the neck of the
femur.
In lymphatism or status lymphaticus, in which the
tubercle bacillus appears as a complication, we must
regard as pertaining to heredito-syphilis the local
strumous constitution peculiarly favourable to the
vegetation of the tubercle bacillus; and this leads us
to the question of the relation of heredito-syphilis and
tuberculosis, a question of the greatest importance,
which appears to us to dominate the entire history of
heredito-syphilis.
We know that appendicitis even has been attributed
1 MM. Raviart, Breton, and Petit have often met with the posi-
tive sero-reaction in subjects who betrayed in any degree an arrested
development of the intellectual faculties : idiocy, semi-idiocy, and
imbecility ; as well as in cases of dementia praecox ; which enables
us to affirm that syphilis plays, in the etiology of these mental . in-
firmities, a far more important part than has hitherto been sup-
posed.
HEREDITO-SYPHILIS 73
to heredito-syphilis, and that it should be regarded
not, of course, as being in itself of syphilitic origin,
but as a secondary infection, perhaps, of an ordinary
character, which finds a predisposition in an organ
which is itself probably modified by heredito-syphilis,
as are the naso-bucco-pharyngeal mucous membranes
in strumous children.
We know that these ideas concerning heredito-
syphilis have aroused a great deal of protest; it is
not easy to see why. If we have adopted them it is
only after verifying their truth in thousands of cases.
Further, here is the opinion of Gaucher, one of the
first authorities in this connection :
" The first category of heredito-syphilitic manifesta-
tions comprises the virulent heredity which may occur
even after several years of infection. This category
includes children afflicted with generalised secondary
heredito-syphilis, with infantile syphilis properly so-
called; this is the classic hereditary syphilis.
" It may also include cases of tertiary heredito-
syphilis. This may be precocious, primary, or con-
secutive upon secondary heredito-syphilis, or delayed :
even very greatly delayed. This tertiary heredito-
syphilis may comprise all the cutaneous, mucous,
osseous or visceral lesions of tertiary syphilis.
" The foregoing manifestations, and above all those
of secondary heredito-syphilis, are common to here-
ditary syphilis of paternal and maternal origin alike.
The following manifestations, of the second and third
category, appertain more properly to the syphilitic
heredity of paternal origin. The first arise from a
virulent syphilis which is still parasitical ; the second,
which we shall now examine, are rather of toxic
origin.
74 SOCIAL DISEASES
"This second category of manifestations com-
prises the remoter consequences of syphilis, but also
affections and lesions of a clearly defined nature, and
parasyphilitic or dystrophic affections, which I rank
as quaternary or quinary heredito-syphilis.
"Strabismus, many cases of myopia, stammering,
rickets, backwardness, idiocy, epilepsy, club-foot,
hare-lip all these are the penalties of a paternal
syphilitic heredity. There are many others, and in
particular I believe most cases of appendicitis are of
syphilitic origin. In 100 unselected patients I
obtained the positive Wassermann reaction nearly 50
times (48, to be exact). These were subjects of all
ages, of whose antecedents I knew nothing whatever.
" And what adds still further to the serious nature
of this syphilitic heredity is the fact that the affection
or malformation, once it is established, becomes
hereditary of itself.
" A person who squints, the son of a syphilitic, will
beget squinting children ; and an epileptic, suffering
from the syphilitic heredity, will beget epileptics and
will perpetuate epileptics through several generations,
without any fresh syphilitic infection.
"It is for this reason, because the first cause often
throws back through several generations, that the
syphilitic origin of a great number of affections has
been denied.
"It is the same with the tendency to bear twins.
Twins are heredito-syphilitics, and the tendency to
produce twins may be transmitted to the following
generation, without further syphilis. This is why it
may be said that the tendency to bear twins is
hereditary in certain families.
"In the third category I place a large number of
HEREDITO-SYPHILIS 75
cases in which the special heredity is not appreciable ;
but this is not to say that it does not exist. These
cases are those of children who present only ordinary
defects, which it is possible to attribute to the
syphilitic heredity only by protracted observation of
similar manifestations. These children are neither
vigorous, nor handsome, nor intelligent.
" It must not be forgotten that at the present time
a fourth part of the male population is syphilitic.
Now the syphilitic heredity does not prevent the con-
tagion of syphilis; so that there are a great number
of individuals who are born syphilitics, yet them-
selves contract syphilis. It may be imagined what a
horde of degenerates this accumulation of syphilis is
capable of producing.
' ' You come across them every day : these young
men with beardless faces, prominent lower jaws,
divided incisors, round shoulders, and narrow chests,
with their arms too long, their legs bowed, and their
toes turned out. Despite their defects, they live, and
may even make some figure in the world, and they
often play their part as members of society as well
as others. None the less, they are the victims of a
syphilitic paternal heredity, and they bear the stamp
of this heredity on the whole of their physique."
Even before Professor Gaucher, Professor Fournier,
in his booklet "For our Sons when they are
Eighteen," 1 sounded the alarm in respect of the de-
vastation due to hereditary syphilis. After pointing
out the individual dangers of syphilis, "let us now,"
he said, " consider the mischief it works in the family,
the child, and the race.
1 Pour nos fils quand Us auront 18 ans. 47 pp. Rueff, Paris, 1902.
76 SOCIAL DISEASES
"As regards the family, syphilis constitutes a
threefold social danger, which includes: i, con-
tamination of the wife in the home (which frequently
occurs, for statistics inform us that of 100 syphilitic
women in a city practice, there are 19 who have been
conjugally infected, that is, about one in five, a
stupefying and heartrending proportion); 2, disagree-
ment, dissolution of marriage, separation, divorce
very natural results of the injury which the husband
has inflicted upon his wife; 3, material ruin of the
family by reason of the sickness, incapacity or death
of the husband. For by reason of its late maturity,
syphilis often presents its account only when the
" rackety " young man of former years is transformed
into a husband and the father of a family. It is
usually, therefore, the husband who pays, in hard
cash, the debt of the youth. But in hard cash and
indirectly the family too expiates the fault of the hus-
band, when the latter becomes infirm, or helpless, or
dies. For being then deprived of its natural support,
it is in danger of falling into poverty, and only too
often does so. How many tragedies of this kind have
I not witnessed as the consequence of syphilis?
" If, as an old practitioner, I am asked what is the
worst, the most disastrous thing about syphilis, I
should reply, without a shadow of hesitation : it is
the group of hereditary complaints which the disease
produces; they are truly frightful, and result in the
wholesale massacre of our children. This is no
exaggeration.
"Syphilis, in short, is enormously deadly to the
child. It kills the child before birth, or during the
first days or weeks of its life, or at a more advanced
age. Very often it wreaks its vengeance upon cer-
HEREDITO-SYPHILIS 77
tain families, producing a whole series of successive
abortions, or the death of the children, to the number
of 4, 6, 8, 10, and even more (as many as 19 have
been recorded). So much so that this infantile poly-
mortality constitutes, from the medical point of view,
an indication of the first importance in the investiga-
tion and diagnosis of heredito-syphilis. So much so,
that in many instances it ends by dispeopling the
home, leaving it empty, literally and absolutely
empty.
" It appears from recent investigations that
syphilis, by means of these hereditary consequences,
may constitute a cause of debasement, of degenera-
tion, affecting the whole species, resulting in the
birth of inferior beings, decadent, dystrophic, fallen
from the estate of healthy humanity. They are de-
graded : either physicallv that is, they are pre-
maturely born, and remain small and stunted, are
infantile invalids, etc. ; later becoming rickety,
deformed, hunchbacked, etc. ; or they are born with
all manner of dystrophias, which are merely the re-
sults of an arrested development (hare-lip, club-foot,
malformation of the skull or the limbs, deaf-mutism,
testicular infantilism, etc.) ; or mentally degraded,
constituting, according to the degree of their intellec-
tual abasement, backward children or simpletons ; or
they are unbalanced, or deranged ; or they are imbe-
ciles or idiots.
" To-day it is not denied that this degradation may
attain the degree of monstrosity. Syphilis may
create monsters : that is, may result in extreme mal-
formations, due to the complete arrest of development.
It may, for example, create dwarfs. This is the
acme of degeneration."
7 8 SOCIAL DISEASES
However highly coloured these pictures of the
syphilitic inheritance may be, they are not yet com-
plete, and the most serious of these defects has not
yet found a place in them.
This taint, whose existence has already been
affirmed by a few observers, has not yet been realised
to its full extent. In any case it has not yet been
given a place amidst the classic beliefs respecting
this disease. We are speaking of the relation be-
tween syphilis and tuberculosis.
In this connection Professor Fournier was the first
to write : "I shall not hesitate to inscribe syphilis
among the etiological factors of pulmonary tuber-
culosis "; but the idea here expressed was still some-
what vague.
This idea was admirably expressed by M. Emile
Sergent, who, in October 1905, at the Congress of
Tuberculosis held in Paris, made a communication
which terminated in these conclusions: i, the rela-
tions between syphilis and tuberculosis are of the
closest character; 2, syphilis, acquired or inherited,
creates a soil particularly favourable to tuberculosis ;
3, to fight syphilis is, in a certain degree, to fight
tuberculosis. " For my part," said M. Sergent,
" the observations which I have collected have led
me to form the conception which I maintain to-day.
Whenever I have been able to look for syphilis in the
hereditary antecedents of tuberculosis, I have found
it in one of the ascendants."
" I do not profess," he adds, "to maintain that
tuberculosis necessitates, for its germination, the
existence of a syphilitic soil ; I am simply trying to
show that syphilis is not merely a threat of predis-
position to tuberculosis in the syphilitic himself ; but
HEREDITO-SYPHILIS 79
that this predisposition is transmitted to his
descendants also, so that the latter inherit the soil
that engenders heredito-syphilis properly so-called
. . . While the syphilitic heredity predisposes to
phthisis, it is far from being indifferent to the de-
velopment of other forms of tuberculosis, particularly
scrofula."
It is of course incredible that such a theory should
pass unnoticed. In reality we have here a highly
important discovery ; and there is only one explica-
tion of the silence which has been kept in respect of
such a hypothesis. It is because the notion that
syphilis is " a shameful disease " is still in full force.
While people will readily own that there are tuber-
culous subjects in their family, they will emphatically
refuse to acknowledge that there are syphilitics :
which is merely childish.
My personal observations, which have included
many thousands of tubercular subjects, have con-
firmed M. Sergent's at every point. Nine times out
of ten I have discovered the stigmata of heredito-
syphilis in patients suffering from confirmed tuber-
culosis.
Further, as a result of these observations, it
appears that there is a visible relation between the
number and severity of these stigmata on the one
hand, and the gravity of the tuberculosis on the other
hand. There is almost always a parallelism between
the severity of the heredito-syphilis and the gravity of
the tuberculosis. Accordingly we are forced to con-
clude that syphilis prepares the soil for tuberculosis.
In other words, the terrible increase of tuberculosis
which we observe with so much alarm can only be
the consequence of a similar increase of syphilis.
8o
If we consider that syphilis may transmit its in-
fluence through several generations through three,
four, five, or perhaps more and that the best quali-
fied and most moderate authorities estimate that a
fourth part of the male population is to-day syphilitic,
we may logically deduce that none of us can flatter
ourselves that we are free from some degree of here-
dito-syphilitic influence, more or less clearly defined,
and in those of us who are fortunate more or less
attenuated ; and that we may thus explain why the
receptivity to tuberculosis tends to become universal
in the generations now living.
More ; the attentive study of the family ante-
cedents of tuberculous patients and in some of my
observations this inquiry has yielded the most valu-
able results indicates plainly that the most marked
cases of predisposition to tuberculosis are the result
of a syphilitic heredity of maternal origin.
Thus, as regards the creation of a soil favourable
to the infection and the vegetation of the tubercle
bacillus, the maternal syphilitic heredity would appear
to be particularly disastrous ; as though the humoral
system of the offspring, for the building up of which
the mother provides all the materials, owed its insuf-
ficiency to the degradation of the system of which it
is merely a sort of annex or continuation.
Before closing this chapter we have still to furnish
the proof of what we have already stated concerning
the manifestations of the syphilitic heredity through
several generations.
The point is important, and deserves that we should
describe in some detail an observation which plainly
establishes the fact under examination.
Replying to an objection which had been made to
HEREDITO-SYPHILIS 81
him in respect of an observation in which he had
spoken of the effects of syphilis in a grandfather,
Gaucher, in a recent discussion before the Academy
of Medicine, asserted that we must very often take
into consideration not merely the syphilis contracted
by the grandfather, but also that contracted by the
great-grandfather. Here is the gist of one of the
observations to which he alluded: i, Great-grand-
father died young, of paraplegia (syphilis of the
spinal cord); 2, grandfather squinted, and without
suffering from acquired syphilis died of cerebral
haemorrhage ; 3, the father did not suffer from
acquired syphilis, nor any other disease, but exhibited
a furrowed tongue; 4, of three children one was back-
ward, almost an idiot ; another had a gap between the
upper median incisors and an abnormally high
palatal arch, suffered from lateral curvature of the
spine, and was operated on for adenoids; a third
suffered from entero-colitis and was also operated on
for adenoids. The sero-reaction of the father and the
children was positive ; that of the mother negative.
The children were breast-fed by the mother.
Thus, in the fourth generation, the hereditary
syphilitic influence of the great-grandfather pro-
duced : i, dental dystrophias, a scoliosis, and
adenoid vegetations; 2, a cerebral dystrophia, idiocy,
dental dystrophias, and strabismus ; 3, entero-colitis
and adenoid vegetations.
CHAPTER III
THE GRAVITY AND EXTENT OF THE EVIL
Before the war a third part of the male adult popula-
tion was afflicted by syphilis ; and the influence of the
disease makes itself felt, in the form of stigmata and
degeneracy, to the fourth and fifth generation ; such are
the two numerical data which enables us to appreciate the
serious nature of the evil. These data refer to the years
before the war ; we may safely assert that to-day the
frequency of syphilis has been increased by a third if not
a half. Syphilis is therefore by far the most serious
evil that threatens society. Although contagion is de-
pendent upon the will, the problem of waging war upon
this social peril is one of the greatest complexity.
A DISEASE which afflicts at least one third of the male
adult population ; a disease whose final symptoms are
mortal ; a disease which frequently entails sterility,
and may be transmitted to the offspring either in its
infectious form, which is then rapidly fatal, or in the
form of defects as numerous as they are varied ; of
which the slightest diminish or even destroy the social
value of those who suffer from them, while the more
serious endanger life ; a disease which extends its
disastrous influence at least to the fourth generation,
and perhaps even, farther ; a disease, that is, which
tends to destroy the race as well as the individual :
such a disease is assuredly one of the greatest of all
social evils,
82
GRAVITY AND EXTENT OF THE EVIL 83
On the one hand, depopulation ; on the other, the
multiplication of degenerates ; such is the work of
syphilis.
Moreover, the syphilis peril has never been so
great as at the present moment, simply because of
the war, which aggravates all the maladies to which
societies are subject, and whose influence in respect
of tuberculosis we have already considered, while we
shall presently see how alcoholism has been affected.
Professor Gaucher, whom we have already quoted,
asserted that after the first three years of the war it
might be estimated that the frequency of syphilis had
increased by one third, if not by half. "We must
recognize," says this eminent syphilographer, "that
the disorder into which the war has thrown men's
minds has rather confused our customary ideas of
morality. Men who have hitherto observed the laws
of conjugal fidelity, and who are suddenly separated
from their families, while conscious that they are ex-
posed to the continual peril of death, forget their
normal prudence. Venereal contagion results from
promiscuous and suspect connections which these men
would carefully have avoided in civil life. On the
other hand, women, left to themselves, often with in-
sufficient resources, permit themselves to replace for
the time the absent husband. Under these circum-
stances, particularly in time of war, men find mani-
fold occasions of venereal contagion, apart from
intercourse with professional prostitutes. These last,
it is true, play an important part in the propagation
of venereal diseases ; but from the interrogation to
which we have subjected our patients we find ithat the
disease is very often communicated by women of a
different class who were only occasionally prostitutes,
84 SOCIAL DISEASES
and were not prostitutes at all before the war, and
sometimes by married women, by the wives of
mobilised soldiers, to whom they made only a trifling
payment, or none at all.
"It is this moral relaxation, inevitable in time of
war, this abandonment of all sexual prudence, born
of the incessant dangers which threaten us, that has
caused the increase of syphilis since the war. And
since the general mobilisation syphilis has been in-
creasing not only among soldiers, but also in the civil
population.
" The statistics of my hospital (Saint-Louis) before
the war, compared with the present statistics relating
to the soldiers and civilians treated in my wards, have
enabled me, thanks to the mingling of civilian
patients, men and women, and soldiers, in the same
hospital, to form an exact idea of the prevalence of
syphilis to-day, since the mobilisation, among
civilians and among soldiers, compared with its
prevalence before the war.
" Between the ist January and the 3ist July, 1914,
that is, in the six months preceding the war, in a total
number of 3,000 patients, I observed, in round
figures, 300 recent cases of syphilis.
" Between the i4th August and the 3ist December,
1915, I received into the same hospital 4,912 patients,
both civilians and soldiers, among whom I noted 793
cases of recent syphilis, or, in round figures, 800
recent cases among 5,000 patients.
"Before the war, then, taking all the patients in
my wards, one tenth of them had recently acquired
syphilis. Since the war the proportion is one sixth.
Syphilis has therefore increased by more than a third,
by nearly one half, since the mobilisation.
GRAVITY AND EXTENT OF THE EVIL 85
" In this hospital, which is to-day a mixed hospital,
civil and military both, the proportion of recently
acquired cases of syphilis is practically the same in
soldiers and civilians. The increase of syphilis since
the mobilisation is the same in the army and in the
civil population. We find chancres, far more than
was formerly the case, in quite young lads and in
elderly men. It would seem as though in the
interior of the country those who are unfit for active
service have replaced, as far as contracting syphilis
is concerned, those who have left for the armies." 1
That is where we stand at present. It is easy to
see what we are coming to.
Even after the war of 1870 the physicians declared
that there was " a generation of the Siege of Paris,"
marked by its special nervous temperament, and a
characteristic feebleness of constitution ; and this was
after a war that lasted barely six months.
We can already affirm that the "generation of the
Great War," which lasted more than four years, will
be poor numerically, but rich in heredito-syphilitics.
Syphilis, even more truly than tuberculosis, is a
social malady, because contagion is, after all, volun-
tary, and the individual can perfectly well avoid it.
The contagion of tuberculosis, of course, is not
influenced by the will ; and it is inevitable that we
should be exposed to the undetected absorption of the
infective bacilli. A tuberculous sufferer breathes in
our faces with his germ-laden breath ; a gust of wind
results in our absorbing the contaminated dust of the
highways ; or flies walk over our food with feet which
are loaded with microbes from the expectorations of
consumptive patients.
1 Communication to the Academy of Medicine, 28 March, 1918.
86 SOCIAL DISEASES
As for syphilis, we know very well where the danger
lies and what we must do to avoid it.
It would seem, therefore, that the campaign against
syphilis must be particularly easy ; but such a belief
would argue a singular ignorance of human psych-
ology. The inquiry which we are about to make into
what has been done in this direction, and what yet
remains to be done, will clearly show the full com-
plexity of the problem.
THE CAMPAIGN AGAINST SYPHILIS. WHAT HAS BEEN
DONE
In the absence of a medical treatment capable of
actually sterilising 1 the syphilitic system, which would do
away with the problem of combating" this scourge, various
measures of public order have been recommended with
a view to stamping out the disease. The measures at
present in force in France constitute what is known as
the Regulation of Prostitution or the Police des moeurs.
This Regulation is merely the enforcement of a police
order, not the application of a law ; but this is not its
chief defect. What condemns it without appeal is that
it is ineffective, that it has proved absolutely helpless
against the spread of the social scourge. Nevertheless,
in certain communities the campaign against syphilis
has proved highly effective. It should be noted that the
Police des moeurs supervise and prosecute only women,
while in the above-mentioned communities, in the Army,
for example, the campaign has particular reference to
the men.
We have brieflv indicated, in the foregoing pages,
the cycle of depopulation and degeneration due to
syphilis.
We shall now consider the difficult problem of
combating this peril.
It is very obvious that if we possessed a truly
specific medical treatment for syphilis the problem of
the anti-syphilis campaign would no longer exist.
87 7
88 SOCIAL DISEASES
A few years ago it was believed for a moment that
we were at last in possession of this great sterilising
treatment. The new arsenic compounds, 1 imported
from Germany with a great blowing of trumpets,
were, we were told, those heroic remedies which
would in the space of a few days destroy the very last
of the very hardiest treponemae in the infected
organism.
The trial of this new treatment was then made in
France. The drugs were tested conscientiously and
extensively. But their use had quickly to be discon-
tinued or diminished ; and we doubt if a single
physician could be found to-day who would argue the
reality of the radical cure of syphilis by the arseno-
benzols and other similar products.
These products proved to be active cicatrising
agents, rapidly bleaching the ulcerous syphilids
a property by no means without value, from the
standpoint of possible contagion and useful in the
treatment of the few patients who cannot tolerate mer-
curial treatment.
But the arsenical treatment cannot be applied with-
out the risk of serious and sometimes fatal results ;
and it has also been accused of favouring the nervous
and cerebral forms of the disease, and of rendering
them precocious.
However this may be, this treatment, active though
it is, does not result in the radical and final cure of
syphilis; and we cannot from this point of view de-
clare it superior to the classic mercurial treatment, to
which a number of practitioners have wisely and
wholly returned.
But we know that however valuable this classic
1 Arseno-benzol, 606, etc. etc.
CAMPAIGN AGAINST SYPHILIS 89
treatment may be it does not protect the patient from
active returns of the disease.
By administering the treatment as it should be
administered, over years and years four, six, eight,
even ten years we often succeed in maintaining the
syphilitic in a state of apparent health, in suppressing
the external manifestations of the infection, in curing,
if you will, his individual syphilis; but the treatment
of the patient does not suppress the results of the
disease in his descendants, and it is even probable
that it favours the development of dystrophic heredito-
syphilis. For while syphilis that is not treated
usually involves sterility, abortions, or hereditary
infantile syphilis, the patient who is duly treated is
prolific, and produces offspring tainted with the
syphilitic heredity ; so that the individual benefits pro-
cured by treatment are perhaps counter-balanced by
the racial mischief committed ; so that it is not para-
doxical to say that dystrophic heredito-syphilis, the
generating cause of tuberculosis, may result from the
treatment of syphilis.
Owing to the comparative bankruptcy of therapeu-
tics where syphilis is concerned it has been necessary
to have recourse to protective measures as against
contagion ; and in France the outcome of this neces-
sity is an administrative method : regulation, con-
trolled and sanctioned by the Police des moeurs ; that
is, the inscription of women giving themselves to
prostitution, the institution of licensed houses, the
sanitary inspection of the prostitutes, and their intern-
ment on the appearance of a contagious disease.
It may be remarked that, to begin with, this regu-
lation is not legal, since it is not the application of
any law ; but this is a point of secondary importance,
90 SOCIAL DISEASES
which it would not be difficult to remedy, if the
system of regulation had yielded such results as one
had the right to expect of it.
In principle it is quite admissible that the pros-
titute, who exercises a dangerous profession, should
be subjected to special supervision, as are all persons
exercising a calling dangerous to the public health.
As for the results of interning the diseased, and its
value as a measure of prophylaxis, we cannot do
better than repeat the commonsense argument
invoked by M. Fournier and the ficole de Saint-
Lazare : namely, that a woman in prison contamin-
ates no one as long as she is in prison, and that this
is an undeniable advantage.
It must be recognized, however, that these are only
two minor aspects of the question, and that criticised
from a higher standpoint regulation appears to do
more harm than good.
Summing up the discussion of regulation which
took place at the International Conference of Brussels
in 1910, M. Fiaux brings the following indictment
against the regulation of vice and the Police des
moeurs :
" In the course of its earlier labours the conference
caused a multitude of inquiries to be made, as to the
organisation and operations of, and the results
obtained by, the Police des moeurs. These inquiries
resulted in a mass of information, statistics, etc., the
most abundant obtained since the work of Parent-
Duchatelet and the recent English, Italian, and
Russian inquiries; with this advantage, that it was of
a universal character.
"This is what we call the criticism of the Police
des moeurs by the facts.
CAMPAIGN AGAINST SYPHILIS 91
" If this first series of inquiries had proved the ex-
cellence of the Police des moeurs the work of the
Conference would have been completed, and its reply
would have put an end to anxieties and inquiries.
The system of the Police des moeurs would have
emerged from the Palais des Academies in Brussels
recognized, undisputed, and triumphant. It would
only have remained for the State and municipal
authorities to enlarge the system, above all to render
it more rigorous, and also more autonomous, more
independent of the laws and of all control.
But the trial was far from ending in victory ; it was
pitiful; it was unfavourable and more often than not
disastrous to the system.
" It appeared, to begin with, that the system was
based upon the official recruiting of vice from the
ranks of the poorest of the female proletariat; young
girls, minors, were the precocious and obligatory con-
scripts of this lamentable wrong.
" It then appeared that the recruiting of these girls
by the police, their inscription upon the registers,
and their confinement in licensed houses, ensured,
without possible remission or exception, the con-
tamination of these unhappy creatures, delivered over,
by the very fact of their official submission, to the
tender mercies of the male ; and that they immediately
became the indirect instruments by which the public
was poisoned.
" It appeared also that administrative medicine was
the most ridiculous and perilous of the comedies
played at the expense of the public health and con-
fidence. Women suffering from disease, described
as ' treated ' or ' cured,' were sent back as ill as they
were before ; whitewashed, said a great French
9 2 SOCIAL DISEASES
physician, exasperated by this pseudo-therapeutic
camouflage; painted over, was the severe verdict of
an eminent and courageous magistrate of the Court
of Paris, who on a later occasion was asked to express
his opinion. ' Damaged goods ' were made sound
at Saint-Lazare in one month ! Often even the
radical cure took even less time ; it was enough merely
to pass through the prison !
" It appeared at the same time that this administra-
tive medical service had the most disastrous influence
upon the medical service of the Assistance publique
itself, contributing to maintain in the hospitals, as
against ordinary patients afflicted with sexual
diseases, but having no connection with the Police
des moeurs, the absurd prejudice that the venereal
diseases are shameful; a prejudice highly unfavour-
able to the investigations undertaken by the scientific
and disinterested efforts of an efficacious and devoted
medical service like that of the hospital physicians of
Paris and the provinces.
" It appeared lastly that this system whose so-
called legality was that of the regulations issued by
the Lieutenants-general of Police in the time o^ Louis
XIV. and Louis XVI. had never at any time in-
cluded, for the benefit of the unhappy women thrown
into this common sewer, the slightest attempt at an
official institution of rescue, the most modest munici-
pal reformatory or house of retreat ! Woe to the
young girl, the young woman, who has fallen ! The
inscription on the registers of the Parisian Prefecture
of Police, or the Central Commissariats of the
provinces, replaces for them the terrible sentence read
by the Florentine poet above the entrance to the place
from which none ever returns : for them there is no
CAMPAIGN AGAINST SYPHILIS 93
more hope . . . inscribed as prostitutes, they
could only die as prostitutes."
This severe criticism of the system of the Police des
moeurs is certainly impressive, for it appeals to
humane considerations which cannot be neglected.
But from the practical point of view, in the limited
connection of the anti-syphilis campaign, and the
protection of the public, it would seem that the dis-
cussion between those who uphold regulation and
those who favour abolition can have no issue, as
neither of these parties can bring decisive arguments
to bear.
It is certainly the case that within limited areas the
system of regulation and supervision, strictly applied,
has been and should be able to protect certain collec-
tivities against syphilitic infection ; and this bene-
ficial result has been obtained, both in certain
colonies, and in military circles, where the measures
of supervision may be made extremely rigorous,
although they apply to men only, whereas the official
supervision applies only to women. 1
1 It is interesting to note the protective measures which have
been instituted in the American Army operating in France.
In France, in order to combat the recrudescence of the venereal
peril, in the Army and the workshop, we have contented ourselves
with multiplying the centres where syphilis is treated when acquired.
This, as M. Sabouraud remarks (Presse mtdicale, 18 February, 1918),
is what we might call the ancient prophylactic formula, of pro-
phylaxia after the event. It involves war upon prostitution, avowed
or clandestine, raids, compulsory inspection and treatment, and the
internment of contagious subjects. Are not our efforts wrongly
directed, and could we not do something better?
Now this is how the prophylaxis of venereal disease is understood
and applied in the American Army and these are the results obtained
thereby :
As soon as he joins his unit, the American soldier is warned ex-
plicitly of the dangers of venereal disease, and what he has to fear.
He is warned by means of compulsory lectures, given by Army
surgeons. These lectures not only put the man on his guard against
chance encounters, but they explain most carefully that even after
94 SOCIAL DISEASES
But apart from these results, which are assuredly
not to be neglected, yet are too limited to make it
possible for us to attribute a decisive value to the
system of police regulation, there is one general fact
of capital importance which dominates the entire dis-
cussion : it is, that syphilis is on the increase, and
alarmingly on the increase.
And this increase is not solely the result of the
war, for it was already visible before the war. In-
1900 Professor Fournier estimated that in Paris at
least 20 out of every 100 men were infected with
syphilis; in 1914 Professor Gaucher found this pro-
portion had increased to 30 per cent.; in 1916 he
believed that this last figure had increased by a third
or even half; and in 1917 he affirmed that the fre-
he has been exposed to danger he must endeavour to obviate its
consequences, and that if he does not do so he will be punished.
That is the first method. Here is the second : In every American
garrison town permanent prophylactic stations are installed, which
are open at any hour of the day or night, and every officer and
soldier must carry upon him the list of these stations corrected to
date. Every man must, when he has had sexual relations, under
pain of punishment, present himself at one of these stations, as
quickly as possible after connection (at the latest within four hours).
In Paris there are two of these stations, of which one alone gives,
on an average, 75 treatments per diem.
These stations are kept by medical orderlies selected for their par-
ticular practical intelligence. The treatment which it is their duty
to administer is simple and does not take more than ten minutes.
To begin with the genital organs are washed with soap and water.
An instillation of protargol, 2 per cent., is then made in the anterior
urethra, with a glass syringe, as a prevention of blennorrhagia.
The injection made, the patient keeps the urethral orifice closed with
the finger for a space for five minutes. Then follows, as a pre-
vention of syphilis, a copious inunction of the glans, the prepuce,
and the sheath of the penis with an ointment containing twenty-five
per cent, of calomel, and the patient is careful to apply it by mas-
sage, under the eyes of the orderly ; and this massage must be par-
ticularly attentive to the region of the preputial frenum and to both
sides of the frenum. This massage also is continued for five
minutes, after which the penis is enveloped in a dressing of silk
tissue-paper, and this the soldier must retain for at least four or
five hours, until the subsequent washing.
CAMPAIGN AGAINST SYPHILIS 95
quency of the disease had increased by two-thirds.
This brings the proportion to 50 per cent.
Apart from any other consideration, a system of
protection which gives such results is judged without
appeal. We must have something better than this.
It goes without saying that each station possesses a register on
which are entered the day and hour of treatment, with the name of
the patient and his rank.
These simple prophylactic methods have been in use in the Ameri-
can Army since 1911. It was soon noted that only those soldiers
who did not present themselves at a station, or attended too long
after connection, were contaminated. It was therefore decided that
every man afflicted with venereal disease should be punished forth-
with, the mere fact of infection being regarded as a sufficient proof
of his default.
In barracks venereal supervision is undertaken by an army
surgeon. Twice a month without warning he makes a special in-
spection. The man who is found to be infected is sent ipso facto
before a tribunal of military police, which condemns him to three
months' suspension of pay.
From previous statistics it appears that in time of peace 7 to 8
per cent, of American soldiers who had promiscuous sexual relations
were infected. This ratio rose to 12 and 15 per cent, during the
war in Cuba and the Philippines. With the present prophylactic
methods it has fallen to % per cent.
The Australian Army has had only one case of infection per
thousand ; and at Bordeaux, of a thousand men treated, not one
developed infection.
" Is it not a striking thing," says M. Sabouraud, who relates
these facts, " to see, once more, a prophylactic method which was
entirely French in its origin applied in France by other nations,
while we make no use of it? "
CHAPTER V
THE CAMPAIGN AGAINST SYPHILIS. WHAT MUST BE
DONE?
Syphilitic infection arises from voluntary actions.
Therefore, to combat it, we must appeal to the will.
We can influence the will in two ways : through fear
and through interest. The education of young people
of both sexes, as to the peril of syphilis, will appeal to
it through fear. This education has been attempted,
but timidly, in a limited fashion as regards both time
and extent. It is a matter of urgency that it should be
continued, and on a larger scale. Persuasion through
interest could be effected by a law making intersexual
contamination a penal offence ; a law making men and
women equally responsible for syphilitic infection, which
would do away with the twofold scandal, moral and
hygienic, of the system of police regulation. The logical
corollary of the sexual education of the adolescent of
both sexes, and of a law making intersexual contamination
a punishable offence, would be the suppression of official
or " protected " prostitution.
In order to combat a disease whose cause in this
case inter-sexual contagion is subject to the indi-
vidual will, we must influence that will. In order to
fight tuberculosis it was necessary to invoke hygienic
changes ; in order to fight syphilis we must involve
psychological changes; we must influence the men-
tality of individuals.
96
CAMPAIGN AGAINST SYPHILIS 97
We know of only two genuinely efficacious means
of acting upon the will : persuasion through fear and
persuasion through interest. These two means will
provide us with weapons which, properly handled,
would probably yield us results which constraint and
violence, in the form of the official regulation of vice,
have been powerless to achieve.
Let us first of all consider the method of persuasion
through fear. Such persuasion, obviously, can be
effected only by the tongue and the pen, by spoken
or written lectures ; which lectures should be multiplied
in every direction, especially in collectivities of young
people, such as schools and colleges for boys and
girls, young men and women, private or public
administrations or corporations, workshops, etc.
A first effort has been made in this direction, and
we have already mentioned the little booklet published
by Professor Fournier, in 1902, under the title : " For
our Sons when they are Eighteen. Some Words of
Advice from a Doctor." 1 This booklet has been
widely distributed by the French Society for Sanitary
and Moral Prophylaxis ; 2 but this effort was only
temporary, while- the generations succeed one another,
and wholesome advice must be given to them in a
continuous stream.
Professor Fournier's lecture is very well calculated
to effect the desired persuasion, showing in an impres-
sive light the misdeeds of individual and inherited
syphilis, and indicating how the disease is contracted,
how it is recognized, and how avoided.
1 Pour nos fils quand Us seront 18 ans. Quelques conseils d'un
medicin.
2 Societe fratifaise dc Prophylaxie sanitaire et morale.
9 8 SOCIAL DISEASES
" It has been said in jest," says Professor Fournier,
" that the fear of syphilis is the beginning of wisdom.
So be it ! but we do not comply with wisdom merely
because of fear; we comply with it also by reason of
other sentiments of a higher order : namely, the prin-
ciples of morality and religion, self-respect, respect
for women, the respect which is due, in advance, to
the one who will be your helpmate, to the children
who will be born of you, to the home that one day
will be yours."
Addressing himself to young men, Professor
Fournier does not hesitate to tackle the question of
continence. "Much has been spoken, improperly
and lightly, of the dangers of continence to the young
man. I must confess that if these dangers exist I am
not aware of them, and I, a physician, have never yet
observed them, although I have not wanted for sub-
jects of observation.
"Moreover, I will add, in the name of physiology,
that the true virility is not attained before the age of
twenty-one or thereabouts, and the need of sexual
intercourse does not make itself felt before this period,
above all if unwholesome excitations have not pre-
maturely awakened it. Precocity is merely artificial
and more often than otherwise is simply the result of
an ill-directed education.
" In any case, be sure that the danger in this case
resides less in restraining than in anticipating the
requirements of nature."
The only fault we might find with this instruction
as to the venereal peril is just that it has not insisted
at sufficient length upon the deplorable prejudice that
continence is dangerous, and that the sexual cravings
of young men are to be respected ; a prejudice which
CAMPAIGN AGAINST SYPHILIS 99
in many families is shared by the fathers themselves,
who declare that "youth must have its fling."
The exercise of the reproductive function before
growth is completely terminated is harmful from more
than one point of view. Firstly, from the standpoint
of individual development, which is arrested, and re-
mains fixed, when the genetic function enters into
operation.
Secondly, we have noted how dangerous sexual
prematurity may be as regards the development of
tuberculosis.
Lastly, the danger of syphilitic infection completes
the tale of the mischief worked by this prematurity ;
for the lack of experience natural to young men, and
the class of women to whom they resort, render this
terrible contamination almost inevitable.
When a man allows himself to be led away by a
clandestine prostitute the index of the danger incurred
is, as we have stated elsewhere, as high as 33 per cent.
In other words, with this class of women of three
dealings one will almost inevitably be followed by
infection.
Of course the corollary of this advice is to recom-
mend early marriage, and here again there is need to
modify the ideas in this connection which are
prevalent in most French families, where people think
much more of secondary and material interests, which
cannot make anyone happy, than of the health of the
children and the vigour of the generations to come,
and it is precisely these that are the true elements of
happiness.
To attain this end we must address ourselves also
to young girls; we must make them understand in
particular the dangers of conjugal and conceptional
ioo SOCIAL DISEASES
syphilis ; of the disastrous results, in the children, of
paternal or maternal heredito^philis ; and we must
persuade them that in order to avoid all these evils
the surest means is to marry, when quite young, a
young man.
Parents, too, should assure themselves by every
means at their disposal that the individual whom they
are about to bring into the family, and who is
destined to perpetuate them, is not already the victim
of personal syphilis or tainted by a strongly-marked
syphilitic heredity.
Of course, in the present state of our morals it
would be rather difficult to establish this state of
affairs. We hardly see ho\v it could be done save
by the provision of a medical certificate furnished by
the family doctor. The refusal to submit to examin-
ation at the hands of the physician would be equiva-
lent to a confession of disease, that is, of unfitness to
marry.
The French Society for Sanitary and Moral
Prophylaxis has also distributed information intended
^for young girls, in the form of a booklet by Dr.
Burlureaux. 1
It must be admitted that these efforts are highly
praiseworthy, intended, as they are, to give young
people that indispensable special education of which
we are speaking; and they have certainly produced
1 Pour nos jeunes filles, lorsqu' elles auront seize ans. Dr.
Burlureaux has not hesitated to grapple with the delicate problem of
the sexual and anti-syphilitic education of young girls, and he has
solved it successfully by a frontal attack. He believes that young
women and even young girls are often acquainted with all the
secrets of the so-called " hidden " plagues, and that they are
ignorant only of their dangers. His pamphlet is a welcome com
panion to that of Professor Fournier.
very happy results. But they are not continuous,
whereas they ought to be renewed year by year, for
years and years on end, indefatigably ; and above all
they ought to be multiplied and extended, in order to
penetrate all those circles where they might reach
young people in need of good advice.
So much for persuasion through fear ; but as we must
not count too greatly upon its power in a matter where
the appetites are appealed to by exciting factors which
are still more widespread and still more powerful than
any appeal to fear may be, it would be as well, with-
out delay, to proceed to the other method which "we
have mentioned, and on which we have reason for
basing stronger hopes : we refer to persuasion
through interest.
It was once more the Conference of Brussels which
tackled this further question. The arbitrary system
of police regulation, a system absolutely one-sided,
appeared to the Conference so illogical, so puerile,
so futile, that it condemned the method in an almost
dogmatic fashion ; indeed it waived the matter, pro-
pounding the question of making intersexual con-
tamination a punishable offence ; or, in other words,
the problem of sexual equality in respect of prostitu-
tion.
For what is peculiarly scandalous in the system of
police regulation is that it punishes only the infected
woman, who is already the victim of some man who
has sought her to derive pleasure from her. And
this man remains free to make as many similar vic-
tims as he chooses.
And the scandal is not merely a moral scandal; it
is also a sanitary scandal, for it is evident that we
cannot combat a contagion if no steps are taken
102 SOCIAL DISEASES
against half those persons who are responsible for its
spread.
In 1903, as a result of a moral scandal, the Govern-
ment appointed an extra-Parliamentary Commission 1
which was required to investigate the reforms which
might be introduced into the system of the Police des
moeurs ; and this Commission, like the Brussels Con-
ference, came to the conclusion that the Police des
moeurs was incapable of reformation or even of
improvement. It voted for its abolition, pure and
simple, considering that a system applied to one sex
only was an iniquity both from the moral point of
view and as a matter of justice ; while from the
hygienic standpoint it amounted to the organisation
or at least the sanctioning of contagion, since, (con-
sidering the matter from the moral point of view)
the woman alone was penalized, while (considering
the hygienic issues) the man was always left free to
propagate the disease without running any risk of
personal inconvenience.
To remedy this twofold scandal the Commission
proposed to substitute, in place of a system which
had long been condemned by its bad results, a system
amenable to the common law, of which the two
principal features, the two extreme terms, would be :
(i) the misdemeanour of recruiting for immoral pur-
poses, and (2), the misdemeanours, civil and penal,
of intersexual contamination, delinquencies applic-
able, of course, to persons of either sex, without dis-
tinction of condition or quality. We know that con-
tagion is acknowledged a misdemeanour by the
French courts. In the case of conjugal syphilis it is
cause for separation or divorce, and pecuniary com-
1 Commission extra-parlementaire du Regime des moeurs.
CAMPAIGN AGAINST SYPHILIS 103
pensation ; and a celebrated judgment delivered in
1903 by that eminent lawyer the President of the
Civil Tribunal of the Seine, M. Ditte, sanctioned the
extension of this important and valuable social juris-
prudence to the protection of the unmarried woman
when proof of intersexual contamination can be fur-
nished to the judge.
The question of the misdemeanour of contamina-
tion would therefore seem to be solved.
There remains the question of the penal offence.
The law voted by the Commission was thus ex-
expressed : "The penalties provided by articles 305,
310, 311, 319, and 320 of the penal code are applic-
able, in accordance with the distinctions therein con-
tained, to contamination by venereal diseases. Pro-
ceedings can be instituted only on the complaint of
interested persons, who can always, until final judge-
ment, stay proceedings."
In accordance with the legislation revised by the
Commission, the delinquencies punished by the law
would be : (i) Voluntary, intentional, premeditated
contamination (of a determined victim) ; a mode of
transmission less rare than would be supposed in the
annals of disorderly houses ; (2), conscious contamina-
tion, that is, effected by a person knowing himself or
herself to be diseased and contagious ; (3) contamina-
tion by imprudence, effected by a person not knowing
himself or herself to be diseased, or unaware of the
nature of the malady, or having more or less excuse
for believing himself or herself to be cured.
The scale of penalties should correspond with the
gravity of the offence, as in all the branches of the
penal law ; and extenuating circumstances would of
course figure largely in the new system.
8
104 SOCIAL DISEASES
In support of the juridical creation of the penal
offence, which was voted also by the French Society
for Sanitary Prophylaxis, M. Lucien le Foyer writes :
" The principle of the new misdemeanour is this :
there is such a thing as the evolution of the ideas of
evil ; consequently there is an evolution of the con-
ceptions of civil repression and criminal reparation
of and for the harm done to others. The idea of
disease tends to enter into the conception of wrong-
doing, and to become confounded with it; hence the
conceptions of civil reparation and criminal repression
tend to attach themselves to the communication of a
disease to another person.
"Disease inflicts injury as does a wound. The
virus of the disease in particular is a poison. Poison-
ing appertains to the penal code. In connection with
certain special diseases, the communication of which
presents rather the obvious characteristics of an
attempt upon the life or health of another, the concep-
tion of disease becomes socialised; that is, the con-
ception is becoming civilised by reparation and
generalised by repression.
"Contamination rests upon the same basis as
murder and homicide. Everybody knows that
criminality is coming to be more and more regarded
as a matter of pathology; opinion inclines to consider
crime the result of a disease. But we must not look
at only one side of a truth. We must understand it
in an inverse sense. Pathology is coming to be re-
garded as a matter of criminality ; opinion must in
time come to consider disease as the result of crime.
To commit a crime is a disease ; to transmit a disease
is a crime.
"To tell the truth, disease is a physical crime;
CAMPAIGN AGAINST SYPHILIS 105
crime is a social disease. Let us make reparation for
the one and repress the other."
M. le Foyer rejected the division of contamination
into voluntary and involuntary contamination, which
would have made it too simple a matter to assimilate
the new misdemeanour to the old offences of volun-
tary and involuntary wounds : for the words "volun-
tary contamination " he substituted " conscious con-
tamination." "The knowledge of the disease from
which one is suffering," said M. le Foyer, very justly,
"combined with the absence of the intention to
injure the contamination of others, which is not
avoided, though involuntary constitutes conscious
contamination. This degree of the misdemeanour is,
by a long way, that which is most frequently met
with."
As for "involuntary" or unconscious contamina-
tion, it can hardly be admitted except in the case of
backward persons, when the diseased subject may
really be unaware that he is diseased, and that his
malady is of a special nature, and transmissible.
To confirm the legitimacy of the penal delinquency,
M. E. Dollians, in his work on the Police des moeurs,
very justly makes a comparison between the conse-
quences of the action of the man who has rendered a
woman enceinte and the man who has contaminated
a healthy woman. "The man," he says, " who has
made use of a woman for his own pleasure cannot
make the objection that the child is, for the woman,
a natural risk involved by the act to which she con-
sented, and that she must make herself responsible
for it ; the person guilty of contamination cannot de-
clare that he had no intention of contaminating."
This was in reply to the much too specious objec-
io6 SOCIAL DISEASES
tion that the sexual act involves a risk of disease,
disease, like a state of health, being a natural
condition !
To sum up : as M. Dollians has said, the mis-
demeanour of contamination respects the principles
infringed by the misdemeanour of prostitution :
equality between the sexes and classes, and the
liberty of all sexual union. It satisfies the principle
of equality before the law. One of these theoretical
advantages is precisely the juridical affirmation that
the man and the woman are equally guilty of propa-
gating the venereal peril, which deprives the man of
his privileged position, his immunity. It establishes
equality in sexual relationships ; all differentiation of
the latter, all tendencies to form a hierarchy, dis-
appear; lastly, the establishment of the offence of
contamination respects the liberty of sexual union ;
it does not imply any right of judgement or control
of the sexual act itself.
The question of making intersexual contamination
a penal offence has now been thoroughly threshed
out and is in a condition to be submitted to Parlia-
ment. 1
It would seem superfluous to criticise this reform
in this chapter from the legal point of view; more-
over, it would be beyond our province. But we find
in it precisely that persuasion through interest (re-
inforced, if you will, by the fear of the police) which
is, it seems to us, together with persuasion through
fear of disease, than which it is more powerful, the
1 This question has been excellently discussed in all its bearings
by M. Louis Fiaux, in a volume entitled Le Dilit penal de contamin-
ation intersexuelle (Paris, Alcan, 1907), from which we have bor-
rowed freely.
CAMPAIGN AGAINST SYPHILIS 107
only factor capable of acting on the mentality of the
individual, restraining him effectually from the
accomplishment of those possible sexual crimes which
spread the contagion of syphilis in so alarming a
fashion.
For with this new law added to our penal legisla-
tion everyone would be warned that a serious and
effective responsibility was incurred by the man or
woman who should communicate the disease of
syphilis to another person.
"Like all laws," M. Fiaux observes, "this law
would act principally by force of threat and example.
Be sure that a few examples, in which the law should
be justly, severely and rigorously applied, would
have an excellent effect as a public disinfectant, moral
and sanitary, and a disinfectant of this nature is what
everybody is asking for, without distinction of doc-
trine. Poena in paucos et metus in omnes, according
to the excellent penal formula."
Here, moreover, are some instructive figures; they
are furnished by M. le Pileur, who, of 532 young
girls and women who were suffering from syphilis,
discovered that
Years of Age.
6 girls had been seduced when 10 to n
2 ,, ,, n ii to 12
8 ,, 12 to 13
24 ,, ,, ,, ,, . I, 13 to H
50 ,, ,, ,, n n H to 15
142 women had been seduced when 15 to 16
106 ,, ,, ,, ,, 16 to 17
86 ,, 18 to 19
38 ,, >, n 19 to 20
24 ,, ,, ,, ii 20 to 21
io8 SOCIAL DISEASES
Years of Age.
ii women had been seduced when 21 to 22
II ,, ,, ii ii n 22 to 2 3
7 >i ii > 2 4 to 26
And M. le Pileur gives us the following summary of
these statistics :
Seduced at - 16 years
Prostituted at 17 ,,
Syphilitic at 18 ,,
Here, again, are some figures furnished by M.
Martineau, which give the age and profession of the
seducer and the age of the victim :
Number Age Age of
of girls, when seduced. Quality of seducer. seducer.
13 The father 45
14 Traveller in wines - 26
15 Conseillerde Prefecture 32
17 Naval lieutenant 33
20 Banker 40
21 Solicitor's clerk 22
24 Physician 24
And so on ; we find, in long lists similar to this,
among the seducers of girls of from nine to twenty
years of age, relatives (uncles and cousins), the idle
rich, wine-merchants, timber-merchants, linen-drapers,
cafe" proprietors, actors, music-hall artists, draughts-
men, students, civil service clerks, architects, lawyers,
officers, physicians, married men. Of 582 syphilitics
M. le Pileur found that 65 belonged to the liberal pro-
fessions, and ii were employers of labour.
CAMPAIGN AGAINST SYPHILIS 109
Well, there is no reason to doubt that the great
majority of these interesting persons would have been
deterred by the fear of imprisonment and the pros-
pect of paying damages. Intimibility, as Lombroso
used to say, would here have produced its full pro-
tective effect.
And in the face of these statistics let there be no
more talk of the sexual need and the legitimacy of its
satisfaction !
For we might ask why all these honourable men,
having to satisfy a legitimate sexual need, had care-
fully chosen virgins for this commonplace physio-
logical operation !
And we are thus led in the last resort to conclude
that the necessary corollary of a methodical sexual
education of young people of both sexes, in which
the family and the school authorities would co-operate,
and the promulgation of a law making intersexual
contamination a penal offence, would be the suppres-
sion, pure and simple, of official prostitution, the
resort to which appears, more often than not, to be
the complement of excessive libations in more or less
fashionable restaurants and cabarets.
There are cities, even in Europe (notably in Swit-
zerland), where licensed houses are unknown, and
where the recruiting of prostitutes, and the persecu-
tion of women, are severely punished. It is probable,
since the function makes the organ and also creates
the desire, that the inevitable and respectable sexual
requirements of the citizens of these communities have
undergone a notable and beneficial diminution.
Public health and morality could only gain, and
gain enormously, by the disappearance of the
organised and regulated scandal of official prostitu-
i io SOCIAL DISEASES
tion ; and by the convergent action of the various
means which we have proposed there is reason to
hope that syphilis, as a social scourge, would dis-
appear.
BOOK III
ALCOHOLISM
BOOK III
ALCOHOLISM
CHAPTER I
THE NATURE OF THE EVIL. THE DISORDERS RESULTING
FROM IT
Alcoholism, which must not be confused with drunken-
ness an incident which may leave no traces results
from the prolonged impregnation of the cells of the
organism by alcohol, a toxic substance which tends to
destroy them by the retardation of organic combustion
which it produces. The doctrine that alcohol is a food
will not bear examination. The repeated contact of
alcohol with the elements of the tissues causes the fatty
degeneration of these tissues and leads to fatty hyper-
trophy of the organs. If the exaggerated consumption
of wine, rather than that of spirits and liqueurs, is at
fault, the liver becomes hypertrophied, then indurated,
and insufficient. In all cases alcoholism is characterised
by digestive and nervous disorders which diminish the
productivity of the individual, and his resistance to in-
fectious diseases, and cause precocious senility. Merely
by reason of the individual wreckage which it causes,
alcoholism is a serious social malady. But there is also
a hereditary alcoholism. The descendants of alcoholics
form that great army from which the doomed and prema-
ture victims of alcohol, crime, and insanity are recruited.
Arthritism appears to be the ordinary form of heredito-
alcoholism.
In alcoholism we have t'o deal not with a microbic
disease, resulting from the invasion of the system by
"3
ii4 SOCIAL DISEASES
a living parasite, but with a chronic intoxication due
to the impregnation of the organism by a substance
which profoundly deranges the functioning of the
cells of all the tissues of the organism. This derange-
ment is characterised by a retardation, more or less
accentuated, in accordance with the doses absorbed,
of the organic combustion which, as we know, takes
place in the very substance of the cells.
The result of this retardation of cellular combustion
is, in the long run, to provoke the deposit of fine fatty
granulations in the cells themselves, and in the organs
as a whole of the fatty substance which is characteris-
tic of the alcoholic, that is, the individual chronically
intoxicated by alcohol.
Alcoholism, therefore, is a chronic intoxication, a
slow poisoning, by alcohol.
We shall not dwell upon drunkenness, which is the
acute form of this intoxication, and which results
from the congestion of the mucous membranes of the
stomach and of the brain owing to the sudden con-
tact of an excessive dose of the poison. This exces-
sive dose provokes violent reflexes, such as vomiting,
which results in the expulsion from the system of
part of the poison absorbed.
If the organism does not succeed in thus ridding
itself of the poison, then, after the brain has mani-
fested its reaction by the disorder of the ideas and
movements, the drunkard falls into a state of torpor
characterised essentially by a fall of temperature,
which, under certain conditions of external tempera-
ture, may be fatal. This is due to an exaggeration
of the physiological action which we have already
noted.
Drunkenness, may of course lead to alcoholism, and
NATURE OF ALCOHOLISM . 115
is often the prelude to it ; it may also occur during
the course of alcoholism ; but drunkenness does not
cause alcoholism, nor does it by itself constitute
alcoholism. It is an acute incident which certainly
fatigues the organism, but does not as a rule leave
lasting traces.
Alcoholism requires for its production the pro-
longed contact of the body-cells with the substance
which tends to destroy them ; the elements of the cells
must be impregnated with alcohol, and unless the
doses absorbed are excessive this impregnation does
not occur, nor is the violent reaction of defence and
rejection produced which constitutes drunkenness.
In reality alcoholism is not one invariable form of
intoxication : it comprises at least three intoxications
which present certain slight points of difference : the
intoxication by alcohol properly so-called, or
ethylism; intoxication by wine, or cenolism; and in-
toxication by beverages containing various essences,
of which the type is absinthe, for which reason this
form of intoxication is described as absinthism.
As a matter of fact the intoxication due to wine or
liqueurs is itself ethylism, for all these beverages are
more or less alcoholic ; but the special poisons which
are added to the alcohol, and which complicate and
even aggravate its action, give oenolism and
absinthism special characteristics, which we shall
duly note.
The alcohol which is absorbed by the organism is
not all dealt with in the same way. One portion of
it the smallest portion undergoes combustion on
passing into the pulmonary circulation ; and it is for
this reason that some have maintained that alcohol
is a food, since it produces heat and therefore
n6 SOCIAL DISEASES
economises the reserves of the organism. But this
comparison is a specious one, for we must not take
into account only one of the effects produced, when
this effect is favourable, and pass over the rest, which
are truly deplorable, in silence. We might, as a
matter of fact, work a turbine by employing sulphuric
acid instead of water; but the result would not be
encouraging, for the turbine would quickly be
destroyed ; and if we recognise that alcohol is able to
produce heat, we must not disregard the degenerative
changes which it may produce in the cells with which
it has been in contact, before undergoing combustion.
Moreover, the quantity of alcohol thus physiologi-
cally burned is extremely small. This quantity cor-
responds with the amount of wine consumed by sober
persons who experience no inconvenient results from
this beverage owing to their leading an active open-
air life. But it is not these sensible wine-drinkers
who become alcoholics.
Directly the quantity of alcohol absorbed exceeds
this physiological dose, which, we repeat, is extremely
small, and is even non-existent for some persons, the
toxic substance circulates in the blood-stream, which
brings it into contact with all the organs, and conse-
quently with all the constituent elements of these
organs.
To say that alcohol is a toxic substance is to say
that the impregnation of the body-cells with this sub-
stance does not take place without damage to them ;
the texture of the organs and the content of the cells
are impaired by this contact, and the damage done is
more extensive in proportion as the contact is more
frequently repeated.
To begin with, alcohol, when brought into contact
NATURE OF ALCOHOLISM 117
with the mucous membranes of the stomach, provokes
a congested condition of these membranes, with or
without erosions ; and presently the portal vein, which
conveys the blood of the stomach and the intestine to
the liver, reveals an inflammatory condition of its
walls.
The brain, which, on the absorption of the poison,
is subjected to repeated congestions, involving at first
the dilatation of its small blood-vessels, presents,
after a certain time, a slight degree of sclerosis. Seen
under the microscope the nerve-cells appear infiltrated
with pigmentary or fatty granulations.
The viscera, notably the heart and the liver, dis-
play an excess of adipose tissue and also a fatty in-
filtration of their elements. In intoxication by
alcohol only ethylism properly so-called cirrhosis
of the liver is hardly ever observed ; but this cirrhosis,
at first hypertrophic, then atrophic, and finally com-
plicated by ascites, is the rule in cenolism, by reason
of the potassium salts contained in the wine, which
act as a special poison upon the hepatic cells.
The fatty degeneration of most of the glands is
also observed; and there is too a deposit of fat, in
more or less considerable masses, in the subcutaneous
tissue, principally in the region of the abdominal
wall.
Of these various lesions some are caused by the
direct irritant action of alcohol on the tissues, and
others by the retardation of combustion, which is
proved by the diminution of the proportion of car-
bonic acid exhaled.
This explains why alcoholism is peculiarly serious
in gouty and arthritic subjects, whose constitutional
disorders are aggravated by it. Now these disorders are
n8 SOCIAL DISEASES
closely analogous to the modifications which appear
in the tissues with advancing age : which caused
Lancereaux to say that the drinker, from the physio-
logical as well as from the pathological point of view,
is comparable to the old man, and that the abuse of
spirituous liquors results in a premature old age.
The disorders observed in alcoholics affect more
particularly the digestive functions and the nervous
system.
The appetite is diminished, the digestion is
impeded, there are burning sensations in the region
of the stomach (pyrosis), and slimy vomiting in the
early morning (morning phlegm).
On the other hand, the majority of the nervous
functions are affected in chronic ethylism : the vic-
tims experience a pricking or tingling sensation in
the extremities, which may give place to a certain
degree of insensibility.
The muscular strength diminishes, and presently
a slight tremor appears, at first passing, then per-
manent, consisting of slight rhythmical and svm
metrical jerks of the upper limbs, which become more
noticeable in proportion as the victim tries to sub-
ject his movements to accurate control. The lips and
tongue, and the muscles of the face, may also be
affected by this tremor.
After a certain number of years of alcoholic excess,
the muscular strength is so diminished that the
drinker has lost almost all his capacity for work, and
finds himself obliged to abandon any calling that
demands any muscular effort. At the age of fifty a
drinker is usually "done for," as far as his produc-
tive capacities are concerned.
The genital functions suffer the same depression as
NATURE OF ALCOHOLISM 119
the muscular strength, and absolute impotence is a
frequent result of alcoholic excess.
Then appear cerebral disorders insomnia, dreams,
and nightmares, often characterised by visions of
terrifying phantoms or strange animals. On waking
the alcoholic often suffers from vertigo and visual
disorders, above all if he drinks liqueurs.
When an alcoholic who has reached this stage in-
dulges in fresh excesses, exceeding the dose to which
he is accustomed, drunkenness may manifest itself by
a violent nervous crisis of delirium and tremor
(delirium tremens). A crisis of this nature may be
precipitated by an ordinary chill, an injury, or an
attack of some infectious disease, such as pneumonia
or erysipelas.
This trembling delirium, which is characterised
principally by terrifying hallucinations in the slighter
forms, is marked in the super-acute forms by an ex-
treme agitation in which all the muscles are in move-
ment, without rest or remission. The face is flushed,
and covered with sweat, and the eye haggard ; the
temperature is high ; there is extreme thirst ; convul-
sions may occur, necessitating the use of the strait-
waistcoat ; and after a longer or shorter period of this
ungovernable excitement (six, twelve, twenty-four
hours), during which he may be a danger to himself
and to those who approach him, the patient, ex-
hausted, falls into a state of collapse and dies. 1
1 We have not considered absinthism separately, as it may be
regarded as an aggravated form of alcoholism, consisting as it does
of simultaneous alcohol poisoning and poisoning by drugs or
essences.
All drinks containing essences bitters, pick-me-ups, liqueurs may,
like absinthe itself, which is the typical example, produce absinthism.
Thus absinthism has been observed in quite young girls who had been
advised to take peppermint or eau des Carmes for digestive troubles.
9
120 SOCIAL DISEASES
The development of ethylism is as a rule rather a
slow process, for the abuse of alcohol requires several
vears to impair the system seriously. Only in the
second period of ethylism, when the disorders, at first
congestive, have become organic, owing to the fatty
degeneration of the cells, is alcoholism really
established. This period is characterised by an
imperious need of alcohol ; and it is then that the
French proverb " he who has drunk will drink " be-
comes strictly accurate. In the third period the
alcoholic is characterised by his general malnutrition
and sottish degradation.
But long before he has reached this degree of
degeneration the social value of the alcoholic is pro-
foundly diminished, from the productive as well as
from the reproductive point of view.
We have said that the abuse of alcohol makes the
drinker old before his time. That is, he is diminished
in his physical and intellectual value, as a producer
and also as a procreator. At forty years of age an
alcoholic often appears sixty; so that a third of his
life has been destroyed, and precisely that portion of
his life which, in well-balanced and industrious men,
is the most fruitful, owing to the skill and experience
acquired.
The leading characteristic of acute absinthism is the occurrence of
convulsive crises which approximate closely to the crises of epilepsy.
As for chronic absinthism, its special physiognomy results princi-
pally from disorders of sensibility which are at first localised in the
extremities, afterwards gaining the trunk, in a more or less sym-
metrical fashion. These disorders of sensibility consist of an ex-
cessive exaggeration of the reflexes and of sensitiveness to pain.
Finally, a symptom comparatively common in the drinker of
absinthe or similar liquors is a peripheral paralysis, perfectly sym-
metrical, localised by preference in the nerves of the lower limbs,
although it may affect the pneumogastric or phrenic nerves, when
it involves fatal complications.
NATURE OF ALCOHOLISM 121
It will be seen what waste alcoholism is responsible
for, from the social point of view.
Does alcoholism favour tuberculosis ? Does it, as
has been said, manure the soil for tuberculosis ? In
a certain sense it undoubtedly does so ; but indirectly,
through the poverty which, in the working classes, is
usually its accompaniment, and the insufficient
alimentary repair which results from the abuse of
alcohol.
As for the direct creation of a soil favourable to the
development of tuberculosis, we do not believe that
alcohol has this effect ; indeed we rather incline to the
contrary opinion. We have considered elsewhere
this question of the soil favourable to tuberculosis,
and we have attributed its production to the syphilitic
heredity. There is no need to be surprised therefore
if we find many alcoholics among the victims of tuber-
culosis, for the syphilitic heredity often manifests it-
self by a special mental degeneration, compounded
of impulsiveness and suggestibility, which is entirely
propitious to the development of alcoholism.
But while alcohol does not directly cause a predis-
position to tuberculosis, it is none the less true that it
confers a character of special gravity upon any infec-
tious disease by which the alcoholic may be attacked.
The system steeped in alcohol loses all powers of
defence against the virus of disease, and this is why
pneumonia and erysipelas, which, as we know, are
serious maladies in old men, are equally serious in
alcoholics, who often exhibit, during the development
of these diseases, excitement, delirium, and a coma
which may be fatal.
Physicians have noted the marked influence of alco-
holic drinks upon skin diseases in general and the
122 SOCIAL DISEASES
cutaneous complications of syphilis in particular ; and
Professor Fournier, at Saint Louis, used constantly
to remind his students of the way in which syphilis is
exacerbated by alcoholism.
Wounds are commonly more serious in alcoholics
than in temperate persons; and surgical operations
are more dangerous. Many wounded soldiers during
the Great War were unable to support indispensable
operations because of their alcoholic taint.
Statistics, moreover, prove how little resistance the
alcoholic opposes to disease in general. Out of 4,744
patients M. Jacquet found that 1,905 were alcoholics,
or at least drinkers, a proportion of 29.01 per cent. ;
out of 1,328 patients in the Parisian hospitals he
found that 610 were alcoholics, or 46 per cent.
It was said, d propos of the revision of the 1914
conscripts, that " if the young men of twenty years
of age were finer than those of twenty-one, this was
because they had had a year of drink the less." It
must be recognised that the premature consumption
of alcohol and in certain parts of France they begin
to give alcohol to the child almost in the cradle has
caused a terrible degeneration of that splendid race
of men of whom certain provinces, such as Normandy,
were formerly so proud.
But it is above all from the age of thirty years and
upwards that a man really begins to drink, or rather
to feel the effect of what he drinks. He then, one
may say, begins to age visibly, and alcoholics of
forty to forty-five years of age are often no more than
sheer human wrecks, who look to have long passed
their sixtieth year.
In this connection the remarks made by certain
prefects, at the time of the inspection of discharged
NATURE OF ALCOHOLISM 123
and exempted men, which was undertaken at the end
of the year 1915, with a view to remobilisation, are
characteristic. We cannot quote them here, but they
will be found in the official report. 1
The general mortality of alcoholics is of course
much higher than the average. This average for all
professions being represented by 100, the mortality
of the publicans of the industrial districts of England
is represented by 2,030 and that of the farmers by 506.
The infantile mortality of the descendants of alco-
holics is also very high. M. Jacquet, between the
ist of May, 1912, and the ist of May, 1913, investi-
gated the facts relating to the offspring of 396
drinkers. These were classed in three groups,
according to their consumption of alcohol. One
hundred and forty-one moderate drinkers lost 83
children; 108 heavier drinkers lost 115; while 147
heavy drinkers were responsible for 244 deaths.
Is there such a thing as hereditary alcoholism ?
Alcoholism is already a social malady, owing to the
individual degeneration of which it is the cause.
Does it further threaten the race itself?
A very striking fact is the exceptional frequency of
arthritism in the offspring of alcoholics. Now arthrit-
ism is a mark of a constitution characterised by re-
tarded nutrition ; hence it seems that there must be
a hereditary transmission of the retardation of
organic combustion which is, as we have said, the
physiological characteristic of the action of alcohol
on the system.
Arthritism, an ordinary heredito-alcoholic taint,
1 Rapport fait an nom de la Commission de Legislation fiscale
chargee d'examiner le projet de proposition de loi sur le Regime
d'alcool, par. M. Coutan.
124 SOCIAL DISEASES
would thus be an indirect disproof of the creation by
alcoholism of a soil favourable to tuberculosis; for
there is an actual antagonism between arthritism and
tuberculosis. The tubercle bacillus vegetates only
with difficulty in an arthritic soil, and tubercular
lesions in arthritic patients are characterised by their
tendency to sclerosis, that is to cicatrisation.
In confirmation of this origin of arthritism, the
offspring of arthritics often suffer from defects which,
as we shall see, are assuredly the result of heredito-
alcoholism.
Among these defects we must first of all mention
the inborn tendency to use and abuse alcoholic drinks
commonly observed in the children of drunkards.
"It is usually between the ages of 15 and 25," says
Lancereaux, "that the tendency reveals itself, in an
extremely insidious fashion, in young men and even
in girls. The appearance of these cravings may
account for the tendency of certain races to indulge,
more than others, in the abuse of alcohol ; it explains
the great number of Norman and Breton alcoholics
observed in the hospitals of Paris."
But there is more than this to be considered. It is
probable that epilepsy and hysteria, when they are
not derived from syphilis, are the results of alco-
holism. The nocturnal terrors of children are more
often than not due to the alcoholism of their parents,
if not to the intoxication of the child itself.
Lastly, we often detect alcoholism in the family
antecedents of young criminals of the impulsive or
amoral type.
We have already drawn attention to those wretched
"Saturday's children" who are characteristic of
certain industrial communities. It is from this
NATURE OF ALCOHOLISM 125
tainted youth that all the victims of precocious vice
and crime are recruited.
Of the mental disorders which constitute heredito-
alcoholism, MM. Triboulet and Mathieu write: 1
" The intelligence is not greatly impaired in the first
generation of the offspring of alcoholics, and there
were comparatively few idiots or imbeciles in the
cases observed by Legrain, who investigated 215
families of drinkers. The children are intelligent and
precocious, but they suffer a sort of arrest at a given
age ; they are not endowed with any great intellectual
or moral stability. Moreover, they are nervous;
neuropaths ; and from their early youth one perceives
that their character and intelligence are ill-balanced;
they are capricious, ill-tempered, and violent, exhibit-
ing an exaggerated delight or an abnormal state of
depression for the most trifling causes.
" What is more serious is that in a certain number
of cases we observe errors of conduct, sexual excesses,
or conscious obsessions.
" Under the title of moral insanity Legrain has
observed, in 32 out of 508 children of alcoholics, the
following defects : bad instincts and vices, lying, in-
subordination, precocious prostitution, sexual per-
version of every kind, theft, swindling, vagabondage.
"The dangerous impulses observed are of every
kind : assaults, quarrels, homicide under the influ-
ence of drink, acts of brutality and rebellion, threats
of death, etc.
" It will be seen how burdened is the mental state
in these individuals, who, as a rule, are not
habitually sufficiently insane to necessitate intern-
ment.
i L'Alcool et V Alcoolisme, by H. Triboulet and F. Mathieu.
126 SOCIAL DISEASES
But mental alienation itself receives a very large
contingent of heredito-alcoholics. Legrain has
observed 106 cases among 508 individuals, and notes
that depressed and melancholy states of mind pre-
dominate, with a frequent tendency to suicide.
" Occasionally special symptoms of alcoholic
heredity are developed. Delirium tremens may
appear by hereditary transmission. More rarely
hereditary tremors are said to have been observed.
"The impairment and unsettlement of the nervous
centres of heredito-alcoholics may give rise to
maladies of the nervous system. Infantile convul-
sions are recorded with some frequency in the cases
noted by H. Martin (in 48 out of 1697 subjects) and
Legrain (in 39 out of 508). Hysteria, too, is
observed, or hystero-epilepsy (in 60 out of 119 sub-
jects) and true epilepsy (in 52 out of 508 subjects).
Absinthism in the parents appears directly and almost
inevitably to engender epilepsy in the children. A
few cases of chorea are observed.
" In the second generation of heredito-alcoholics
the observations of Morel and the statistics of
Legrain, who investigated 98 families, producing 294
children, we find an aggravation of symptoms. The
intelligence is more seriously impaired. Idiots and
backward children are numerous, and 23 cases of
mental alienation are recorded. In 40 families there
is epilepsy. Infantile convulsions and meningitis are
frequent. Drunkenness is almost constant.
" In the third generation Legrain follows up seven
families with 17 children, who are all defective; some
are idiots, backward, or weak-minded ; others suffer
from moral insanity, hysteria or epilepsy.
"It is not only by mental or nervous defects, but
NATURE OF ALCOHOLISM 127
also, in many cases, by defects of the physical con-
stitution that organic disorder is revealed in the
descendants of alcoholics.
" Fe're', investigating the embryos of animals, has
subjected eggs to the influence of alcohol ; he opens
them before they hatch, and discovers alterative
changes which give rise to monstrous deformities.
Duneaux and Breschet also have encountered atrophic
malformations in human foetuses born of alcoholic
parents. Legrain, in a total of 215 families, noted
174 cases of fcetal mortality or precocious mortality.
The alcoholism of the parents thus contributes to the
depopulation of the country.
"The physical defects of the children consist in
what are known as the stigmata of degeneration ;
these are, malformations of the skull and asymmetry
of the face; sometimes strabismus, blindness, deaf-
ness, deafness and dumbness, and malformations of
the vertebral column ; and we may also regard infan-
tilism as due to arrested development. Thus, in a
minor degree, since the investigations of Magnus
Hus, Rabuteau and Lancereaux, hereditary alco-
holism is held responsible for the falling off in the
average of stature and physical vigour, and the re-
sults of military enlistment in France and Switzer-
land appear to confirm this opinion.
"The children of alcoholics offer less resistance to
disease, and when they escape meningitis or scrofula
they are decimated before maturity by acute
diseases."
There is no doubt that the observers whom we have
quoted have often mistaken the stigmata of heredito-
syphilis for those of heredito-alcoholism ; and in
reality it must have been difficult enough to dis-
128 SOCIAL DISEASES
tinguish between them at a time when heredito-
syphilis was still imperfectly understood especially
before the test of sero-reaction was known the more
so as syphilis and alcoholism often go hand in hand,
to their mutual aggravation and complication.
The statistics to which we shall now appeal will
show us, moreover, in a more striking fashion than
any pathological considerations, the close and deadly
connection existing between the consumption of
alcohol, crime, and lunacy.
CHAPTER II
THE EXTENT OF THE EVIL. ITS SOCIAL CONSEQUENCES
During the last fifty years the consumption of alcohol
in France has doubled, and in this connection the country
is now at the head of all the countries in the world.
At the same time criminality, mental disorder, tuber-
culosis and suicides have similarly increased. The war
has still further aggravated this condition. As a result
of the new habits formed by the female workers in
factories and workshops, there is reason to fear that
alcoholism is becoming more frequent among women.
Anyone considering the present extent of the evil
would find it difficult to believe that alcoholism is a
disease of recent development. Yet in 1852, when
the Academic Francaise awarded one of the Montyon
prizes to Magnus Hus, a Swedish physician, who in
1849, dismayed by the advances which the new
malady was making in Sweden and Norway, was the
first to sound the alarm, the author of the academic
report was still able to write: "France contains
many drunkards, but fortunately no alcoholics."
The times have changed indeed. Eighteen years
after this happy period, in 1870, Bergeron, calling
the attention of the Academy of Medicine to the
prevalence of alcoholism, stated that " the evil was
already very great," and since then all the States of
Europe, notably England, Denmark, Russia, Swit-
139
1 30 SOCIAL DISEASES
zerland, and even the United States, have been forced
to give attention to and organise a campaign against
the new scourge. Further, the plague has passed
into the hot countries, and in Algeria, as in the
tropical regions, it has been responsible for terrible
ravages.
In order to appreciate the danger with which it
threatens France, we must inquire into the consump-
tion of alcohol of recent years. The statistics of the
Ministry of Finance inform us that the quantities of
alcohol which have paid duty have increased from
18,748,668 gallons (851,825 hectolitres) of pure alco-
hol in 1860 to 34,296,730 gallons (1,558,234 hecto-
litres) in 1913. l The amount of alcohol paying taxes
has thus nearly doubled in 53 years.
These figures, it must be remembered, do not take
into account the so-called " family consumption " of
alcohol : that is, the brandy which the bouilleurs de
cru (farmers, vine-growers, etc., who distil spirits
ostensibly for their own use) are allowed to consume
without paying duty, after distilling it from their
wines and ciders, the residuum of the wine-press or
cider-press, the dregs of the vats, or the fruits grown
in their orchards. Everyone knows that the alcohol
thus obtained is in reality consumed not by the family
of the distiller, his servants, friends, and neighbours,
but also by their labourers, and even by the cus-
tomers of certain wine-shops, cabarets, etc., supplied
by the distiller unknown to the Control (Re"gie).
The number of gallons of pure alcohol made by the
1 These and the subsequent figures are quoted from the report of
the Commission de la legislation fiscale chargee d'examiner le projet
et les propositions de lot sur le regime d'alcool, by M. Tournan
(Paris, 1916).
EXTENT OF ALCOHOLISM 131
bouilleurs de cru, and therefore not controlled, has
increased, according to the estimates of the Control,
from 110,000 in 1896 to 220,000 in 1913. It has
therefore precisely doubled. But there is reason to
think, according to M. Tournan, that the estimates
of the Administration amount only to a fraction of
the alcohol utilised for family consumption or secretly
supplied to retailers.
Judging by the total of the official statistics the
average amount of alcohol consumed per inhabitant
amounted in 1913 to 6.86 pints of taxed liquor, and
7.92 pints, or close upon a gallon, with the liquor
exempted from taxation. These figures, compared
with those of other countries, are extremely high;
for excepting Denmark, where the consumption per
head, in 1911, was 10.102 pints, in all other countries
it was below 7 pints.
In other words, France appears to be the most
alcoholic country in the world. But a more careful
analysis of the situation soon shows us that the fol-
lowing figures afford us a very insufficient idea of the
quantities of alcohol consumed by each drinker.
To begin with, the consumption per head, calcu-
lated for each department, turns out to be very
unequal. Between 1904 and 1913 it varied from 21.44
pints in Seine-Inferieure to 1.4 pints for Gus.
And the average per inhabitant is higher in. the
towns than in the country. In 1913 it was 13.8 pints
in communes of 4,000 to 6,000 inhabitants, as against
5.67 pints in the country.
Lastly, in the same town all the inhabitants do not
drink equally : the children consume little or no
spirituous liquor ; and the women, even in provinces
where they drink too much brandy, as in Normandy,
I 3 2 SOCIAL DISEASES
do not drink nearly as much as the men. Finally,
there are water-drinkers. Also, it has been ascer-
tained that in towns such as Le Havre, Caen, Rouen,
and Boulogne-sur-Mer, the greater part of the alcohol
is consumed by a small number of drinkers, who
drink annually, on an average, 52.8 pints of alcohol
at 100, or 132 pints of alcohol at 40 (the normal
strength of brandies), or 3,000 small glasses or
" nips " in the course of the year, which gives a daily
consumption of eight small glasses. 1
But even this is not a maximum. " In many
cantons of Eure, Calvados, Seine-lnferieure, Manche,
and notably in Mortinais and La Hogue, the country
of the legendary "cafe a la mort," there are many
men, farmers or fishermen, who drink not less than
half a litre (.88 of a pint) of brandy every day.
Some boat-owners or farmers pay all or part of the
wages of their men in brandy, served at the cafe's,
without food. The women themselves in certain dis-
tricts have contracted the drink habit. The children
who take their meals to school sometimes carry in
their food-baskets a bottle of coffee laced with
brandy, and the school-teachers state that it is not
unusual to see them arrive at the school drunk."
(Tournan, report already cited.)
It is impossible to obtain statistics of the indi-
viduals afflicted with alcoholism ; the more so as it is
with alcoholism as with all other diseases : all
degrees of the malady may be observed, from the
slightest to the most advanced cachexia. But there
is no doubt that a great part of the population of
France is afflicted with it.
1 G. Lachapelle, L'Alcoolisme, in La Revue de Paris, December 1915.
EXTENT OF ALCOHOLISM 133
We may judge of this by the frequency of extreme
cases, which do get recorded, since they are observed
and catalogued in the prisons and lunatic asylums.
Alcoholism leads to crime and insanity. Let us see
in what direction the statistics of crime and insanity
are tending in France.
M. Legrain, the chief physician in the Asylum of
Ville-Eveard, has submitted to the Socie'te' Generale
des Poisons the results of statistics which he person-
ally collected, relating to 2,500 drinkers, the majority
of whom would have been liable to prosecution had
they not been sent to the Asylum under his direction.
Investigating the " criminological value " of alcohol,
he ascertained that of these 2,500 patients 1,664, or
66 per cent., would have been liable to prosecution
and imprisonment.
As to the nature of the crimes and misdemeanours
committed, M. Legrain found that of every 100
drinkers 21 had been guilty of acts of violence
(blows, etc.); 17 of vagabondage or mendicity; 10 of
threats ; 8 of resistance to the law ; 3 of breaking out
of custody.
The Keeper of the Seals, in the General Account of
the Administration of Criminal Justice in France,
notes during the last few years before the war a very
perceptible increase of those crimes which have their
origin in the taverns and places of amusement, and
which are the result of vice and alcoholism. The
increasing number of assaults and stabbing affrays,
etc., also appears to the Keeper of the Seals to be
an obvious consequence of alcoholism.
About one third of the cases of resistance to the
law and assaults upon policemen, etc., are provoked
by the abuse of alcohol ; one fifth of the cases of
134 SOCIAL DISEASES
personal violence and robbery with violence are
caused by drunkenness; one sixth of the offences
against morality are due to the same cause. "It is
violence, there is no doubt of it," says the Keeper
of the Seals, " that constitutes the specific criminality
of drunkards and alcoholics; acts of violence, homi-
cidal or covetous, blows and wounds, and violent
acts of immorality : such are the crimes most fre-
quently engendered by the abuse of alcohol."
In point of age the number of prisoners addicted
to drink is proportionally larger among adolescents
than among adults; and this fact by itself would ex-
plain the ever-increasing proportion of juvenile
crime, the statistics of which can but follow the
increasing statistics of alcoholism.
Lastly, the districts in which crimes of violence are
most frequently the results of alcoholism are situated
in the regions which show the greatest consumption
of alcohol : Besanrcon (where absinthe is chiefly re-
sponsible), Rouen, Caen, Paris, Douai, Amiens,
Nancy, Angers, Rennes. In these districts the
average proportion of intemperate delinquents is ten
times greater than elsewhere.
Moreover, the statistics of the prisoners tried in the
Assize Courts during the ten years 1904-1913 confirm
these conclusions : the amount of criminality is
greater in the departments which consume an exces-
sive amount of alcohol than in the others.
The data relating to insane alcoholics are in all
respects comparable to those relating to criminal
alcoholics.
Certain insane persons owe their condition solely
to their abuse of alcohol ; others seem to have been
led to the asylums by various diseases epilepsy,
EXTENT OF ALCOHOLISM 135
auto-intoxication, etc. ; but alcoholism has intervened
as the last straw, aggravating the previous affection,
and without it there would have been no obligation
to resort to internment. These two categories, how-
ever, do not constitute the entire population of insane
alcoholics. " How many alcoholics," says Professor
Debove, "exhibit mental disorder, without being for
that reason shut up in an asylum ! For one actual
lunatic, how many alcoholics over the brink of mental
alienation enjoy their liberty and are not included in
the statistics ! "
According to statistics drawn up by the Poor Law
authorities (Direction de 1'Assistance Publique) re-
lating to those insane persons whose condition is
attributed to alcoholism, the proportion of patients
afflicted with alcoholism, for the period 1861-1885,
was 5 per cent, in the case of the women and 21 per
cent, in that of the men. But a comparison of the
beginning and end of this period is highly significant
as showing the progress of alcoholism ; for the figures
relating to women rose from 2.82 per cent, in 1861-5
to 9.58 per cent, in 1881-5; while the figures relating
to men rose from 14.78 to 21.9 per cent, during the
corresponding period.
In 1907 a fresh inquiry was conducted in the
various asylums, with a view to determining the exact
number of patients whose mental alienation was
caused partly or wholly by the abuse of alcohol. In
1907 their numbers were 9,932 among 71,547 patients,
which represents a total of 13.60 per cent, of the entire
population of the asylums. In ten years there had
been an increase of 50 per cent.
Finally, between 1893 and 1912 the number of
alcoholic patients under treatment in the public
10
i 3 6 SOCIAL DISEASES
asylums increased from 76,413 to 101,461 ; that is, by
nearly one third. During this period the numbers
of those patients whose malady was attributed to
alcoholism rose from 5,050 to 10,037 > tnat ' s ^ had
almost doubled.
We have already expressed our opinion of the
relations between alcoholism and tuberculosis : that
it does not seem to us that alcoholism is specially pro-
ductive of a soil peculiarly favourable to tuberculosis,
as syphilis appears to be. But we are fully alive to
the influence which the anti-hygienic conditions under
which the majority of alcoholics live may exert upon
the development of tuberculosis. This influence is
no less obvious for being indirect, and it is interesting
to inquire what the statistics have to say in this con-
nection.
Now M. Fuster has shown us that nearly all the
towns of more than 20,000 inhabitants which have a
death-rate from tuberculosis higher than the average
death-rate obtaining in towns of this size are in the
north-west of France (notably 16 towns out of 25 in
Normandy and Brittany), and the same author has
drawn a map of "rural tuberculosis," showing its
incidence by departments; a map whose agreement
with that showing the consumption of alcohol is
remarkable.
The statistics issued by the medical boards exam-
ining recruits (Conseils de revision) between 1906
and 1915 show that in general those departments in
which large quantities of alcohol are consumed
furnish a high ratio of tuberculous subjects. While
the average for the whole of France was 13.50 per
1,000 of the men called up, it was 43.30 per 1,000 in
Ile-et-Vilaine, 34.51 in Orne, 33.78 in Mayenne, 24.35
EXTENT OF ALCOHOLISM 137
in Calvados, 23.09 in La Manche, and 15.52 in Seine-
Infe"rieure.
Again, the advance of alcoholism is commonly
invoked to explain the extraordinary increase of the
number of- suicides in France during the last forty
years. From 5,276 in 1875 the number rose to 6,259
in 1880, 8,418 in 1890, 8,926 in 1900, and 9,810 in
1910, or 2.4 suicides per 10,000 inhabitants. Given
the mental instability of alcoholics, who readily pass
from a state of exaltation to one of depression, it is
permissible to conclude that alcoholism plays a
prominent part in this progressive increase of the
number of suicides, the more so as those departments
in which the greatest number of suicides are recorded
are also those which consume the greatest quantities
of alcohol. In 1905 the department of Eure stood at
the head with 186 suicides, or 55 per 100,000 in-
habitants. Seine-Infe"rieure came immediately after
with 338 suicides (53 per 100,000 inhabitants). Paris
was fourth on the list, with 1,462 suicides (35 per
100,000 inhabitants).
Thus during the last fifty years the tide of alco-
holism has been steadily rising, and simultaneously
its social symptoms criminality, insanity, and
suicide have made alarming advances.
Note that the figures which are given above are
pre-war figures, and that there is no room for doubt
that the war has aggravated the situation, as it aggra-
vates the other social maladies. The victims which
alcoholism has claimed during the last few years have
hitherto evaded the statistician ; but the extraordinary
frequency of cases of drunkenness, the prelude of
alcoholism, the spread of drinking habits among
women, who have been passing the wine-shop on the
i 3 8 SOCIAL DISEASES
way to and from the munitions factory, and have not
failed to leave there a large proportion of their un-
hoped-for earnings, are disturbing symptoms of the
aggravation of the scourge.
It is high time to take counsel. But before inquir-
ing what remedies it would be possible to apply to
this painful situation, we will examine the conditions
which favour the abuse of alcohol in the individual.
WHY AND HOW ONE BECOMES AN ALCOHOLIC
The factors of alcoholism are of a physiological and
psychological order. The absorption of alcohol in
quantities larger than the dose which can be dealt with
by a given organism, and the continued absorption of
alcohol of a particularly toxic quality, constitute its
physiological factors. The psychological factors are :
the craving for the stimulus due to the absorption of the
poison ; imitation ; the temptation of passing wine shops,
cabarets, bars, etc., where the poison is sold, at every
step ; the craving for rest and amusement, in those who
are idle or in those who work, and the want of a home
in which they could find either. Feminism, which re-
sults in taking the woman out of her home, in order
to perform work which is more and more closely ap-
proximating to that of men, will cause a yet greater
number of uninhabitable homes, and will at the same
time multiply the " poor man's clubs " that is, taverns,
wine shops, etc.
If we inquire into the individual causes of alcohol
we shall find that these causes are of two kinds :
physiological and psychological.
Physiologically, a man becomes an alcoholic be-
cause he absorbs a quantity of alcohol which is larger
than that which his system is able to burn, and there-
fore larger than that which the tissues should be
called upon to tolerate.
139
i 4 o SOCIAL DISEASES
It is difficult to ascertain this quantity, since it
varies with the individual, with his constitution, and
with the kind of life which he leads.
Thus arthritic subjects tolerate alcohol very badly ;
and for them a quantity of alcohol which a normal
subject can perfectly well support is absolutely
poisonous.
Similarly, persons who work in the open air, and
with their muscles, are not incommoded by a quantity
of wine which would be dangerously toxic to the
sedentary worker. Thus there are furniture-removers
who drink ten to fourteen pints of wine a day, and
who take quite a time to succumb to such habits,
which would kill an office-worker in a few months.
Physiologically, again, a man becomes an alco-
holic more especially because he drinks alcohol of
bad quality a poison doubly poisonous.
Fifty years ago the alcohol consumed was usually
diluted sufficiently to prevent its producing very
harmful effects; and brandy was too dear to be with-
in the reach of every purse.
But presently the manufacture of industrial alcohol
was developed with extraordinary rapidity, and its
price, which was 166 francs per hectolitre in 1854,
fell in seven years to 44 francs, involving a parallel
depreciation in the price of grape brandies, which
fell from 193 francs to 58 francs. It was then that
alcohol began its ravages.
On the other hand, as the industrial alcohols had a
disagreeable taste, which had to be removed by recti-
fication, and as the product thus obtained was de-
ficient in flavour, the manufacturers were led to add
all sorts of essences, which were highly seductive to
the palate, but extremely toxic to the organism :
WHY ONE BECOMES AN ALCOHOLIC 141
notably thuyone, benzoic aldehyde, and salicylic
ethers. These dangerous substances were further
capable of masking the unpleasant flavours of ill-
rectified alcohols, which are particularly poisonous.
What was then offered for consumption was, as M.
Grivean justly remarked, " poisoned poison."
In 1913, when 34,296,730 gallons of alcohol paid
duty for general consumption, the "poisoned
poisons," such as absinthes, bitters, etc., amounted to
8,9 2 5>957 gallons, or more than one fourth of the
whole. Between 1872 and 1913 the quantity of
absinthe consumed increased to 36 times its initial
figure; and France absorbed more absinthe than all
the other countries put together. 1
1 Concerning the quantity and quality of alcohol absorbed, the
essences being reckoned as impurities, M. Ponchet, in a report upon
a proposed law relating to the sale of liqueurs, aperitifs and alco-
holized wines, submitted in the name of the Conseil d'hygiene pub-
lique de France, expresses himself as follows :
" If we seek to classify spirituous liquors in accordance with the
foregoing data, we see that the first term of the series consists of
neutral industrial alcohol reduced in strength for consumption, that
is, white brandy ; and the last consists of the same alcohol containing
in solution, and in the largest doses, the essences extracted by macer-
ation and distillation from plants containing substances which are
recognised as being extremely dangerous that is to say, absinthe.
" Between these two extreme terms we place the various natural
brandies, aromatic wines, and liqueurs.
" Alcohol in itself is a toxic substance, whose harmful effects no
longer call for demonstration ; but this disastrous effect is still further
increased by the aldehydes, the acetones and the ethers which are
formed during fermentation or exist in the natural state in all the
ingredients employed in the preparation of aromatic beverages. The
toxicity of these products is all the greater in that the manufacturer
passes from the derivatives of the fatty series to those of the aro-
matic series, while the chemical composition of these compounds
becomes still further complicated. From this point of view the
maximum toxicity must be attributed to the derivatives of the group
of bi-cyclic terpins, whose principal representative, in the aromatic
plants employed, is thuyone. For an equal dose of alcohol, there-
fore, these liqueurs are all the more dangerous in that they contain
a greater quantity of essences, for all the essences used are harm-
ful, and more particularly the essences of the menthene group.
1 42 SOCIAL DISEASES
Among the psychological factors which lead to
alcoholism, we must, to begin with, reckon the agree-
able excitation which follows immediately upon the
absorption of a small quantity of alcohol. This
sensation, moreover, is common to the absorption of
all toxic substances in small doses, whatever the
nature of these substances whether they are poisons
of mineral, vegetable, or even microbic origin. One
often observes it, indeed, in the early stage of infec-
tious diseases, during the period of incubation. This
excitation gives the person who experiences it an im-
pression of strength and capacity for work, which is
precisely why the victim predestined to alcoholism
will resort to it whenever he feels a little lazy, and it
becomes necessary for him to exert himself. Such
occasions for resorting to the favourite stimulant are
not lacking in modern life. We may add that this
sensation of strength and capacity is wholly illusory,
for experiments have proved that the work produced
under these conditions is perceptibly inferior in quan-
tity and in quality to work done when the blood is cool.
And this sensation of power is only enjoyed at the
cost of the state of depression which presently follows
it, which is itself very often the cause of one or more
returns to the stimulant, in search of departing
courage.
To this quest of a pleasant stimulus we must add
" It may be added that for equal doses of alcohol and essences
the liqueurs are more dangerous in proportion as their powers of
seduction are greater, for those which most attract the consumer are
those which he can least resist, so that he takes more of them.
Here intervenes an individual psychological factor, which the obser-
vations of the alienists have clearly proved. We must realise, in
short, that the influence exercised by essences, as well as by alcohol,
on the neurones of the central nervous system is much more intense
and much more marked than their toxic power."
WHY ONE BECOMES AN ALCOHOLIC 143
imitation, a factor which is common to the majority
of human actions, and which acts here with special
force, because of the fact that the consumption of
alcohol usually takes place away from the home, in
public, and this function of imitation, by means of
which the drinker influences the sober man, women,
and even children, is perhaps one of the most potent
factors of the spread of alcoholism.
We may add that it is favoured greatly by the
scandalous multiplicity of drinking-bars, cabarets,
etc., of every kind, which the passer-by, whether
townsman or villager, find by the roadside..
Indeed the places where drink is sold are met with
in France to-day at every step ; cafes, brasseries,
restaurants, public-houses, bars, hotels, music-halls,
cinema-theatres, tobacconists, dairies and pastry
cooks', groceries, linen-drapers', coal and wood stores,
to which we must add the innumerable wine-mer-
chants' offices, and the cabarets a femmes or cafes
chantants, in which lubricity serves as a bait to the
drinker. In 1913 there were in France 482,704
establishments where alcoholic drinks were sold : or
i for every 82 inhabitants.
M. Tournan (in his Report, already cited) lays
stress upon the disastrous part played by the private
distillers or bouilleurs de cru. "The privilege which
the farmer enjoys of distilling, without declaration
or taxation, the products of his harvest, has led him,
little by little, in certain districts, to pour into the
still all his spoiled wines and ciders, the residuum
from the wine-press, the dregs from the vat, in short
all the products that cannot be directly consumed.
The distillation is often effected with rudimentary
apparatus, and without the least care. The brandy
144 SOCIAL DISEASES
thus obtained being as a rule of small value, the dis-
tiller has formed the habit of consuming it in large
quantities, and this habit has gradually spread to all
the members of the family. It goes without saying
that the retailers of the neighbourhood do not fail, as
opportunity serves, to make surreptitious purchases
of this peculiarly harmful liquor. The alcoholism
prevalent in the Norman countryside must be attri-
buted largely to the privilege enjoyed by the private
distiller."
While the working man has his wine-shop, the
farmer his still, and the townsman his cafe", where
flows a continuous stream of those innocent cocktails
and liqueurs, containing a high percentage of alcohol,
which are certainly responsible for more victims than
the long drinking-bouts of old, at the close of which
the drinkers rolled dead drunk under the table, the
more fashionable circles of " good society " intoxicate
themselves by drinking aromatic wines or old
brandies, and no good middle-class hostess gives a
dinner without offering her guests the traditional
glass of cognac at the end of the meal.
Lastly, among the important psychological factors
of alcoholism, above all among celibate workers, we
desire to lay stress upon the absence of a home in
which they might find rest and happiness after the
day's painful toil. " It has been said that the
cabaret, or the bar of the gin-palace, is the ' poor
man's parlour'; the comparatively luxurious, warm,
well-lit room in which he can take refuge in order to
avoid the murky, confined tenement or slum bedroom
in which the wife scolds and the children cry. He
goes to the cabaret to forget his miseries, his dis-
appointments, and to drown his cares. Alcohol is the
WHY ONE BECOMES AN ALCOHOLIC 145
Lethe of modern society ; rich and poor appeal to it
for a little consolation. In the most luxurious hotels,
in the humblest lodgings, in the disreputable wine-
shop there is, before all, the marvellous elixir which
gives to each, for a few minutes or a few hours, the
illusion of happiness. (Tournan.) "
This factor the absence of a home, of a family
can but assume a more aggravated form ; for it does
not affect only the bachelor or the unhappily married
worker. With the current of feminist ideas which is
impelling women more and more to seek work away
from the home, the home and the family will be
cherished less and less; and at the close of the day
husband and wife, each returning from the workshop
or the office, meeting in the cold, slovenly tenement
the resources of the couple being increased by the
wife's wages or salary will go to the cabaret to-
gether, there to seek rest and distraction.
The attractive centre of the home, the child, is on
the way to disappear here is yet another social
plague which we shall presently consider ; and the
child alone might have rivalled the cabaret. With
the sterile wife who will be the achievement of
feminism, the victory of alcohol threatens to be
complete.
CHAPTER IV
THE CAMPAIGN AGAINST ALCOHOL. WHAT HAS BEEN
DONE; WHAT NEEDS TO BE DONE; WHAT IS GOING TO
BE DONE
The example of water-drinkers ; the effect of Temper-
ance Leagues, conferences, and pictures ; anti-alcoholic
education in the school and the barracks ; the law re-
lating to drunkenness ; the prohibition of absinthe ; the
limitation of licences : this, at present, represents the
campaign against alcoholism. And it is not enough.
Popular education is disappointing, and the influence of
legislation is illusory. There is only one possible and
effectual means of combating alcoholism : namely, the
absolute prohibition of all alcoholic drinks other than
the so-called hygienic beverages. The United States
have applied this measure to more than half their terri-
tory. Why should it not be applied in France? There
are several explanations of the timidity displayed by the
authorities. The chief of these is that the State profits
by alcohol. The State could continue to profit by it by
allowing it to be used for lamps, stoves, motors, etc.
In place of the radical measure of prohibition, what
does the State propose? An increase of the duty upon
alcohol, and a monopoly of industrial alcohol. And
alcoholism will remain as prevalent as ever.
ALCOHOLISM being a voluntary intoxication, the cam-
paign against this intoxication must be directed
against the will, and all possible motives of action
imitation, f.ea.r, and lastly constraint should, on
146
CAMPAIGN AGAINST ALCOHOL 147
principle, and under various forms, lend their quota
of influence to the struggle.
If we consider the measures, private or public,
which have been adopted in order to combat the
increasing plague of alcoholism, we shall find that
they belong precisely to these three classes of
motives.
We must further recognize that the campaign in
question is particularly difficult, because of the
strictly private character of the evil to be fought.
Only one person is in question, namely, the person
who is soaking himself in alcohol ; and he is fully
persuaded that he cannot harm anyone but himself,
provided he will even go so far as to admit that the
evil is a real one. On the other hand, the drinker,
even if he could no longer obtain drink out of doors,
could still indulge his disastrous passion in the
privacy of his home.
The first efforts directed against alcoholism in
France were due to private persons, who carried on a
propaganda in favour of water-drinking. We know
that imitation is all-powerful as a motive of action,
and there is no doubt that the water-drinkers have
very fortunately increased. For one thing, the com-
plaints of the wine-sellers, who accuse the medical
profession of having spread this new fashion, are very
eloquent in this connection.
The only fault we have to find with propagandists
of this class though in principle we agree with them,
for we hold that wine is to some extent dangerous,
and that it is preferable to abstain from it when
abstention is expedient is that their demands are
exaggerated when compared with the effort which
H 8 SOCIAL DISEASES
they entail, and that for this reason they are not
likely to produce any effect beyond the limits of a
rather restricted circle.
The propagandists have also tried to exploit fear,
and have taken measures to make the dangers and
evil effects of alcohol widely known in every class of
society. Temperance leagues have been formed
(ligues anti-alco cliques), which, by means of lectures,
leaflets, and picture-posters, have preached the
crusade of health. In schools and barracks an anti-
alcoholic education has been organised.
In this connection certain physicians have certainly
rendered great services, distributing anti-alcoholic
instructions in the hospitals and dispensaries, and, in
conversation with their patients, endeavouring to
inspire them with a dread of the poison.
All these efforts are highly meritorious; but if we
are to confess the truth, they do not appear to have
yielded such results as one might have expected from
them. The drinker is sceptical and suspicious. He
does not wish to believe in the dangers of alcohol.
These dangers, moreover, are not speedily manifested
by visible and tangible symptoms, such as those of
syphilis ; they take a long time to mature, and to the
ordinary observer they remain somewhat problemati-
cal. All that the drinker is willing to see in all the
advice pressed upon him is that people want to
deprive him of his chief pleasure ; moreover, he is
always convinced that he does not commit such ex-
cesses as those of which he is shown the dangers. In
fact the mentality of the drinker is the mentality of a
child ; and this characteristic becomes more marked
as the action of the poison on his brain progresses.
We must not, however, despair of the activities of
CAMPAIGN AGAINST ALCOHOL 149
the leagues. In the United States and the Scandi-
navian countries the temperance societies have
exerted a very great influence. In Norway, in 1912,
there were 258,384 total abstainers, and in Sweden
500,000. In England there are 5,000,000 abstainers,
belonging to 392 temperance societies.
At one time the public authorities felt that they
themselves ought to do something to check alco-
holism, and on the 23rd January, 1873, an Act re-
lating to drunkenness was passed. The intention
was good, but the manner in which it was formulated
was illogical. For drunkenness is not alcoholism; it
might be completely abolished, yet alcoholism would
continue to ravage society. We may add that this
law has remained almost a dead letter, and that the
agents of the Government have almost everywhere
become accustomed to tolerating public displays of
drunkenness. This is perhaps regrettable as a
matter of public order, but it is of no great import-
ance as regards alcoholism. If we wish really to
influence drinkers we must begin by decreeing the
internment of all incorrigible drinkers in special
asylums, as has been done in Sweden, Norway,
Switzerland and the United States. But we have
halted at the first step on the right path, which we
ought to travel to the end.
Let us be just, and mention two fresh efforts of
recent date.
The first is represented by the Act of the 9th
November, 1915, which will prevent, or at least we
hope it will prevent, the further multiplication of re-
tailers of drink. This law prohibits the opening of
new establishments for the sale of spirituous liquors,
and permits of the removal of old establishments
150 SOCIAL DISEASES
within a radius of 150 metres only, provided they re-
open within a year of the date of their closing.
But the regulation of these establishments is still
rudimentary ; it does not prohibit the sale of liquor
at certain hours, nor to children, women, and soldiers,
nor the sale of liquor on credit ; nor does it forbid the
retailer to keep an accessory shop, or to introduce
attractions, or to employ, for the sale of liquor, women
other than those of his family.
The second recent effort, which we record with
satisfaction, is represented by the Act of the i6th
March, 1915, which -prohibited the manufacture and
sale of absinthe and similar liqueurs.
At first sight this law would seem to represent a
great advance. Unhappily the advance is only
apparent, for the expression " similar liqueurs " lacks
preciseness, and thanks to this lack of preciseness
the retailers continue to sell a number of drinks as
dangerous as absinthe, which will inherit the cus-
tomers for the latter drink. Alcoholism will have
suffered nothing by the change.
Further, the law should suppress the sale of con-
centrated essences and extracts which enable any-
one who pleases to prepare his absinthe for himself.
In short, all that has hitherto been done to combat
alcoholism is absolutely insufficient. Generation
upon generation must elapse before the results
obtained by the temperance leagues are appreciable,
if they are ever so; and as for the recent laws, they
are so much " eye-wash," for the benefit of the public.
They walk round the question instead of delivering
a frontal attack ; they seek to run with the hare and
hunt with the hounds that is, with the drinker and
CAMPAIGN AGAINST ALCOHOL 151
the wine-merchant ; and, above all, with the legislator
and the elector.
Since it is recognized that the fear of alcohol, incul-
cated by the education of the public, is unable to
obtain the desired result, we must, without hesitation,
employ constraint.
Radical reforms are always the best. They make
straight for the goal, and they attain it ; and they are
not less readily accepted than reforms of a timid and
ineffective kind.
It is admitted that alcoholic drinks are toxic. Very
well : let alcoholic drinks be suppressed, with the ex-
ception of those known as " hygienic drinks " that
is, wines, beers, and ciders.
Would it be impossible to apply such a measure ?
In the United States it had already been applied in
nine of the States, and in half the districts of 16 other
States. At the moment of writing absolute temper-
ance is imposed upon fifty million inhabitants of the
United States, occupying about 76 per cent, of the
territory of the Union. Recently the advocates of
temperance demanded of Congress a measure of abso-
lute prohibition, and they obtained 197 of the 256
necessary votes.
But, it will be said, such a measure would not be
accepted in France. Are the citizens of the great
American Republic less jealous of their liberties than
the citizens of the French Republic ? On the other
hand, we know of no population more docile than
that of France, and the administrative abuses which
it tolerates without a murmur often exceed all
measure.
At the beginning of the war the prohibition of the
sale of alcoholic drinks would have been accepted
ii
152 SOCIAL DISEASES
with enthusiasm, everyone being ready to make all
necessary sacrifices. But this psychological moment
was foolishly or criminally allowed to pass, and it
must be admitted that the matter would be more diffi-
cult to-day ; not that the people would oppose any
obstacle; but the poison-merchants have raised their
heads again ; the members of Parliament are bound
hand and foot by their most influential electors, and
it would be impossible to count on a Parliamentary
majority in favour of a radical measure.
On the 29th February a Deputy put before the
Chamber the following proposition : "In no place
where intoxicating liquor is sold shall any person be
allowed to sell, to be drunk on the premises or to be
taken away, otherwise than as an adjunct to food, any
spirituous liquors, liqueurs, or aperitifs, other than
those with a vinous basis or of a less strength than
23 degrees." This proposal received only 83 votes
among 530 voters. It was useless to insist.
Yet at the beginning of the war, on the 22nd
August, 1914, a ukaze prohibited the sale in Russia
of vodka and all other alcoholic drinks. It is true
that this prohibition, which was very well received,
was intended only for the duration of the war, but
the Tsar it was perhaps his only good action, but
it assuredly was not to be despised declared that he
had decided permanently to suppress the sale of
vodka by the State.
And what were the all but immediate results of the
total abolition of alcohol in Russia ? There was a
most notable improvement in the public health, and
an increase in the productiveness of labour ; the de-
posits in the savings banks rose from 1,673 millions
of roubles on the ist September, 1914, to 2,195
CAMPAIGN AGAINST ALCOHOL 153
millions on the ist September, 1915, and continued to
increase regularly by 100 millions per month ; fac-
tories were built for the industrial consumption of
alcohol, and nearly 44 millions of gallons were ex-
ported. (Report of the Russian Ministry of Finance.)
Of course the first act of the Revolution was to re-
establish the sale of alcohol, in which the miserable
"Reds" proceeded to soak themselves, which, better
than anything else, explains their delirium.
There is no longer any chance of obtaining the
prohibition of alcoholic liquors in France, and this
for two principal reasons. In the first place, the
great majority of politicians are subject to the orders
of their electors, and the wine-merchants have become
the most influential electors in France ; secondly, the
State itself profits by the sale of alcohol.
We will not enlarge upon the first point, since it
would involve us in considerations which have no
connection with medicine or hygiene. Our readers,
and the electors of France, can supplement our re-
marks by their own reflections.
But it is easily demonstrated that if the public
authorities refuse to deal with the drink problem in
a radical fashion in order to husband the resources of
the State they are making a grievous mistake.
There is one very simple means of rendering the
trade in alcohol more profitable, while prohibiting
its sale as a beverage. Let the State release it for
use in internal combustion engines, instead of allow-
ing human beings to drink it.
We know that alcohol may be utilised for lighting
purposes, for heating, in motor-cars, and above all
in the manufacture of chemical and pharmaceutical
products, alcohol being employed either as a raw
154 SOCIAL DISEASES
material or as a solvent in the preparation of a very
large number of these products.
Now the facilities of all sorts which the industries
of Germany enjoy for the employment of denatured
alcohol have contributed to the extraordinary develop-
ment of the German industrial companies whose
products used to invade both France and England.
The German manufactories of chemical products,
for example, contrived to sell their goods so cheaply
that they used to provide the French houses with
goods intended for French customers at a price below
the cost price of the products as produced by the
French manufacturers.
Lighting by means of alcohol is all but unknown
in France; but heating by means of this fuel might
easily become general. In 1913 more than 10,000,000
gallons of alcohol were burned in France in all sorts
of apparatus : chafing dishes, small stoves, heating
stoves, salamanders, soldering and blow-lamps, blow-
pipes, hot-irons, foot- warmers, etc., etc.
If alcohol were sold at the price of petroleum and
one could count on the stability of that price, it is
certain that the use of alcohol stoves, etc., would
rapidly become more extensive, and that they would
gradually replace petroleum stoves.
We know that the flame of alcohol, which does not
give any light to speak of, becomes a good illu-
minant when the alcohol is enriched by a hydro-
carbon, such as benzol, and that there are excellent
systems of intensive lighting in which this illuminant
is utilised.
In Germany alcohol as a public illuminant has been
found the most economical of all next to incandescent
gas.
CAMPAIGN AGAINST ALCOHOL 155
Alcohol may also be used as a domestic illuminant,
either enriched, or as a source of heat merely, the
light being emitted by incandescent mantles.
But before all else the motor-car would absorb
large quantities of denatured alcohol. It has been
proved that alcohol may with advantage replace petrol
in internal combustion motors. Its lower calorific
power is largely compensated by a higher dynamic
yield, and taking it all round the alcohol motor is
theoretically superior to the petrol motor.
At the present time it is estimated that the abate-
ment of the price of denatured alcohol would enable
automobile locomotion to absorb, within a short space
of time, some 15,000,000 gallons yearly.
In Germany, in 1913, 37,940,000 gallons of de-
natured alcohol were consumed, which corresponds
to a consumption of about half a gallon per head. In
France the average was only 3! pints.
It is therefore certain that the employment of
alcohol for domestic and industrial purposes could
be very greatly increased ; and it remains for the
public authorities to suppress the vast tangle of
administrative red-tape which prevents this develop-
ment.
It should be noted that the Germans have the same
motives as ourselves for developing the industrial
use of alcohol. These motives are those that under-
lie the war upon alcoholism and the war upon
petroleum and petrol, foreign products, which might
to great advantage be replaced by alcohol, a home
product. The utilisation of the potato is an important
problem in Germany, for its production is so
abundant that neither human consumption, nor
stock-raising, nor pig-keeping, nor the manufacture
i 5 6 SOCIAL DISEASES
of starch will suffice to absorb it. Germany was
therefore compelled to turn her attention to the em-
ployment of alcohol in industry, and we shall be
forced to do the same in France, if the increase of
duties, in default of a more radical measure, should
reduce its consumption as a beverage, and if we are
obliged to find each year an outlet for 13,000,000 to
15,000,000 gallons of alcohol, under penalty of ruin-
ing the beet-growing industry.
By selling at a loss denatured alcohol, the price of
which never exceeded 40 pfennigs per litre (about
2|d. per pint or 1/6 per gallon), at a strength of 90,
and by raising the price of potable alcohol, in such
a way as to make the latter bear the losses caused by
the alcohol intended for industrial purposes, and by
the increased cost of raw material due to bad harvests,
the German system has after all solved, in a fairly
practical if not radical fashion, the problem which
we are considering, namely, the reduction of the
quantity of potable alcohol consumed, and the in-
crease of the industrial consumption of denatured
alcohol, by lowering and fixing the price of the latter
product.
It is very probable that we shall adopt some such
system in France. The Commission for Fiscal Legis-
lation instructed to examine the scheme and the pro-
posed law relating to the control of alcohol has in-
deed adopted a system which it recommends as
mobilising the Treasury for the war upon alcoholism ;
a system to which it naturally attributes all the quali-
ties requisite for attaining the desired end.
This system involves raising the general con-
sumer's dutv to 500 francs per hectolitre (about 18/2
per gallon) of pure alcohol, while abolishing the octroi
CAMPAIGN AGAINST ALCOHOL 157
duty, or to 400 francs without touching the octroi,
which in Paris amounts to 165 francs.
It also includes a Government monopoly of indus-
trial alcohol, intended to assure an outlet for the
whole output, and to safeguard the agricultural
interests threatened by the certain ( ?) decrease in the
consumption of potable alcohol.
The monopoly, it must be admitted, would not be
without advantage from a hygienic point of view;
for while, if absolutely necessary, the purity of
alcohol could be guaranteed by the permanent in-
spection of the distilleries, it would incontestably be
easier to divert industrial spirit from employment as
an intoxicant if it were wholly in the hands of a
State department.
The suppression of the scandalous privilege of the
private distiller, or bouilleur de cru, would be the
necessary corollary of the system adopted. No doubt
the State monopoly would not be extended to natural
brandies, but the regulations affecting them ought to
undergo profound modifications.
In the first place, the increase of duty would not
make it permissible to maintain the privileges which
the private distillers enjoy. Not only has their privi-
leged position made for the drunkenness of the rural
population, but it also causes the Treasury a loss
which may be estimated at some ^28,000,000 annu-
ally, a loss in part due to fraudulent evasion of the
customs. Now this fraud is all the more alluring
as the rate of dutv is higher; so that the distillers'
privilege could not co-exist with a duty as high as
400 francs per hectolitre, or 14/6 per gallon almost
double the present duty. The most obvious result of
such an increase of duty, if it was not accompanied
i 5 8 SOCIAL DISEASES
by the suppression of the privilege, would be an in-
crease in the number of persons enjoying the said
privilege. It has already been ascertained that the
progressive increases of the duty have resulted not
only in a larger number of private distillers in the
districts where this privilege is of long standing, but
also in their appearance in departments where the
practice of distillation was formerly unknown. The
C6tes-du-Nord and Morbihan, where the practice of
distilling is of recent introduction, already contain
9,500 and 11,000 bouilleurs de cru respectively!
The new scheme, whose essential elements are the
State monopoly of industrial alcohol and the sup-
pression of the privilege of the bouilleurs de cru, in-
cludes also a certain number of accessory regulations,
whose value, from the hygienic point of view, appears
worth consideration, at least at first sight.
In the first place, with regard to the manufacture
of essences, the Government has been inspired by
the advice given by the Academy of Medicine and
the Conseil SupeVieur d' Hygiene, and proposes the
prohibition of certain essences employed in the fabri-
cation of liqueurs and aromatic wines (thuyone,
benzoic aldehyde, aldehyde and salicylic ether), to-
gether with the limitation of the total content of the
essences whose use is authorised to o gr. 50 per litre
of the product.
It may be noted here that at the present time cer-
tain brands of cura9oa contain as much as 2 gr. 25
of essences per litre, while in kiimmels the amount of
essence per litre may amount to 2 gr. 10, in bitters
i gr. 50, in menthe i gr. 30, in anisette i gramme,
and in green chartreuse o gr. 75.
The Commission, less courageous than the
CAMPAIGN AGAINST ALCOHOL 159
Government without any very apparent reason pro-
poses to allow as much as 400 milligrammes to 2
grammes of essences the latter strength being con-
fined to liqueurs containing only essences of orange
or carraway or cumin, on the pretext that these
essences have never given rise to abuses, or at least
do not appear to have been condemned by the
hygienic experts. (See M. Tournan's Report,
already cited, p. 204.) Moreover, " these liqueurs
are, we are told, the object of an important export
trade, and great care must be taken not to place
obstacles in its way." This last phrase strips us of
our last illusion, for we had hoped for a moment that
the principal object of the proposed reform was to
combat alcoholism !
This reform, which is a half-and-half sort of affair,
appears to be chiefly a fiscal measure, its hygienic
proposals being merely so much camouflage.
We do not hesitate to stigmatise it as timid and
inexpert, for it is based on considerations relating to
the development of the use of industrial alcohol,
which seemed to promise such profits together with
the monopoly that the prohibition of liqueurs might
be considered without any risk of impoverishing the
Treasury.
The Parliamentary advocate of this proposal, esti-
mating the hygienic results of raising the duty,
considers that the increased duty would have the re-
sult of decreasing the consumption of potable alcohol,
\vhich would fall from 36,850,000 gallons to some
22,000,000 gallons. But this is bv no means proved,
for of late years wages have risen to such an extent
and had risen even before the war that the amount
160 SOCIAL DISEASES
consumed will probably be maintained at the old
figure.
It is true that the same writer states that in Eng-
land, during the last forty years, each increase of the
tariff has resulted in a diminution of the quantities
paying duty, so that in spite of the increase in the
tariff the yield of the tax has remained almost constant.
The last reform, which in 1890 increased the duty at
one stroke from 18/10 to 25/10, is reported to have
caused the consumption to fall from 22,369,490
gallons to 14,979,410 gallons.
This is true; but since then the consumption has
risen. By 1912 three years after the increase of
duty it amounted to more than 17,600,000 gallons.
Further, if we ask what has happened in France,
where the duty has been raised on several occasions,
notably in 1871 and 1901, we do not find any per-
sistent decrease of consumption as a result of this
measure. In 1871 the consumption amounted to 4*95
pints per head; the duty was increased to 150 francs
per hectolitre (5/6^ per gallon), and by 1875 the con-
sumption had returned to 4*96 pints per gallon. In
1901 the consumption was 6'2 pints per head; the
duty was increased to 220 francs per hectolitre (8/-
per gallon), and by 1903 the consumption had in-
creased to 6*23 pints per head.
There is no doubt that every increase of duty
causes a momentary disturbance of equilibrium in
the matter of private expenditure, and this disturb-
ance is manifested, for a few months, by a restricted
consumption.
But matters quickly adapt themselves. If alcohol
is dearer, this means, to the artisan, that living is
dearer. Strikes intervene ; wages are increased ; and
CAMPAIGN AGAINST ALCOHOL 161
the increase of wages, without in any wav improving
the position of the worker, goes to enrich the State
and the wine and spirit merchant, who always in-
creases the price of his wares by a sum larger than
that of the super-tax. It is the same old story : and
the same thing will in all probability happen over
again with the reform now promised as a panacea.
After a few years, perhaps after a few months, it
will be found that the consumption of alcohol has
resumed its upward tendency ; and the Treasury,
which will need money worse than ever, will con-
gratulate itself, while the hygienists, as always, will
lament ; and the same discussions will recur, until
once again the duty is increased.
And alcoholism will continue its ravages. 1
The drinkers of alcohol will not fail to be grateful
to their mandatories for their benevolent foresight.
1 Since these lines were written the question of the control of
alcohol (le Re'gime de 1'Alcool) has been under discussion in the
Chamber of Deputies ; and legislation has been introduced which
would establish a control still inferior to the modest provisions which
we have suggested.
This law ratifies, it is true, the monopoly of alcohol. The State
will have the monopoly of purchasing all industrial alcohols ; that is,
alcohols which do not proceed from the distillation of wines, ciders,
perries, residual waste, lees, and fruits ; and we are promised that
it will concern itself with extending the industrial uses of alcohol.
The speakers who took part in the debates on this law were for
the most part extremely emphatic as to the mischief done by alcohol ;
but when it was a matter of deciding whether industrial alcohol
should or should not be permitted as a beverage, out of 485 voters
only 43 voted for the negative motion (14 March, 1918) !
It is true that the Chamber decided that the price of this alcohol,
when sold for internal consumption, should not fall below ifr. 50
per litre of pure alcohol about 8jd. per pint !
The arguments invoked in favour of retaining industrial alcohol
for internal consumption deserve to be put on record. The speakers
feared lest the consumers should go short of their favourite poison.
France produces only some 1,210,000 gallons of natural alcohol, and
the consumption of alcohol after the war was estimated at 22,000,000
gallons. There would thus be a deficit of 50 per cent., which would
obviously be very annoying for the consumers of alcohol,
162 SOCIAL DISEASES
As for the privilege of the bouilleurs de cru, there
was no discussion of the matter. Their position,
however, will be more advantageous than ever.
On the whole, then, nothing will be altered. This,
alas ! is just what we foresaw.
BOOK IV
STERILITY
BOOK IV
STERILITY
CHAPTER I
THE DEPOPULATION OF FRANCE
France is the only country which has hitherto been
afflicted by the malady of depopulation. The evil in-
creases year by year. The cause is not an excessive
mortality, but an insufficient natality. For a hundred
years the birth rate has been steadily falling- ; it is now
lower than the death rate, which is itself as low as can
be expected. Although unequally distributed in the
various provinces, the evil is none the less general.
Barely a score of departments can at present boast that
their population is slowly increasing. The war has still
further aggravated the evil, and in a very great degree.
FRANCE is becoming depopulated.
The depopulation of our country is indeed a
malady, and one of the deadliest of maladies more
serious than those which we have been considering
for it threatens the very existence of France, and the
danger is immediate.
Tuberculosis, syphilis, and alcoholism these are
chronic social maladies, to which a nation cannot
succumb until it has been a long time sick, when it
may sink under the weight of accumulated de-
generacy.
165
i66 SOCIAL DISEASES
Depopulation is an acute disease, for it is enough
to prolong the graphic curve of the evil for a very
few years to discover a point, which will be nearer
as the curve is steeper, at which the nation will have
lost its rank in the world. As a nation it will actually
be extinct.
The evil is great enough in the case of a country
whose population is stationary, for not to advance, in
the midst of peoples who are advancing and this is
the case with all the peoples that surround us is in
truth to fall back.
Depopulation is at present a malady peculiar to
France. 1 No doubt the growth of the population
has, during the last half century, suffered a certain
abatement in almost all European countries; but this
abatement cannot in any way be compared with that
which characterises the French population.
During the last century the normal increase of the
French people has steadily fallen off : and during the
last twenty years we have witnessed a symptom whose
serious nature we cannot disregard : the number of
births has been so far reduced that it has barely made
up for the number df deaths.
To-day the fatal boundary-line has been crossed.
We are no longer standing still even ; we are abso-
lutely falling back.
" In 1700," according to M. Bertillon, "the only
countries which wielded a considerable political influ-
1 It has been credibly reported that the death-rate has exceeded
the birth-rate in Germany and Austria during the latter period of
the war : though as yet we have no very reliable figures. This, how-
ever, if true, is due chiefly to malnutrition, and when some system
of exchange is once more at work in Europe it is probable that the
population of the Teutonic Stat" c will recover its old rate of increase ;
though the infantile mortality mzy remain slightly above the normal
for a generation or two.
THE DEPOPULATION OF FRANCE 167
ence formed a total of fifty millions of inhabitants, of
whom forty per cent, were French. France pos-
sessed the largest population of any European
monarchy, and was therefore the most powerful from
the economic and military point of view.
" By the close of the i8th century the situation was
less favourable. The German population had in-
creased more than that of France ; moreover, Russia
had become a considerable power. In the total popu-
lation of the Great Powers then 96 millions France
could now boast of only 28 millions of inhabitants,
or 27 per cent.
" Since that time the foreign nations have greatly
increased. Moreover, Italy has been created. In
Europe to-day France accounts for only 12 per cent,
of the populations of the Great Powers. But this
calculation is no longer accurate. The United States
are bearing an ever-increasing part in the trade of
Europe, and they have just given proof that they
intend to bear their part in international politics.
" In the total thereby increased France counts only
for 10 per cent."
These remarks, which, one would suppose, referred
to the present day, were made by M. Bertillon in 1899.
From that date the evil steadily increased until 1914,
when the war resulted in an acute aggravation of the
trouble.
What are the causes of this serious depopulation ?
Is there more disease in France than in other
countries? By no means. The death-rate in France
is not high ; it is even lower than in other countries
of the same latitude.
Of every 1,000 inhabitants, 32 die annually in
Spain, 27 in Italy, and only 22 in France.
12
168 SOCIAL DISEASES
Among the most favoured countries are Belgium,
with 20 deaths per 1,000; Holland, with 21 ; England,
with 19; Ireland, with 18; Scotland, with 18; Den-
mark, with 19; and the Scandinavian peninsula
with 17.
It will be seen that the difference is not great and
it certainly is not sufficient to explain the malady
from which we are suffering.
The cause of this malady is indeed quite other than
an excessive mortality. It is simply an insufficient
birth-rate.
For a hundred years the birth-rate of France has
been steadily falling, and to-day she is of all countries
that in which it is lowest. France is also the only
country that is steadily undergoing depopulation.
From 1806 to 1810 there were in France 33 births
per 1,000 inhabitants. For the period 1851-1860
there were only 26, and in 1900 only 21. Thus, in a
century, the birth-rate had fallen by precisely one-
third, constantly approximating to the death-rate, and
at last, at the beginning of the 2Oth century, meeting
it and falling below it.
The evil, moreover, is prevalent throughout the
country. Although all the departments do not suffer
from it equally, they are all affected by it.
In 1886 the population was decreasing in 29
departments only ; in 58 it was still increasing. Ten
years later, in 1896, it was decreasing in 63 depart-
ments, and in only 23 was it increasing.
Pas-de-Calais, Finistere, Vendee, Haute-Vienne,
Morbihan, Le Nord, Les Landes, Lozere, and
Correze are now almost the only departments in
which, during the last few years before the war, the
birth-rate was still ahead of the death-rate.
THE DEPOPULATION OF FRANCE 169
On the other hand, Orne, Lot-et-Garonne, Gers,
Tarn-et-Garonne, Aube, Eure, Yonne, and Sarthe
are peculiarly afflicted by this evil, and the births
represent only 20 to 60 per cent, of the deaths.
In 1825 the annual excess of births over deaths in
France was 67 per 1,000 inhabitants; in 1850 it
had fallen to 5 - o, by 1885 to 2-5, and by 1900 to 1-3
per 1,000.
During the same period the same surplus increased
in Germany from 8*0 to 147 ; in Austria from 7*4 to
n*5; in Holland from 10-5 to 15*0; and in Italy from
6' i to iro per 1,000.
In England, where for some years a slight decrease
of natality has been manifest, the surplus birth-rate
still stood at ir6 per 1,000 in 1910, as in Sweden and
Norway.
We should note that the other nations, while far
from being afflicted with the evil of depopulation,
display, nevertheless, an abatement of the splendid
increase of their natality.
Thus, in America the statistics show that the
number of children born in the families of men who
have attended centres of higher education has de-
creased from 56 per 1,000 in 1800-1810 to 20 per 1,000
in 1870-88. It is probable that this remarkable
decrease is not peculiar to the well-to-do classes, but
that it extends to the whole population.
However this may be, the misfortune of one class
cannot cure the misfortune of others.
In France the war, which, as we have seen, has
aggravated all the social maladies, has certainly
affected the depopulation of the country.
The latest statistics relating to the movement of the
population in France, published in 1915, refer to the
1 70 SOCIAL DISEASES
first six months of 1914. We see by these that the
number of deaths, during this period, was 357,256,
and the number of births 331,398. Thus, during the
first six months of 1914 France had already lost more
than 25,000 inhabitants !
Dr. Thuillier (in the Revue de Medicine et de
Chirurgie] endeavours to show how we may estimate
the demographic disasters of the war. He reckons
the monthly average of deaths during hostilities at
75,000, and that of births at 30,000 ; the difference
between these two figures giving a deficit of 45,000
per month, or 540,000 per annum : that is, more than
half a million.
And here are some reliable figures which show
that these dismal prophecies are by no means exag-
gerated : In Paris, in March, 1916, from the ninth
to the thirteenth week of the year, the excess of deaths
over births attained the unheard-of figure of 2,245
(4,546 deaths and 2,301 births). If we take the
quarter from July to October (from the 27th to the
39th week) there seems to be an improvement : the
excess of deaths over births is only 1,040 (7,544
deaths and 6,504 births) ; but if there are fewer deaths
per month there are also fewer births, since these
amounted to no more than 2,168 per month. Now
what was the situation when times were normal?
During the quarter July to October, 1913, there were
in Paris 8,566 deaths and 10,837 births, or 3,612
births per month.
In 1916 the deficit of births appears to have been
17,000 for the capital alone.
In 1918 the monthly average of mortality in Paris
was, in January, 1,000; the average of natality did
THE DEPOPULATION OF FRANCE 171
not exceed 600. For February the corresponding
figures were roughly 800 and 600.
There is no need to-day, we imagine, to insist on
the disastrous consequences of this evil, which has
so grievously afflicted France. 1
Not only does the French population, since it fails
to increase, lack the necessary force of penetration to
expand outwards and utilise its splendid colonial
domain; but we have seen, alas! with what difficulty
it has been able to defend its own territory.
Of course and this is a situation of which we all
of us, to-day, understand the full danger the number
of foreigners settled in France has of late years under-
gone a rapid increase. From 392,814 in 1851 it had
increased to 1,300,915 in 1891.
No European country nourishes such a number of
foreigners. And nearly all these foreigners, as M.
1 Even if the natality were to cease to decrease from now onwards,
the absolute number of births would not remain stationary, as is
often supposed ; owing to the inevitable reduction in the number of
marriages it would still continue to diminish.
Here are the figures given by the " National Alliance for the
Increase of the French Population " :
" The average age of marriage in France being 27 years, the
622,000 young people married in 1912 were born in the neighbourhood
of the year 1885, during which year 924,000 births were registered.
So 924,000 births were required to give rise to 311,000 marriages,
the proportion being almost exactly 3 to i.
" Now in 1912 there were only 650,000 births ; so in 27 years time,
in 1930, we shall have only some 250,000 marriages.
" If the fertility of the young parents has not altered, there will
be born, in that year, only 600,000 children ; these, when they are
grown up, will give rise to only 200,000 marriages, and so on. In
80 years the number of marriages and of births will have diminished
by one half. And France will be lost !
" If we reflect that the French natality has diminished by more
than 100,000 in 10 years, although the number of our marriages
during this period has remained almost stationary, we shall perceive
what a terrific falling-off there may be to-morrow, under the com-
bined action of a decreasing fertility and a smaller number of mar-
riages. The number of our births may well decrease to half its
present figure in the course of 30 or 40 years !
172 SOCIAL DISEASES
Bertillon remarks, come to settle in France not to
spend money, but to gain it. According to the
census of 1891, there were only 65,664 who belonged
to families living exclusively on their unearned
incomes.
" The condition which we are approaching,"
wrote M. Bertillon in 1899, "is that of the factory,
near Nancy, of which M. Debury speaks. The
owner is a German, captain in the landwehr; the
manager is a German, also a captain ; all the workers
are Germans and German soldiers. When the
landwehr is called up the factory is closed. French-
men are permitted only to pay the police who guard
it, and, if it suffers any damage, to pay compensa-
tion ! "
There was a time when people rejoiced over the
large number of foreigners naturalised in France.
We know to-day the worth of these naturalisations,
and by what good Frenchmen our population found
itself enriched. The Germans naturalised in France
remained Germans, and we know what part they
played in the Great War.
CHAPTER II
THE CAUSES OF THE FALLING BIRTH-RATE
Depopulation is the result, not of natural sterility,
which is not more common in France than in other
countries, but of voluntary sterility, or rather the volun-
tary restriction of the birth-rate. In France it is the
case with nearly eight married couples out of ten that
they do not wish for more than one, two, or three
children, although they might have twice or thrice as
many if they wished. The great number of abortions,
which equals the number of births in our large towns,
confirms the voluntary character of this low natality.
What are the causes of this peculiar mentality of the
French household? M. Bertillon attributes it to the
father's ambitions for his son. Like foresight, economy
and the love of luxury and pleasure may also play an
important part. The most obvious influence is that of
the modern feminist ideas, which take the woman out
of the home and lead her to compete .with man in all
departments of his activity. Woman, wishing to as-
similate herself to man, has realised that she will succeed
in so doing in proportion as she suppresses maternity,
which, for the adepts of feminism, has become a blemish.
WE have seen that the depopulation of France cannot
be attributed to an excessive mortality, and that it is
only the result of an insufficient natality.
We must now inquire as to what may be the causes
of this low natality. It has been steadily diminish-
ing for something like a hundred years, but more
especially during the last twenty-five years.
And to begin with we must inquire whether the
173
174 SOCIAL DISEASES
low birth-rate of the French people is due to the fre-
quency of sterility, for if so we might attribute it to
pathological causes, or a special degeneration, whose
nature we should have to investigate.
Now the proportion of sterile households is much
the same in all countries; it varies from 16 per cent,
in France, as in Germany. And this fact might be
foreseen, since all civilised countries suffer as France
does from the evils that might affect their fertility.
Absolute sterility, such as might be attributed to
a tainted heredity, to individual degeneration, cannot
therefore be held responsible.
If the population of France is diminishing it is not
because there are too many households which have
no children ; it is because there are a great many
which have not enough children.
In round figures, in nine millions of French house-
holds there are five millions more than half which
have only one or two children. If we add to this
group the households with three children and this
number of children is still insufficient to ensure a
satisfactory growth of the population we find that
we can point to only 2,300,000 households of normal
and sufficient fecundity as against 6,700,000 of
restrained and insufficient fecundity.
This is the true cause of the depopulation of France.
Not sterility, but insufficient fecundity. Now if
married couples are able to produce one, two, or three
children it is plainly evident that they are fertile
couples, and that they might as well, if they would,
have four, five, or six or more children.
We are therefore, as all the evidence goes to show,
confronted by a comparative sterility, or more exactly
a voluntary sub-natality.
CAUSES OF FALLING BIRTH-RATE 175
And this fact of the voluntary restriction of the
fecundity of the household is of capital importance,
for this fact, being duly established, will be the pivot
of all the measures which we shall pass in review
when we come to examine the remedies proposed in
respect of depopulation.
Let us then remember these figures that there are
in France nearly eight households in every ten which
refuse to produce more than one, two, or three
children.
Another fact which still further confirms this doc-
trine of a voluntary sub-natality is the steadily in-
creasing number increasing as the number of births
decreases of abortions. According to the best
gynecological authorities, the number of abortions is,
in the larger cities, practically equal to the number
of births.
We are of course speaking here of abortions de-
liberately provoked, of actions which are voluntary,
as is the restriction of the rate of conception. We
are speaking of crimes, which are most commonly
committed to repair errors, oversights, or omissions,
which happen to endanger the private decisions that
have been formed relating to the size of the family.
For it must not be thought that abortions are
destined chiefly to hide moral faults or to save deli-
cate and compromising situations. Very often to-
day these abortions are procured by married women,
legitimately pregnant, in order to keep to the rate of
natality agreed upon for the household. 1
1 M. Mesureur has furnished some suggestive figures for the year
1913 the latest which are reliable relating to this " massacre of
the innocents." These figures were obtained in the Paris hospitals.
176 SOCIAL DISEASES
Having reached this stage of our inquiry into
causes, we are now led to seek for the motives which
can have determined so many households to restrict
the number of their children. At first sight this in-
quiry seems to present peculiar difficulties, since it
must entrench upon a region in which ideas, opinions,
feelings, instincts, and influences, conscious and un-
conscious, mingle and conflict with one another,
reinforce and neutralise one another, forming, as a
whole, a fabric of extreme complexity, which it is
extremely difficult to unravel.
Nevertheless, let us see what we can do.
M. Bertillon attributes the decrease in the birth-rate
to the father's ambition for his son. If we examine
the distribution of the birth-rate among the different
French departments, we shall at once perceive that
the richer the department the lower the birth-rate.
Normandy, the valley of the Garonne, and Bur-
gundy, countries of inexhaustible wealth, are the least
humanly fertile regions of France. On the other
hand, Brittany, Lozere, and Aveyron, which are very
poor countries, are among the regions where the
birth-rate has suffered least. It is the same in Le
Nord and Pas-de-Calais, which are departments
largely industrial, where poverty is very prevalent.
These facts might be interpreted thus : In regions
where people think of their wealth (that is, where
there is wealth to think about), there are few children
About 5,000 women were admitted for miscarriage or abortion, either
before or after the expulsion of the products of conception. During
the same period there were 17,000 accouchements. These 17,000
accouchements represented an expenditure of ,68,000 ; the 5,000
abortions cost .20,000 ; yet for one interrupted gestation there were
3 births. The expenditure in the case of abortions or miscarriages
is therefore in proportion considerably greater than for normal
accouchements.
CAUSES OF FALLING BIRTH-RATE 177
born ; in regions where people do not think of their
wealth (because they have none) there are plenty of
children. 1
M. Chervin, moreover, has shown that in the rich
and sterile department of Lot-et-Garonne (rich in
harvests, sterile as to men) the richest communes are
those where the births are fewest, while the poorer
communes display a less wretched birth-rate. Thus,
in the rich districts, the richest inhabitants are the
least fruitful. Similarly, in the poor districts, as
M. Arsene Dumont has shown, it is the poorest
inhabitants who are the most fruitful.
In Paris itself M. Bertillon has observed similar
results. If we rank the twenty arrondissements
according to the class of population which inhabits
them, we find that their birth-rate diminishes
uniformly with the average wealth of the arrondisse-
ments.
Thus the very poor arrondissements produce 108
children for every 1,000 women between 15 and 50
years of age : the well-to-do arrondissements produce
only 72, and the wealthy no more than 53. The
richest arrondissement of all, the Vlllth, produces
34 only, or one third of the number of children born
in the very poor arrondissements.
The sole cause of these variations, says M.
1 There is another possible interpretation of this fact. When
families are large inheritances are divided ; the children start life
without capital or property. Where they are small the children have
a good start in life. It is to make this possible that families are
restricted. The process works both ways. At the same time, there
is no doubt that the ability to make money and the ability to exer-
cise restraint go together. As far as prudence and forethought for
the children are responsible for depopulation, the situation can only
be bettered by social and economic changes perhaps of a revolu-
tionary character which will enable every industrious man to enjoy
reasonable wealth. B.M.
178 SOCIAL DISEASES
Bertillon, is anxiety about money. People reflect
that if they have children they must have money with
which to educate them ; above all, the family fortune
must be shared, in order to start the sons in life and
provide dowries for the daughters. And when the
children inherit it must be shared again ; x and this
would be intolerable. Conclusion : they take care
not to have any children.
The man who encumbers himself with a numerous
family not only undertakes a very heavy burden ; he
also inflicts a burden upon his children. Wishing
to avoid this evil, he dreads the second child more
than the first.
In support of his thesis M. Bertillon cites the fol-
lowing observations of M. Lancry's : Fort-Mardick,
near Dunkirk, is a commune constituted by Louis
XIV. on the following principles, which are still in
force to-day : Every newly-married couple, when one
of the pair is a native of the commune, and if the
husband is a naval inscript, receives in usufruct (only
in usufruct, that is the essential point) 22 ares (rather
more than half an acre) of land, and a pitch upon the
beach for net-fishing. The commune received from
Louis XIV. a total of 125 hectares of land (308 acres).
What is not distributed in usufruct is let at ^200 for
the benefit of the commune. The married couples
who are granted land can cede their allotments only
to their children. In no case can the allotment be
divided. It is therefore safe from creditors. It is
inalienable, indivisible, and inextensible. The result
is a fairly prosperous population who are yet com-
1 The law of primogeniture does not obtain in France. Every
daughter who hopes to marry must be provided with a dot, and the
sons are favoured equally. B.M.
CAUSES OF FALLING BIRTH-RATE 179
pletely free from any anxieties as to inheritance.
They live, in a sense, outside the civil code. The
result is that marriages are frequent, and as early as
the naval service will permit; illegitimate births are
exceedingly rare (i in 90). On the other hand, the
legitimate birth-rate is extremely high ; it amounts to
43 per 1,000, which is surpassed, in Europe, only by
Russia. But and this is not the case in Russia
of these 43 children, born living, 33 attain the age of
20 years. From 204 inhabitants in 1729 the popula-
tion of Fort-Mardick had increased, by 1896, to 1,672
inhabitants.
M. A. Dumont has described a similar phenomenon
in a very different region of France. At Fouesnaut,
in Finistere, every man who returns from military
service proposes to a landowner to grant him, for a
long term, a lot of uncultivated land. He reclaims it
and settles on it, marries, and has many children ;
for he has no reason to be anxious in respect of his
offspring.
Thus it seems that even in France, as soon as
people cease to be anxious to preserve their fortunes
(that is, not to break them up), the birth-rate is greatly
increased.
M. Bertillon remarks that French Canada offers an
incomparable field of experiment. The province of
Quebec is inhabited by a population principally
French, animated with the true French spirit of indus-
try and economy. But the law permits full liberty
of testament, and the notaries of the country declare
that the fathers of families make general use of this
liberty. They leave nothing to their daughters (hold-
ing that it is for the son-in-law to provide for the
needs of the family) and nothing to those of their
i8o SOCIAL DISEASES
sons who have received a liberal education, and have
become doctors, lawyers, priests, etc. (holding that
the education which they have received constitutes a
sufficient patrimony) ; and among their other sons
they choose that one who appears best fitted to con-
tinue their labours, agricultural or commercial ; and
it is to him that they leave their property and the suc-
cession to their affairs. The result of this state of
things is that among the French population of the
province of Quebec the birth-rate amounts to 48 per
1,000, which is more than double the French rate, and
which even exceeds anything to be found in Europe.
This high birth-rate is evidently due to the fact that
the French Canadians do not perceive, as do the
European French, a relation between the number of
their children and the preservation of their fortune.
France, for that matter, is not the only country in
which the law prescribes the equal division of
property ; but it should be remarked that of the
countries in which the same law exists several,
notably Switzerland and Belgium, are suffering from
a diminishing birth-rate. France being more than
any other country a land of small peasant-owners, it
will be understood why it is more than any other a
provident and economical country.
Such is the theory of M. Bertillon ; and we cannot
deny that his arguments are impressive.
We think it can hardly be denied that the
providence of the parents plays a very large part in
the restriction of the birth-rate : but it is equally
difficult to admit that this providence can be the only
cause of the sub-natality of France.
To begin with, the restriction of the birth-rate very
largely overflows the regions where this providence
CAUSES OF FALLING BIRTH-RATE 181
should be operative. On the one hand, we see it in
wealthy circles, where the motive invoked is hardly
admissible ; and at the other end of the scale it is
becoming seriously prevalent in poor circles where
economy and providence have scarcely any material
on which to exercise themselves.
We are well aware that in these latter circles an
immediate thriftiness, in default of providence, might
be operative, and that the increasing cost of living
might cause people to dread the advent of more
mouths to feed. But it would seem that this motive,
under a slightly different form, is operative princi-
pallv in the strictly well-to-do classes, where the
resources of the household are just sufficient to enable
it to maintain a certain level of appearances always,
of course, superior to what it normally ought to be
and in which the arrival of another child, the
second or third, would force the couple to reduce their
sumptuary expenditure.
The necessity of exchanging a smart-looking flat
for larger but rather less fashionable-looking premises
inspires many a middle-class family with the greatest
terror. The wife, in this altered mode of existence,
sees a downfall to which she cannot resign herself;
and it is she, it appears, who in the majority of cases
opposes the arrival of the additional member of the
family who would bring about this unendurable
downfall.
We believe that the wife is, indeed, most often the
member of the family responsible for the restriction
of the birth-rate.
M. Bertillon has indicted the ambition of the father
for his child. The mother must be condemned for
reasons which are perhaps much less creditable.
182 SOCIAL DISEASES
The love of luxury and pleasure, hardly compatible
with a numerous family in a position of average pros-
perity, and a very moderate liking for the cares and
fatigues of maternity, before and after the birth of
the children these are some of the reasons which
render the latter undesirable.
And here we are naturally led to consider a ques-
tion which has always been neglected by the demo-
graphists and psychologists who have inquired into
the causes of depopulation ; namely, the influence of
modern feminism on the birth-rate.
This word feminism, by which we mean the current
of modern ideas which is impelling women to enter
into competition with men in every department of
external activity, is a word very badly chosen. In
reality we ought to speak of hominism, since the
tendency of the movement is to turn woman into a
being who is as little as possible distinguishable from
man.
As a result of a conception of the purpose of woman
differing entirely from that of the Orientals, who con-
sider that her function is solely to produce children,
the evolution of the Western civilisations, which long
ago created the "lady " a creation for which it does
not perhaps deserve unlimited congratulation is
now in travail with a new order of being, which, in
spite of morphological differences corresponding to
profound physiological differences, is tending socially
to resemble man in all particulars.
To begin with, the same legal rights were claimed
for the woman as for the man ; and we hasten to
recognize that this was no more than elementary jus-
tice. But presently, in the shadow of these legitimate
claims, a doctrine was developed which was presently
CAUSES OF FALLING BIRTH-RATE 183
transformed into an active campaign, the underlying
idea of which was that woman should compete with
man in all the spheres hitherto reserved for masculine
activity, and that this new state of affairs would hap-
pily result in the disappearance of feminine purity,
and of prostitution, which is its inevitable result.
It was the Golden Age (for woman) whose advent
was announced. Philanthropists, who certainly
meant well, but were perhaps short-sighted, incited
women to make an assault upon all the masculine
professions ; from the universities and the laboratories
to the factories and workshops, all doors were quickly
thrown open to them.
We are speaking, of course, of the situation before
the war. Since then, by the force of circumstances,
the situation has been enormously aggravated, and
the new situation which has resulted will prove to be
not the least difficult of our after- war problems.
However this may be, the feminists consider, with
some justification, that they have won a great victory.
Generally speaking, as a matter of fact, in the new
spheres open to her activities, woman has done well.
Despite the undoubted difference between the quality
of her intelligence and that of the masculine intelli-
gence, she has developed abilities which have enabled
her to enter upon the branches of learning, the pro-
fessions and the trades hitherto reserved for mascu-
line activity. Served by a good memory, great appli-
cation, and a violent desire to succeed, woman has
often proved herself to be a very apt scholar, a very
good employee, and a very good worker. She was
quickly proclaimed the equal of man ; and some, no
doubt out of chivalry, exaggerating in the manner to
13
1 84 SOCIAL DISEASES
which the journalistic style has accustomed us, have
declared that she is man's superior.
We will not be discourteous. Let us accept the
verdict. After all, that is not the point at issue.
The result of these successful experiments was that
women, having tasted a novel activity which offered
them unhoped-for resources which emancipated
them, on the whole, from masculine control, affording
them glimpses of a new morality, a yoke less heavy
than that of our current conjugal morality have
acquired a taste for the game, and, if we may so
express ourselves, have promptly shaken down into
their new role.
But they cannot wholly become men. There is
still one serious obstacle, which has sometimes
brutally reminded them of their natural function :
maternity.
To lose one's figure, to suckle children, to tend
them and rear them : these are highly troublesome
tasks, which are hardly compatible with laboratory
research or the exigencies of a business connection,
or assiduous attendance in the office or workshop ; and
it seemed to those who were confronted by these
opposing demands that it was necessary to sacrifice
one to the other.
It seems that the decision was not in doubt. Since
the child was the real, the only obstacle to the new
virile existence of the new woman, there was nothing
for it but to sacrifice the child : and, on principle,
maternity was suppressed.
Do you think this an exaggeration ? But who has
not heard young girls in all classes of life declare,
with an absolute absence of shame, that they would
marry willingly enough, but that they were not going
CAUSES OF FALLING BIRTH-RATE 185
to have children? And how many young men are
there who would have to admit that this mutual agree-
ment was the first condition of their marriage?
The feminist doctrine was prevalent at first in cul-
tivated circles, but to-day it has become democratised.
The war, with the employment of women in the public
administrations, the factory, and the workshop, has
illustrated in a striking manner the theory of
feminism and the replacement of men by women.
Let us hear what these men-women have to say of
maternity.
This is precisely the point which our propagandists
of feminism had not foreseen, more especially the
politicians, who are always eager to exaggerate, and
who now afford us the strange spectacle of men seek-
ing to reconcile incompatibilities, proposing remedies
for depopulation and in the same breath recommend-
ing the opening of fresh outlets for feminine activity.
Our worthy philanthropists had forgotten only one
thing, which is that woman, by her nature and to
this we must always return in the last resort is above
all a uterus, and that all her functions gravitate about
the important function of this essential organ.
When the uterus performs its functions it absorbs
the whole activity of the woman ; and th^s activity can
only be expended in a virile fashion on the condition
that the uterus is in repose, with all the accessory
functions which are the corollaries of its activity.
And it must not be supposed that maternity entails
only a simple disablement of a few months' duration,
which, after all, cannot seriously incapacitate a
woman. To begin with, pregnancy refuses to accom-
modate itself to a host of activities which demand
muscular effort, and keep the woman on her feet ; then
1 86 SOCIAL DISEASES
the period of giving suck makes its special demands,
and the same with the tending of young children. If
all these functions are not exercised by women, can
they be fulfilled by men ?
Of course, from the standpoint of personal dignity
and justice, woman is strictly the equal of man. It
should not be necessary to make the assertion. But
from the standpoint of the social functions there is
not similarity but only an equivalence between man
and woman.
Need we then insist that the woman and the man
cannot exercise the same function in the community ?
By virtue of her nature, which is to be a mother,
the woman should remain in the home, and the care
of her children above all if she has the number she
ought to have will to a great extent suffice to absorb
the whole of her activities.
External activity befits the man. Formerly, in the
prehistoric ages, it was his part to go fishing and
hunting, in order to provide the woman and the
children with the necessary food. To-day, although
they assume other forms, the fundamental nature of
his activities are still the same. Scientific research,
the exercise of the liberal professions, industrial and
commercial occupations, and the toilsome labour of
the fields, all equally strenuous activities, each in its
own way, which absorb the whole man, demanding
his absence from the home, are the equivalents of the
hunting and fishing of old. Their object is to assure
the material life of the family.
But in order that the family shall fulfil its social
function, without which no society is possible, the
home must exist and the home can exist only by virtue
of the presence of the woman and her children.
CAUSES OF FALLING BIRTH-RATE 187
But if the feminist doctrine continues to gain
ground, the woman, before very long, will regard
maternity as a derogation, marking a return to the
state of nature ; and no argument will have any effect
upon the new feminist mentality.
The uterus is on the way to becoming a blemish;
woman will conceal the fact of its existence, being
unable to suppress it ; and already she has made good
progress in this direction. We have nowadays the
" strike of the abdomen " ; it has been publicly advo-
cated of late years in lectures and speeches which
have been loudly applauded.
Sterility, then, appears to be the logical conse-
quence of the feminist doctrine, which tends to trans-
form woman into a sort of third sex, a monstrous and
unexpected creation of our modern civilisations.
The influence of this disastrous doctrine has mani-
fested itself to begin with by a deficient birth-rate.
It has affected women who have had children, but
have firmly resolved to make an end of this unprofit-
able function, in order to adopt others of a more
lucrative nature.
It will manifest itself more and more frequently in
future by complete sterility, as a result of the loudly
expressed determination, of many of our young girls,
in all classes of society.
It must be largely responsible for the terrible
increase in the number of abortions, of which we have
already spoken. 1
1 It is a remarkable fact that among the many writers who have
spoken of depopulation, and among the speakers who discussed it
before the Academy of Medicine in 1917, M. Hayem, President of
the said Academy, was the only one to mention feminism among the
causes of the evil. So great is the power of fashion, and of words !
Feminism does not merely incite the woman to remain sterile.
By the mere fact that women work away from their homes the
1 88 SOCIAL DISEASES
Providence, thrift, the love of luxury and pleasure,
and feminism : such are the principle factors which
may affect natality, restricting it, and even suppress-
ing it.
To complete our argument we ought to mention
the weakening of religious conviction, which has
been reckoned among the causes of depopulation.
But this influence is so impossible to verify or esti-
mate that it is very difficult to form an opinion of it.
" Statistics, wrongly interpreted," writes M. Ber-
tillon, " would even seem to indicate the contrary,
for the Faubourg Saint-Germain, although sincerely
pious, presents a much lower birth-rate than Me'nil-
montant, although a third of the interments there are
civil." Is genuine, active faith actually rare in our
days? Has it not always been comparatively rare?
Some people readily blame the separation of Church
and State, and the measures taken with regard to the
religious congregations; but we know that in all ages
persecutions, even the most deliberate, have only
exalted faith. Consequently, if faith is growing cold
we can but see in this phenomenon a change common
to all beings and all ideas which are subject to age
and decay.
mortality of the children of those that remain fruitful is considerably
increased.
Miscarriages also are seven times and premature deliveries are six
times as frequent in wage-earning women as in women who are not
forced to work for a living.
There is therefore no doubt that pregnancy is imperilled by the
work of the mother.
As for the necessity of putting the child out to nurse, by confiding
it to baby-farmers, or feeding it with the bottle, this is the cause of
a terrible infant mortality, approximating to 500 per 1,000 (36,000
per annum).
M. Triboulet, in the Presse mtdicale, 23 July, 1917, claims that the
mother should receive two months' maternity benefit after the birth
of a child, and that she should suckle it, receiving special benefits to
enable her to do so.
CAUSES OF FALLING BIRTH-RATE 189
To speak frankly, we do not believe that religious
convictions, although we do not deny their import-
ance from the point of view which we are considering,
are capable, in many families, of contending success-
fully with the manifestations of self-interest which we
have described.
In any case, these various factors and we do not
profess to have analysed all of them form a coalition
which is tending to destroy us. Consciously or un-
consciously, they are combining among themselves,
acting one upon another, and forming that lamentable
mental complex which we must seek to change by all
possible means; a process all the more precarious in
proportion as the malady is more complex in its
causes and its symptoms.
CHAPTER III
REMEDIES
The remedies proposed for depopulation are, like the
causes of the evil, of three kinds : moral, economic or
fiscal, and penal. To make an effort to stem the tide
of feminism which is the contrary of what the Press
and the administrative departments are doing at present ;
to introduce the plural vote, in accordance with the
number of children ; to extend the liberty of bequest ; to
institute and multiply public manifestations of interest and
respect to be accorded to large families ; such are the
principal measures of a moral order which should be
applied. The fiscal or economic measures consist in
imposing a special, direct tax upon celibates and unduly
small families, and in applying the same principle to the
death duties. An ingenious form of taxation to be ap-
plied to dwindling families. Bounties might also be
granted in the case of large families. But this system
is liable to serious drawbacks. In France at all events
the evil is so great, and the need of a remedy so urgent,
that all available expedients must be tried, even those
that appear less likely to prove least effectual.
1 ' FRENCH families, on an average, have three
children born alive, and in German families the aver-
age is rather more than four. Is it impossible," says
M. Bertillon, "to persuade the French family to pro-
duce one or two more children ? We do not believe
it is impossible."
The remedies for depopulation which have been
190
REMEDIES 191
proposed are very numerous, and their very number
is doubtless a sign of their indifferent value. How-
ever, we shall expound the principle of some of them ;
for if we do not decide to apply them all, as Jules
Simon wished to do, in order to make sure of apply-
ing that which will be effectual, yet we ought assur-
edly to decide upon some complex reform which
would correspond with the complexity of the problem.
We have seen that the causes of sterility and sub-
natality are of three kinds : moral, economic, and
criminal feminism, providence, and abortion.
We shall not insist at any length upon the
remedies which might be applied to the moral causes,
for any attempt to influence the nation's morals
appears to us somewhat illusory.
Feminism in particular is the fashion at present.
The Press exalts it ; it is a springboard for aspiring
politicians and a bait to catch votes. Against such a
tide of opinion nothing can be done; the more so as
the Government has deliberately set foot upon the
fatal path, believing that it is acting in a democratic
manner.
Now that the doors of the Universities, the public
administrations, the liberal professions, and the work-
shops have been thrown open to women, it must be
admitted that it would be very difficult to refuse to
allow them to enter.
Moreover, a war of unprecedented dimensions has
been waged, which has made it necessary to replace
men by women in every branch of trade and industry ;
so that feminism has in a few years made advances
that a century of conflict might not have won for it.
How will they welcome the return of the men on
demobilisation, and their own return to the domestic
192 SOCIAL DISEASES
fold all these clerks and officials and workwomen,
who appear to have acquired the greatest liking for
their new functions, by which they have been
emancipated and endowed with fresh courage ? This
is a problem of which we cannot foresee the solution ;
but the solution must assuredly be such as will lead to
that moral change which we cannot hope to produce
by means of laws and regulations.
In the meantime it is a spectacle not devoid of
irony to see our Academies, our Parliament, our
Government investigating with great solemnity the
causes of depopulation, and the remedies to be applied,
while at the same time they are favouring the
feminist doctrine and doing all they can to facilitate
its progress.
Among the remedies of a moral order we must,
however, mention certain possible measures, without
counting too much on their efficacy.
I recommended years ago and the idea has
recently been revived the institution of a plural
vote, its value to be in proportion to the number of
the voter's children. Thus a man with no children
would have only one vote at his disposal, while a
father with three children would have four votes, and
so on. This plural vote, while it would add to the
importance of the fathers of numerous families, would
further have the advantage of giving stability to insti-
tutions, by assuring a preponderance of votes to
electors who would be conscious of their responsi-
bilities and interested in the maintenance of order.
The extension of the liberty of bequest might pos-
sibly prove a highly efficacious measure. Since
French families fear above all things to split up their
wealth, that is, to destroy it, the laws which force
REMEDIES 193
them to do so should be profoundly revised, in the
direction of liberty. Fathers of families must not be
driven to make these disastrous calculations which
are interpreted by the production of a single child.
Lastly, the public marks of interest and respect to
be accorded to large families should be determined
upon and multiplied. In Madagascar General
Gallieni instituted a " Children's Festival," and in
France a few measures of this kind have been intro-
duced, either by the Cabinet, or by the Municipali-
ties, which award medals to mothers having the
largest number of children, or savings-bank deposit
certificates to school-children who have a large num-
ber of brothers and sisters. Such schemes should be
multiplied extensively. As a complement to all these
measures, the best object-lesson would be for the
State to reserve all favours at its disposal for large
families.
It is, we must confess, a somewhat incredible fact,
but in a large number of Government establishments
two scholarships are not given to members of the same
family, although, of course, a scholarship will be
given to an only child. Allowances for lodging,
residence and removal should be in proportion to the
expenses of the family.
M. Jayle asks even the Academies and the faculties
of the great colleges to admit only members who have
at least three children, or who have reared three
children to the age of twenty-one. " If the present
members of these various bodies have not done their
duty to the race as parents, they can easily find wards
among the orphans made by the war."
At first sight it would seem better to rely upon
remedies of a fiscal nature. Since we have to con-
194 SOCIAL DISEASES
tend with habits which have their origin in personal
interest, it would seem that when the pros and cons
are considered it should be enough, if we wish to tip
the balance, to throw in the question of cost.
Again, if we come to consider ways and means, we
ought to seek for the method which will obtain the
greatest effect at the least cost. Let us see what the
economists and psychologists have to offer us from
this point of view.
M. Bertillon proceeds from the principle, to which
we can make no demur, that the fact of rearing a
child should be considered as a form of duty to the
State; in reality, in order that a family may acquit
itself of this duty, it must rear three children.
Consequently, all families having more than three
children should be completely exempted from all
taxation, which could be done for about two million
families by imposing a super-tax of 20 per cent, on
the other ten million families. It would, moreover,
be equitable to impose this super-tax on a sliding
scale, rendering it inversely proportional to the
number of children.
A simple calculation shows that the Treasury would
gain by the process, as in losing 2,112,210 fiscal
units it would recover 2,450,112.
A similar measure, of course, should be applied
not only to the tax upon property but to all direct
taxation. In any case, one should be able to tell an
insufficiently fertile family : " You have (wilfully or
not) done your country a wrong. Far be it from us
to punish you ; but it is not just that you should
profit by it. You must pay compensation."
At the present time the French family is in effect
told the very reverse of this. All taxes, direct or
REMEDIES 195
indirect, customs, octroi, property-tax, licenses, etc.,
are all higher in proportion as the family is more
numerous.
To apply these equitable principles to the death
duties, only children should be placed in the same
situation, as regards inheritance, as would be theirs
if they had brothers. For example, in the case of an
only child half the fortune might be reserved to the
State; in families of two children, a third part; while
families of three children would inherit the whole. 1
The sums which the State would derive from the
high death duties which would be imposed upon those
families which had given France only one or two
children ought to be reserved exclusively either for
the education of poor children or, in accordance with
an old scheme of M. Raoul de la Grasserie's, in order
to secure a provision for the parents of large families
in their old age. This pension, added to the old-age
pension, would assuredly be greatly appreciated.
The objection has been made to the fiscal measures
proposed that they would not demand sufficiently
large sums of money from those households that had
not the charge of children. These sums, says Dr.
1 This, after all, would only be a revival of the " caduciary " laws
of Augustus ; laws so-called because when an inheritance was to be
shared the legacy which would have fallen to a celibate was declared
" caducus, " or void. On the other hand, if the legatee was married
and childless he had a right to only half his share of the inheritance.
Only fathers of families received their full due.
This law was passed in the year 723 : that is 31 B.C. Its conse-
quences were truly remarkable ; for the number of Roman citziens,
which before the law was passed was 4,063,000, had increased, ten
years later, to 4,233,000, and twenty years later to 4,937,000.
On the death of Augustus that law was abrogated owing to the
pressure brought to bear by the wealthy citizens who found it dis-
pleasing that they were compelled to have children in order that they
might inherit. From this moment the population of the Roman
Empire began to decrease, and when the Barbarians appeared later
on the Romans had not soldiers enough to check the invaders.
ig6 SOCIAL DISEASES
P. Gallois, ought really to represent the cost of rear-
ing a child. And he gives a formula which enables
us quickly to calculate this tax for any family subject
to taxation.
The formula is this : - . Here / is the amount
2 n
of the rent, ra the deficit in children, and n the num-
ber of people occupying the house, flat or tenement.
The coefficient of the denominator, 2, is derived from
the fact that it takes two persons to produce a child.
Each household owes three children to the State, so
that each member of the household owes only one and
a half children.
To determine the factor m, the State would con-
sider that the man ought to have one child at the age
of 30, 2 at 35, and 3 at 40 years. As for the woman,
she should bear her first child by her 25th year; her
second by her 3Oth, and her third by her 35th year.
This is how the calculation is made : A man of 42
and his wife, aged 34, have one child. There are
therefore three persons in the home. Their rent is
^48. The calculation is made separately for hus-
band and wife.
The husband, according to the above rule, ought
to have three children. He has only one, so he lacks
two. The formula then gives us :
LOL 48x2 _
2 2 X 3
As for the wife, who is 32 years of age, she ought
to have two children. She has only one; so she
owes one. The formula then becomes :
/ m 48 x I , ^
2 n ' ' 2x3
REMEDIES i 97
The two amounts are then added. The household
will have to pay ^24, representing the cost of rearing
the lacking children.
With the sums thus obtained the State would be
able to grant relief to families having several children.
Adopting the figures of the separation allowances
granted to soldiers' families, it would allow 3fr. 50
per child per week, or 125. per child per month.
We have given insufficient thought, saysM. Gallois,
to the terrible disturbance which will be caused at
the end of the war when all allowances are stopped.
On the one hand, it must not be forgotten that one of
the great causes of the Commune, in 1871, was the
discontinuance of the 30 sous a day allowed to the
population of Paris during the seige. On the other
hand, the State cannot continue to pay all the war-
time allowances. By continuing to pay the sums
allotted for children it would be adopting an excellent
measure of conciliation, while at the same time it
would be applying an effective remedy for depopu-
lation.
The question of the tax to be imposed upon de-
creasing families has recently assumed a slightly
different form, both in Parliament and in the discus-
sions of certain learned societies. Instead of a tax
upon infertility, a premium upon natality has been
suggested.
Speaking in the name of a special Commission
appointed by the Academy of Medicine to investigate
the question of depopulation, and the remedies to be
opposed to this dangerous malady, Professor Charles
Richet concluded that if sub-natality has become
alarmingly prevalent in France it is because of the
ever-increasing providence of parents, who do not
i g8 SOCIAL DISEASES
wish for children because children are costly to rear
and educate, and because the more children they have
the greater their expenses.
Accordingly, this all but unanimous determination
of the French people can be combatted only by
granting a handsome grant (which will, however, still
be inferior to the outgoings) to compensate the
parents for the pecuniary expenditure involved by
the birth and maintenance of a child.
This gratuity, which, according to M. Richet,
should not be less than ,40, would serve to protect
the child, on the one hand, during the uterine period
of its life, and, on the other, during its early infancy :
which would diminish the number of weakly and
ailing children.
However heavily the financial burden might press
upon the unprolific classes of society, this grant for
pregnancies and births would only go a little way
towards restoring the equilibrium of expenditure
between unprolific families paying few taxes and pro-
lific families paying heavy taxes, despite the service
which their fertility has rendered their country.
Families having only a few children, says Professor
Richet, at the close of his remarkable report, should
help those which have many children. This measure,
which is necessary to prevent the extinction of the
French nation, is in strict conformity with the most
elementary equity. The national interest requires it
and justice demands it.
Moreover, savs M. Richet, the application of such
a measure would not really be such " bad business,"
seeing that the Frenchman whose birth would thus
have been bought by a payment of ^40 represents,
REMEDIES 199
when he is an adult, by his labour, an annual sum
of So. And M. Richet estimates that if this idea
were adopted France would have a population of 80
millions in thirty years' time.
To these proposals of a fiscal nature various objec-
tions have been made.
For example, it has been pointed out that as regards
population quality is superior to quantity ; a strange
objection, for a small quantity does not ensure
quality. On the contrary, the care with which the
only child is surrounded often results in assuring the
survival of a complete degenerate. On the other
hand, if quality is precious in time of peace, it is
quantity that is of value in time of war. Without
quantity a nation is liable to enslavement.
It has also been said that it would be better to give
a bounty for the child living at the end of a year
rather than for the new-born child ; and there is cer-
tainly something in that. It is not enough to procure
the birth of a child; it is a matter of elementary
prudence to ensure its survival.
It has further been objected that a grant of ^o per
child would be a financial impossibility in the present
condition of our budget. To this Professor Pinard
has replied by asking whether the state of our finances
at the beginning of the war permitted, in the eyes of
our actuaries and economists, the pecuniary sacrifices
which were and are necessary from the standpoint of
national defence. Yet it is the thousands of millions
spent on our armaments and munitions which, with
our heroic soldiers, has saved France. Only hun-
dreds of millions can give us that other victory :
the victory over depopulation. And if we do not
obtain this victory the first will be useless.
14
200 SOCIAL DISEASES
A criticism of M. Gue"niot's is more serious, and
deserves a little consideration.
According to M. Gu6niot the system of bounties
would be radically insufficient to solve the vital
problem of the birth-rate :
Firstly, because it appeals and can only appeal to
the poorer classes, excluding the rich and well-to-do
classes who represent two-thirds of the population of
France.
Secondly, because the grants, however large they
might be, would still be much inferior to the expendi-
ture involved by the birth and maintenance of a child ;
hence the family (if we confine ourselves to the
pecuniary aspect of the matter) could only regard it
as a disadvantage, despite the bounty, to increase the
number of its children.
M. Gueniot is of opinion that the repopulation of
France can be fully accomplished only by the co-
operation of all classes of society, from the highest
to the humblest, with the help of moral influences (the
influence of example ; large families in the ruling
classes ; the influence of patriotism and duty ; the
influence of religion) ; and of measures of all sorts :
hygienic and medical, administrative and legislative,
which men who are specially competent have many
times recommended, during the last fifty years, as
likely to be efficacious.
In confirmation of his opinion as to the non-
efficacy of bounties as an organised system, M.
Gueniot makes the following remarks, which have all
the value of an arithmetical demonstration. Can
the difficulties of making both ends meet be done
away with by a grant of 4.0 or even ;8o ? Let us
take ;i6, which is obviously a low estimate, as cover-
REMEDIES 201
ing the annual expense of a child; then the main-
tenance of the child until its fourteenth year will
demand an expenditure of ^224. Even if the bounty
were increased to 60, is not the difference consider-
able? ^164 is no trifle for a poor family !
Consider, on the other hand, the household of a
clerk making ;ioo per annum. He has two children,
and, thanks to the bounty, he adds two more to the
first two, but at a cost of twice ^164 that is, ^328;
and the more he increases the number of his offspring
the more his financial responsibilities will increase.
What material advantage would he derive were he to
allow the bounty to affect his decision ? Absolutely
none.
And this is a simple calculation which any
interested person can make. How, after this, can we
believe in the virtue of bounties as the sole remedy
for depopulation ?
Let us, however, admit that in the necessitous
classes a grant of ,40 would be a considerable assist-
ance, and one which the household would gladly wel-
come. But how far would the birth-rate profit by it?
Practically not at all, since without the incentive of
a grant these very poor people already give us as
many children as they can produce. It would simply
amount to relief well placed, but no more than relief.
On the whole we readily agree with M. Gue"niot's
criticism. There can be no question of proposing a
single remedy for the malady of sterility or sub-
natality; we must employ all the remedies; all the
moral influences, as well as all the fiscal measures;
and each of them will doubtless be able to correct the
dominant weak point in this or that defective
mentality.
202 SOCIAL DISEASES
It would be unwise to regard a method as ineffec-
tive because at first sight it appears ridiculous. A
current of thought is often set up by an imponderable
influence. Besides, we must act, and act quickly, for
the life of the nation is at stake. 1
Lastly, there is one further resource : the criminal
prosecution of the crime of abortion ; for although
abortions are not in themselves sufficiently numerous
to explain the depopulation of the country, they are
nevertheless so common that the progress of depopu-
1 We may profitably cite the recommendations and indications of
the Repopulation Commission (Sous-Commission de la Natalit6) :
" In France," writes M. Jacques Bertillon, the spokesman, " the
population thinks more of the income obtainable from capital than of
increasing its capital, and the income from this capital undergoes a
progressive reduction, while taxation and household expenditure are
continually increasing, the result being that the progress of natality
is checked.
" Direct taxes upon consumption, customs duties, and many in-
direct taxes are, for many families, a positive penal exaction. People
have fewer children when the expense of rearing them is heavier.
The intervention of the State in the sphere of private effort, the
creation of monopolies or privileges, and commercial, fiscal or finan-
cial measures affecting the distribution of labour and capital, exercise
a depressive influence upon the growth of the population.
" As abatements can only affect direct taxation, which is by far
the less heavy burden, above all for poor families, it is only just that
in compensation for the much heavier expense entailed by indirect
taxation, and by food taxes, grants should be awarded to heads of
families having more than three children on their hands.
" Expenses should be balanced as equitably as possible between
large families and persons without children : i, by the abatement of
taxes, in proportion to the number of children ; 2, by the creation
of a special tax to be collected from childless persons and to be
shared among the large families in proportion to the number of
children.
" In France, at the present time, the fathers of families are un-
justly over-taxed, and for this reason they have a right to abate-
ments, ' or to compensation, whose amount should be in proportion to
the number of their children. If a tax upon income were voted
without the introduction of considerable abatements in favour of
large families, an injustice would be consecrated which would un-
favourably affect the birth-rate, already lower than the death-rate '
and which might prove to be a fresh cause of depopulation.
" The public authorities should assist large families when they are
poor, above all when they have a widow at their head."
REMEDIES 203
lation would be very greatly impeded, and would
cease to be alarming, were it possible to suppress
them.
Is this resource of any practical value? We shall
consider this question in the following chapter.
CHAPTER IV
THE CAMPAIGN AGAINST ABORTION
There is abortion before conception and abortion after
conception. In order to deal with the first kind, apart
from the moral influences and the considerations of an
economic order which we have examined in a previous
chapter, an energetic offensive should be opened against
the Malthusian or anti-conceptional propaganda.
Against voluntary abortion after conception, which is
a crime, the law may be invoked. But this crime is
referred to the jury, which is always extremely indul-
gent with regard to it. It may seem that there are
reasons in favour of making abortion a misdemeanour
punishable by the police. But this measure would by
no means solve the problem, for the abortions which
become the subject of prosecutions are very few in
number ; from our point of view they are negligable.
A woman who has procured an abortion could hardly
be denounced by anyone but her physician, and the duty
of a physician would absolutely debar him from such a
course. The principle of medical secrecy is unassailable.
Even if we admit that the physician is compelled to
observe secrecy only as regards his own patients, a
woman in hospital for abortion must be regarded as the
patient of the hospital physician who is treating her.
How is this difficulty to be overcome? By deliberately
renouncing prosecution of the woman guilty of abortion,
and by endeavouring to reach the accomplice who has
induced her to procure abortion, and who is in reality
morally and materially responsible for the crime com-
mitted. This prosecution of the accomplice is dependent
upon many uncertain factors. In the meantime we must
204
THE CAMPAIGN AGAINST ABORTION 205
content ourselves with two measures whose efficacy would
be considerable: the org-anisation of lying-in hospitals
where secrecy would be observed, and the moral reform
of the profession of midwife.
ABORTIONS are of several kinds. And first of all
there are abortions before conception. These are in
reality the abortions which we have been considering
in the foregoing chapters. It is these abortions that
are responsible for voluntary sterility and sub-
natality. We have already considered the remedies
to be applied.
But while reviewing the individual causes and the
personal motives of these abortions we have said noth-
ing of the external factors which provoke them. Yet
these are not to be neglected, and should be corn-
batted by suitable legislation.
Thus we should use all the legal means at our dis-
posal to suppress the so-called Malthusian or Neo-
Malthusian propagandas, the cynical newspapers
which teach them, and the unscrupulous persons who
corrupt the population by books and pamphlets in
which are described the means of restricting natural
fecundity.
It is urgently necessary to take the most energetic
measures against the sale of articles capable of pre-
venting pregnancy ; to prohibit the sale or distribu-
tion of remedies, substances, or articles of any kind
destined to procure abortion before or after concep-
tion, even when these articles are probably ineffectual.
Let us pass on to abortion after conception. We
do not of course intend to speak of abortions of an
accidental or pathological nature, nor of those pro-
voked by the physician or surgeon in those cases
which are however extremely rare when abortion is
206 SOCIAL DISEASES
necessary in order to save the life of the mother,
imperilled by the mere fact of pregnancy.
We have in view only the abortion deliberately pro-
voked with the object of ridding the woman of a
coming child : an abortion which is always an indi-
vidual murder and a crime against the nation.
Before proceeding to point out how this crime may
be punished, it would of course be humane to indi-
cate how it might be possible to prevent it.
Now there is no doubt whatever that a great
number of abortions would be avoided if procreation
were no longer, for the woman, a burden or a dis-
grace.
As for procreation considered as a burden, we have
only to refer the reader to the previous chapter, where
this question has been precisely treated : and as for
procreation dishonouring the woman, we must admit
that we absolutely do not know of any means of
modifying the morals and ideals which are current
to-day, and of replacing the idea that procreation
dishonours a woman by the idea that the woman who
is about to be a mother outside the bonds of marriage
is honoured by her maternity. It is incumbent upon
each one of us to make an effort in this direction ; to
persuade both himself and his household ; and
women, by abandoning their conventional severity
in this respect, might do much to effect the desired
reform. We can but suggest, in passing, that herein
they can play a noble part, wholly humane and
patriotic.
In the meantime, while we are waiting until this
moral reform is brought about, is it possible to take
stringent measures against voluntary abortion ?
Of course, we have the weapon of the law, but the
THE CAMPAIGN AGAINST ABORTION 207
law is not applied, or is applied imperfectly. As we
know, the crime of abortion is always referred to a
jury, and the jury, in the majority of cases, exhibits
an extreme indulgence towards this crime.
The remedy for this state of affairs would be to
make abortion and incitement to procure abortion
penal offences punishable by severe penalties, vary-
ing from one to five years' imprisonment and fines
varying from 20 to ^"400. This, by the way, has
already been voted by the Senate, after a first reading,
and in agreement with the Government. Let us hope
that on this point the Chamber of Deputies will share
the opinion of the Senate.
But if the crime of abortion is to be punished it
must be known ; and it is here that the real difficulties
of the problem begin.
For, indeed, except in cases of gross scandal, where
public notoriety points to the guilty persons, how
should the crime of abortion be made known ?
Obviously, in the great majority of cases, by the
physician who is called in to treat the woman who is
suffering from the results of abortion.
Now it is absolutely inadmissible that the physician
should violate the secrecy of his profession, and
denounce the suffering woman who has called him
in.
There are, however, those who have not hesitated
to propose this measure, and M. Cazeneuve has de-
manded that physicians or midwives called as wit-
nesses in a prosecution for abortion should be re-
quired to tell the truth under oath. On this point
the Academy of Medicine was very rightly immov-
able, declaring with great emphasis that the secrecy
of the medical profession could not and should not be
208 SOCIAL DISEASES
infringed, and that no legal obligation could be
superior to the moral obligation.
Might there not be some means of circumventing
the difficulty ? Some have sought to do so by observ-
ing that while the physician owes secrecy to his
patient he does not owe it to those responsible for
her death or for the complications which have
endangered her life.
We really do not know why the Academy rejected
this proposal, which was supported only by Professor
Pinard.
The doctrine that professional secrecy is due to the
patient alone is in other connections a matter of cur-
rent practice, as M. Gallois has shown by a number
of examples.
Thus, the physician employed by an Insurance
Company is not obliged to observe secrecy in respect
of the patients whom the Company requires him to
examine : on the contrary, his duty is to conceal
nothing that relates to the results of his examina-
tion.
It is the same in the Army and all the great
administrative departments, where the medical offi-
cers must inform their superiors of the diseases with
which the patients entrusted to their care are afflicted,
and whether their affections are incompatible with
service, or dangerous to the collectivity of which they
form a part.
In all these cases, it should be remarked, the
patients have not chosen their doctor; they are not
the patients of a given physician ; they are sick people
subjected by order to observation by a physician
appointed by a superior authority, and he is not under
an obligation to defend their interests.
THE CAMPAIGN AGAINST ABORTION 209
It should also be remarked that except in the case
of the Army the patients are not compelled to accept
the conditions imposed upon them, but that their
acceptance is, after all, the result of a contract freely
entered into.
Would it be possible to extend this argument to
include the women under treatment in hospital for
abortion ? Apparently not. To be sure, the hos-
pital doctor is not a physician chosen by the patient ;
but the presence in hospital of such a patient is a
matter of necessity, which she cannot evade except
by endangering her life, and the physician to whom
she confides her secret affairs is under a very real
obligation to defend her interests. Moreover, if
women suffering as a result of abortion knew that
they were liable to be denounced in hospital, they
would refuse to enter the wards, and would run the
risk of dying in their own homes for want of proper
care. The result of such a measure would therefore
be disastrous.
The upshot of all this is that we must abandon the
idea of prosecuting the greater number of the women
who procure abortions, so that the individual punish-
ment of the crime of abortion cannot enter our calcu-
lations in respect of the campaign which we have in
mind.
And this throws a little light upon the verdicts,
commonly so lenient, of the juries which have to try
persons accused of abortion.
Nevertheless, it is possible to get round the diffi-
culty.
A woman with very rare exceptions does not of
herself procure an abortion. She has almost always
an accomplice; and it is really this accomplice who
210 SOCIAL DISEASES
bears the entire material responsibility for the crime,
if not the moral responsibility.
Now if it is impossible to denounce the woman it
is certainly not impossible, through the woman, to
reach her accomplice.
This is no doubt what the Society of Legal Medi-
cine had in mind when it proposed this formula :
"The law should specify that the physician, who is
always exempted from testifying when his conscience
debars him, shall be free to furnish evidence to
repress injustice without incurring any penalty;
moreover, that he must do so against those who pro-
cure abortion, in respect of whom he is not bound by
any professional obligation."
It must be confessed that all these conclusions are
lacking in precision ; and we have a feeling that the
profession of "angel-maker," as the Parisians call
it, is not yet seriously imperilled.
The campaign against abortion still remains to be
organised.
In the meantime it is of urgent importance to resort
to a palliative which might have the happiest results.
I am referring to the organisation of secret maternity-
hospitals, which has been recommended by M. Bar.
It is indeed an urgent matter to provide pregnant
women who desire to preserve secrecy as regards
their pregnancy and accouchement with proper
accommodation. If such existed, many women who,
dreading scandal, have recourse to abortion, would
not hesitate to allow their pregnancy to run its course.
The woman, suggests M. Bar, should be able, with-
out having to reveal her identity : i, to enter at any
moment of her pregnancy an asylum where she could
THE CAMPAIGN AGAINST ABORTION 211
conceal her condition ; and 2, to enter a maternity
hospital at the time of her accouchement.
Now, although the second of these conditions is
realised in the Parisian maternity hospitals, the first
is not, and our legislators have not provided any
asylum of the kind required.
Under the actual conditions the woman who
wishes to conceal her pregnancy, is practically unable
to find any asylum, although in reality a refuge
ought to be offered to the unhappy woman, whose
state of moral depression renders her prone to dis-
couragement.
It is therefore urgently necessary to make an end
of this state of affairs. As long ago as 1891 the
Academy of Medicine, at the instigation of Le Fort,
expressed a recommendation that there should be
established, in each department, at least one asylum
appointed to receive women during the last months
of their pregnancy ; that any woman, if she so desired,
should be received under conditions which would
ensure absolute secrecy as regards her reception and
stay in this establishment, and her accouchement;
and that it should be forbidden to make any adminis-
trative inquiry into the domicile and identity of preg-
nant women or women in childbed in the wards of
hospitals.
To-day it becomes necessary to repeat this recom-
mendation, and M. Bar has requested the Academy
of Medicine to accept the following proposal : "In
each department there should be established at least
one asylum appointed to receive pregnant women
during the last months of their pregnancy, where any
woman, whatever her social situation, might, if she
desired, on payment of money or otherwise, be ad-
212 SOCIAL DISEASES
mitted under conditions which would assure her of
secrecy. Also the public maternity hospitals should
receive without inquiry any woman applying to lie in
who refuses to make herself known."
So much for the woman, and so far it is excellent.
But we must no longer neglect the accomplice who
incites or assists her to procure abortion.
We know that in France the accomplice is, in the
great majority of cases, a midwife, and since a large
number of midwives have given proof of their moral
delinquency, it is obvious that the profession should
be differently recruited, while its moral training
should be improved.
Needless to remark, it would be necessary strictly
to supervise all advertisements, prospectuses, and
placards which give the addresses of dubious dis-
pensaries or so-called consulting-rooms, which are in
reality mere laboratories for abortion.
As a corollary of such supervision, and in order to
facilitate it, the Assistance Publique has requested
that the profession of midwife should be strictly
limited to the practice of normal accouchements. It
is evident that the pretended attentions which the mid-
wife vouchsafes her patient are very often the pre-
liminaries to abortion.
But perhaps something more may be done.
It should be possible to improve the moral standard
of midwives by raising the standard of their training,
and by making it more difficult to obtain a certificate.
The number of midwives would at once diminish,
and their material position would be improved, which
would to a certain extent place them beyond the reach
of criminal suggestions.
Moreover, they might be more efficiently utilised,
THE CAMPAIGN AGAINST ABORTION 213
if they were distributed in the different departments
according to the number of births, and assured of a
pension.
Having reached the end of this chapter, we must
confess that if at the outset we had some hope of
seeing the crime of abortion, whose disappearance
would of itself suffice to increase our birth-rate, prose-
cuted, punished and suppressed, we have hither-
to discovered no certain means of achieving this
result.
On the one hand, we have seen that in the vast
majority of cases it would be necessary to abandon
any hope of proceeding against the crime of abortion
in the person of the woman who has evaded maternity,
since she cannot be apprehended except on the accusa-
tion of the physician, which accusation is inadmis-
sible; and, on the other hand, we have shown that
if we wished to proceed against those who procure
abortion we could in reality discover these criminals
only by the denunciations of their victims, on whom
it would be foolish unduly to rely.
As we have seen, in the hope of somewhat improv-
ing this lamentable situation the establishment of
secret maternity hospitals has been proposed. But
these would affect only those women for whom
pregnancy is a disgrace, not those for whom it would
be an insupportable burden ; and the number of the
first category is probably small as compared with the
number of the second.
The restoration of the proper ratio between natality
and mortality is rather a matter for these last, and
this must not be forgotten.
Lastly, the profession of midwife must be reformed.
But apart from the midwives, and if they were all
214 SOCIAL DISEASES
impeccable, there would still remain those " lady
specialists " whose lucrative occupation would prob-
ably still continue.
CONCLUSION
FROM the foregoing pages we may conclude that the
civilised races are a prey to complex degeneracies,
arising from the hereditary taints of syphilis, tuber-
culosis and alcoholism, and that all these morbid
inheritances mutually aggravate one another in a
vicious circle.
Sterility, voluntary or otherwise, is one of the re-
sults of this degeneracy ; it is, as it were, a sort of
natural defence against the degradation of the race,
and all the physical and mental suffering which
results therefrom.
As we have seen, the gravity and the nature of all
these scourges are perfectly understood ; we have
exactly measured their extent and we have the tale of
their misdeeds.
But an inquiry into the remedies to be opposed to
them is, we freely confess, more than a little dis-
appointing; not that the remedies are not clearly
indicated ; but the application of them seems to bristle
with difficulties of every kind, the most serious of
which is our terror of radical measures; yet only these
could be of any avail.
Are the social maladies for this reason incurable?
Can they be the maladies of old age; the pretexts
which Nature, so to speak, offers to the aged, that
they may quit the stage ?
We do not believe that we have yet reached this
215 15
216 SOCIAL DISEASES
stage. In any case, it would be finer to die on our
feet, fighting. One remembers the motto of Charles
the Bold, the leader of the League of Public Welfare :
" No need of hope that we may undertake; no need
of success that we may persevere."
By the Translator
THE SOCIAL MALADIES IN ENGLAND
Modifications due to Social, Psychological or other
factors Tuberculosis in England Its prevalence What
measures are taken against it Their imperfection Its
origin The Council School and the Picture Theatre
Preventive measures Treatment Fear of the Disease
Carelessness as regards contagion " Consumption in
the family " Education the remedy The deadly frying-
pan Cheap underclothing Syphilis in England Pros-
titution How caused Remedies Abstinence Sexual
education Ignorance and insufficient fear of disease
Prostitution and alcohol Education Alcoholism in Eng-
land Remedies The great cause of alcoholism is de-
generacy Vicious circles The breaking of vicious circles
Sterility The problem with us is not what it is in
France Quantity and quality The great danger of neo-
Malthusianism The campaign against it in America
Results of the campaign Voluntary sterility in England
Terrible results of abortion Difficult to proceed
against because usually self-procured The fertility of de-
generates and the sterility of the higher types From
Revolution to Bolshevism The future of civilisation
Feminism The future lies with women Wanted, a new
religion The need of clear thinking and resolute pro-
paganda.
OWING to social, political, psychological, or geo-
graphical factors, the problems which confront us in
England, in respect of the social maladies, are not in
2.7
2 i8 SOCIAL DISEASES
all respects the same as those with which the French
sociologist has to deal. It will be as well, therefore,
briefly to review the four maladies of which this book
treats as affecting the British people in particular; to
consider their extent, how far they threaten our future,
what is being done to combat them, and what might
be done.
The problem of tuberculosis presents but few
special aspects. As far as this disease is concerned,
indeed, we may consider ourselves comparatively for-
tunate, for, common though the disease may be, the
death-rate from tuberculosis in England and Wales
is one of the lowest in Europe ; the actual number of
deaths, in 1918, from all forms of disease being
58,073.
But the morbidity is high. Multiplying the above
figure by 20, which is the ratio furnished by the offi-
cial statisticians, we obtain a total of 1,161,460 persons
suffering from the disease ; the majority of whom,
perhaps, are centres of contagion.
A few years ago nothing worth mention was done to
check the spread of the disease ; and even to-day the
organisation of the anti-tubercular campaign is
wretchedly inadequate. Compulsory notification of
the disease, for Great Britain only, was introduced in
1912. But who is "compelled" to notify it? In
many cases the sufferer or his relatives will shrink
from doing so, fearing the inconvenience or expense
entailed. And the great majority of cases do not
come under the notice of the physician in their early
stages.
Sanatorium treatment is provided by the State : but
this is not much more efficient than notification. To
take insured persons first : the Insurance Committees
THE SOCIAL MALADIES IN ENGLAND 219
are supposed to provide sanatorium treatment wher-
ever required. As a matter of fact the funds for
the purpose are insufficient; and in many cases
patients rightly or wrongly leave the sanatorium
at the earliest opportunity, do not return if the disease
relapses, and discourage others from undergoing
treatment, alleging, justly or unjustly, discomfort,
or unduly harsh discipline, or coarse food. (In this
respect sanatoria differ enormously but should not
do so). As for uninsured persons of the same class,
the Insurance Committees may provide treatment for
the dependents of insured persons, but as the funds
are insufficient for the latter there is usually nothing
left for the former. As for patients who are neither
insured nor dependent upon insured persons, the
County Councils may provide treatment for them.
But as persons receiving any sort of benefit from the
State are usually treated like criminal paupers, and
subjected to endless and irritating formalities, the
tendency is to avoid treatment rather than to claim it,
or to become an out-patient of a hospital or dis-
pensary. For soldiers and sailors treatment is pro-
vided by the Soldiers' Sanatorium Benefit Fund. And
for the middle classes, who supply the brains of the
country, our doctors, lawyers, engineers, school-
masters, clergy, and a great part of our politicians
and administrators ; and who, moreover, pay most of
the taxes ; for them the State, as usual, does nothing.
So far, then, the prevention and cure of consump-
tion are very poorly organised. What is done is not
done thoroughly ; and too much is left undone.
To begin with, what is actually done to prevent
contagion ? Obviously propaganda is required : a
campaign of education. How often do we see
220 SOCIAL DISEASES
placards about the streets, asking us not to expec-
torate in the open ? How often are public spittoons
provided in the streets, or in railway-stations, waiting-
rooms, etc. ? And where warnings are exhibited, is
the reason for the admonition ever clearly explained ?
Contagion commonly occurs for the first time, at
all events in early childhood. Council schools and
picture-halls are clearing-houses for pulmonary
germs. The children of poor families go to school
in charge of the eldest sister, with one large, un-
speakable handkerchief among the lot. As each child
requires it and all, needless to say, suffer from
chronic nasal or bronchial catarrh the sinister rag is
brought into requisition. After use the youngest, as
likely as not, exploits its possibilities as a plaything,
dragging it along a filthy pavement. At school the
"little mother," out of sheer habit, uses it to polish
the nose or lips of any child within reach who needs
attention. "Class" is a period of suppressed snuf-
fling, hawking, and wheezing, which becomes acute
as each lesson comes to an end. The same sounds,
as of a catarrhal menagerie, may be heard at the
" pictures," during the "children's matinees," when-
ever a moment's intermission permits the poor little
victims to become conscious of their discomfort. The
back of the hand or the sleeve will serve if the
handkerchief is mislaid or non-existent ; and so, in
play, each child infects his fellows. The constant
absorption of poisonous mucus ruins the digestion,
tries the nerves, and stupefies the brain. Of these
children, how many fall victims to phthisis? How
many to bronchitis and broncho-pneumonia, the first
time they get thoroughly chilled? How many, in
later life, can stand exposure to the elements without
THE SOCIAL MALADIES IN ENGLAND 221
disaster? Our training-camps killed thousands be-
fore ever they got to the trenches.
Here nothing but education can avail. Propa-
ganda persuasion fearless, lucid, well-expressed, is
the duty of the State. By means of newspaper
advertisements, by means of leaflets left in every home
and given to every child, by means of brief, intelli-
gible "talks" in school, the working-classes, young
and old, must be persuaded of the existence of pul-
monary germs, must learn how they are acquired, and
how conveyed to others, and how deadly is mischief
that they cause how great the suffering, loss, and
waste and must be convinced that hygienic homes
and habits are not only their duty but their interest.
School clinics should be a reality, not a paper scheme
only half enforced ; smears or cultures should be
prepared and inspected, "carriers" placed in special
quarantine classes and properly treated, and all
confirmed cases should be isolated in comfortable
sanatoria.
So much for prevention. Now for treatment.
This includes two problems : (i) the provision of
sanatoria; (2) the means of inducing the sufferer to
enter them.
The first problem is purely financial ; and it is
really no problem at all. If we can spend eight
million pounds a day in killing aliens we can afford a
small fraction of that sum to save the men, women
and children of our own race. It is as Dr. He"ricourt
has told us, merely "good business" to do so.
The solution of the second problem is equally
simple. It is not practicable to examine every in-
habitant of the country periodically and kidnap him
if he shows signs of tubercle. The only alternative
222 SOCIAL DISEASES
is to make sanatorium treatment attractive. Instead
of puzzling a sick man with badly drafted application
forms, he should be qualified for immediate admis-
sion upon examination at a public clinic. Instead of
being treated as a nuisance, a pauper, a criminal, a
child, or a lunatic, he should be met with courtesy
and kindness, and treated like a reasoning being and
a responsible citizen who is asking for what is his
right and duty. Life in the sanatorium should be
made pleasant in every possible way : it should be
a delightful holiday. If this is done and it is only
a matter of recruiting the right sort of doctors and
nurses, rejecting the ill-bred and consequential, and
inculcating the right spirit there will never be any
difficulty in persuading the sufferer to apply for
admission.
While he is under treatment, the patient's depend-
ants must receive an adequate allowance. It is
Society's fault, not his, that he is afflicted ; Society
must foot the bill.
Education, as we have seen, is the great preventive.
Education, too, must be relied upon to ensure treat-
ment. It may not at once be apparent, but it is true,
that education is called for also as an adjunct to treat-
ment.
For one of the great factors of the successful cura-
tive treatment of tuberculosis is cheerfulness, and the
conviction that the disease is curable.
Physicians have an idea that the consumptive is
always hopeful. This may be true of the wealthier
classes, and in the later stages of the disease. But
in the working-class world many a sufferer has been
killed by sheer panic or despondency rather than by
consumption.
THE SOCIAL MALADIES IN ENGLAND 223
At the present time a fixed idea prevails among the
poorer classes that consumption is inevitably fatal ;
and that the man who coughs up a spot of blood is
doomed. Sometimes the first slight haemorrhage is
followed by absolute moral and physical collapse, and
death follows within a few months. The patient has
frightened himself to death; or his relatives or
neighbours have practically killed him by their head-
shaking and dismal prophecies.
Equally mischievous in many cases is the belief
that tuberculosis is hereditary. It not only depresses;
it prevents the adoption of the strenuous measures of
hygiene which might otherwise isolate the evil. I
remember some years ago my landlady in a small
river port spoke to me in great distress about her son
a fine healthy young fellow of tw r enty-three. His
father had died of consumption, a few years before.
Lately he had caught a slight cold. The cough (I
had heard that cough it was purely nervous : no
man with sore lungs could have endured it for a
moment) had persisted; he had "seen blood" (the
result of continually coughing and smoking shag).
He had thereupon thrown up his job as a house-
painter and had taken resolutely to drink. To all her
remonstrances he replied that he was doomed, and
was going to have " a short life and a merry one."
I turned him over to a charming lady, gay, wise,
and courageous, a chronic sufferer, who had several
times been solemnly given up by the doctors. Every
time, however, courage and a sensible regimen had
induced the disease to resume the latent form. She
treated the young man to a "straight talk " : assured
him that he was perfectly healthy : that consumption
224 SOCIAL DISEASES
was not hereditary ; that his cough was nervous ; that
his attitude was unmanly, and that if he persisted in
it he would either die of drink or really contract tuber-
culosis for the house had never been duly dis-
infected. The cough stopped then and there, and a
day or two later the young fellow was back at work.
Why had he been convinced that consumption was
hereditary ? In the same town an old medical prac-
titioner had lately died, out-living two wives and
eight children, all of whom died of consumption. He
had been a "carrier," or rather a chronic sufferer
from a very attenuated but highly contagious form of
the disease. He had infected both his wives, and one
by one, over a long period of years, the children he
had brought into the world only to kill by his ignor-
ance or heedlessness had acquired the disease from
him and died : without a fight, believing themselves
doomed, as the children of consumptive mothers!
Yet the mothers were originally healthy.
The result was, of course, that the whole neigh-
bourhood was profoundly convinced that consumption
was an hereditary scourge. Lives were lost every
year that education would have saved.
The State cannot be accused of having utterly
neglected the weapon of education. But it has used
it ineptly. If as much determination and common
sense were given to hygienic propaganda as is de-
voted to the floating of a war loan we should not be
a " 3 nation," threatened with military weakness
and commercial defeat.
Before we leave the subject of tuberculosis, let us
glance at one peculiarly British defect. If " feeding-
up" and fresh air are the accepted cure for tuber-
THE SOCIAL MALADIES IN ENGLAND 225
culosis, malnutrition and bad air are among its chief
exciting causes.
Malnutrition is more often due to badly selected
food, or food of poor quality badly cooked, than to
any insufficiency. Those who do not know the
"poor" would be amazed to find how enormously
the working classes over-eat. One of the causes of
this vice is greed ; another is cheap food ; but the
principal cause is bad cookery.
It would be difficult to speak too severely of the
absolutely vile cooking of the average working-man's
wife. She has commonly two ways of cooking meat.
It is "stewed" that is, boiled to a tough, stringy
mass with vegetables, including plenty of onions : or
it is " fried " or " stewed in the pan " ; which means
that it is reduced to the consistency of shoe-leather by
throwing it into a frying-pan containing a little boil-
ing water. In other cases all the salts are boiled out
of the vegetables and the water poured away.
This tasteless or onion-flavoured stuff has little food
value. Such "cookery" is ruinous to the teeth, the
stomach, and the nerves; it is one of the chief causes
of alcoholism, and it is undoubtedly responsible for
many cases of tuberculosis.
Our council schools ignore the fact that they are
dealing with a population which is, to begin with, of
inferior or backward stock for the " lower classes"
are the remnant of the conquered races Mediter-
ranean, Pict, Celt, Iberian, Saxon, Angle who have
sunk into servitude beneath successive waves of con-
quering Romans, Danes, and Normans and which,
alas ! is largely diseased and degenerate. The cur-
riculum, purely theoretical, is utterly useless, and the
little that is learned is forgotten within a year of
226 SOCIAL DISEASES
leaving school. If girls were taught to scrub, sew,
wash, cook, and care for children, and instructed in
the facts of sex and child development, they would
still be able to understand half the words in the
bilingual newspapers, which, because they never
learned any Latin root-words, are largely unintelli-
gible to them, and they might conceivably make
tolerable wives and mothers.
As for bad air the plebeian distrust of open
windows is proverbial. The reason for the prejudice
is not so generally understood. Working-men wear
under- vests or shirts of cheap "mixture," largely
cotton. This becomes easily soaked with sweat, and
once damp remains clammy and sodden. Such
clothing is in itself one of the chief causes of tuber-
culosis. An open window is one thing to a man with
a newly-washed body clad in warm dry wool ; to a
man with a clammy, unwashed body wearing cold,
clammy underclothing an open window in a germ-
laden house means draughts, colds, rheumatism. As
the working-classes very generally sleep in their
underclothing the windows remain closed at night
also. The remedies are cheap wool, and education.
Again, the State must realise that Victory Loans are
not the only things that can be advertised ; and that
a narrow scholastic curriculum is not education.
The problem of syphilis is exceptionally difficult
and serious in England because of the policy of
prudery, hypocrisy and suppression which has
hitherto made all open discussion of sexual problems
impossible. Children grow up in utter ignorance of
the real facts or the vast importance of sex : what
knowledge they do obtain is incorrect, and smirches
the mind, so that the more fastidious reject even that.
THE SOCIAL MALADIES IN ENGLAND 227
Such a policy of obscurantism results, in healthy,
growing children, in morbid curiosity; finally, very
often, in obsession. Ignorant of the dangers that
confront them, boys and young girls contract
diseases of whose existence they are barely aware,
avoid treatment, and are ruined for life. General
practitioners have in the past refrained from telling
their patients the grim truth, so that they have mar-
ried as soon as they were considered, or considered
themselves, free from infection.
Of late certain novels, and such plays as Brieux'
" Damaged Goods," have sought to ventilate the
question ; but so profound is the ignorance of certain
classes that in many parts of England not one woman
in ten clearly realised the purport of Brieux' play.
The great machine for propagating syphilis and
infecting the general population used to be the Army.
Attempts were made to enforce the registration and
medical examination of all prostitutes in garrison
towns and naval ports. They were abandoned partly
because they were not very efficient, and partly as a
result of a sentimental campaign due to the fact that
suspect but actually respectable girls were occasion-
ally examined.
The system might be made effectual, but as Dr.
Hericourt has shown us, it invites the most terrible
abuses.
Ordinary police vigilance and education seem to
have been more successful. The official statistics of
venereal disease in the Armv are as follows :
228 SOCIAL DISEASES
Ratios of Admission per cent, per annum for Venereal
Disease in the Alder shot Command, London District,
and United Kingdom.
United
Aldershot. London. Kingdom.
1885 32-17 ... 33-94 ... 27-54
1897 J 3'oo ... 16-52 ... 12-75
1900 8-44 ... 13-22 ... 8-59
1905 7-99 ... 17-65 ... 9-05
1910 5-00 ... 13-70 ... 6-50
1913 2-98 ... 9-56 ... 5-09
It will be seen that the rate of admission in the
Army has been enormously reduced. This is due
chiefly to education, largely in the matter of pro-
phylaxis. But in 1885 it will be noted that every three
years the entire British Army was infected. Those
men were the fathers of the present generation. It is
little wonder that in some parts of England 40 per
cent, of recruits had to be refused, in 1914, as
physically defective.
In the Indian Army matters were even worse. The
curve of admissions runs up into a peak, showing the
terrible ratio of 58 per cent, for the year 1895,
Prompt measures, steadily applied, have gradually
reduced this figure to 5-2 per cent, for 1910.
As regards the general population, the figures re-
lating to the death-rate from venereal diseases are
utterly unreliable, since medical men are becoming
increasingly unwilling to register deaths as due to
such diseases. The opinion of the Commission on
Venereal Diseases was that the prevalence of syphilis
has not markedly decreased of late years, although
THE SOCIAL MALADIES IN ENGLAND 229
with new methods of treatment its manifestations are
less violent.
The extraordinary reduction obtained in the Army
before the war, and in the Australian and American
Armies during the war, point to the fact that pro-
phylactic treatment should be as far as possible
generalised by education and the establishment of
clinics.
So much for prophylaxis after coition. But the
true method of preventing venereal disease lies in
another direction in the prevention of prostitution.
The real facts of prostitution are seldom faced ;
perhaps because they are not flattering to our national
self-esteem, and because they confront us with that
disheartening bogey of the sociologist a vicious
circle.
First, as to the supply. Some pious persons believe
the prostitute to be a highly vitalised woman of
violent sexual passions, who leads a "gay" life be-
cause it is to her taste.
Nothing could be further from the truth, as re-
gards this country. (In France the type is not un-
known, though the abnormally thrifty type is
commoner.) The prostitute is nearly always a
degenerate, under-vitalised, often under-sexed, and
in some degree mentally deficient.
Four chief factors are responsible for recruiting the
profession. These are (0 starvation; (2) laziness or
anaemia the two are almost synonymous; (3) a
vulgar love of finery ; (4) the conviction that a
"fallen" woman must "go on the streets." The
action of these factors is usually mixed.
The first factor sends an occasional prostitute back
to the streets oftener than it makes a new recruit.
230 SOCIAL DISEASES
The first steps require a certain recklessness which
the starving seldom possess.
Laziness : This recruits many girls from shops and
factories. They see other girls go the easy way.
Apparently a life of rest, leisure, ease, and pretty
clothing awaits them if they are willing to cast them-
selves adrift from respectability. The healthy girl
has healthy passions ; the idea of chance promiscuity
disgusts her. The under-sexed girl is less fastidious.
As a rule, those who yield to this factor, or to the
love of finery, are more or less mentally deficient.
Recent investigation has shown that from 40 to 60
per cent, of the children attending the primary
schools of London are mentally unable to profit fully
by the curriculum. Only the laziest of these
mentally and physically that is, the most deficient,
would as a rule become prostitutes. The rate of
mental deficiency or dullness must therefore be even
higher among these last.
The conviction that a " fallen woman " must go
on the streets is responsible for the degradation of
practically all those women who become prostitutes
as a result of seduction.
Being mentally lazy, the prostitute is of all women
most conventional. It is the conventional who lapse
on to the streets. The idea of their own degradation
hypnotises them.
Servants, shop-girls, farm servants, village girls,
etc., who have been seduced belong to this class.
Very often the parents are responsible. The fact of
seduction is discovered ; the culprit is turned out of
doors with a direct reminder that respectable people
will henceforth have nothing to do with her. Only
the mentally sturdy resist the suggestion.
THE SOCIAL MALADIES IX ENGLAND 231
If there is a child the need of maintaining it may
drive the mother on to the streets. If she bears it in
a rescue home or hospital she becomes aware that her
fellow sinners fully expect her to be "gay" in
future. If she goes to an obliging "lady friend"
the latter is often only too willing to put her feet on
the primrose path.
Very often the mistress or employer of the servant
or shop-girl is more to blame than the seducer. The
world of "virtuous " women form a trade union that
has no pity on blacklegs. Any change of morality in
the direction of freer sex relations would make it
more difficult for unattractive women to establish
themselves as respectable parasites; and mothers
would find it more difficult to get rid of their
daughters.
Very often the difference between the "fallen"
woman and the respectable matron is only that the
former has been more generous, less calculating.
There is no great virtue in an official registration ; and
the woman who brings a healthy child into the world
has deserved well of her country. It is horrible that
a woman who knows the pains and fears and joys of
maternity should turn upon a friendless girl for whom
they are aggravated or marred by financial disaster.
The result of charity, however, is not always
encouraging. Any woman who is brave enough or
enough of a practical Christian to befriend an "un-
married wife" is shunned by her neighbours. Even
her beneficiary may insult her. I remember a case
in which a servant, greatly troubled about the pay-
ment of maintenance for her child, confided in her
mistress. The latter was extremely kind and helpful,
16
232 SOCIAL DISEASES
and tried to restore the girl's self-respect. To her
horror, the girl eyed her with a leer, saying: " It's
easy to see as how you've been in the same box your-
self, else you wouldn't be so feelin' ! "
The general feeling in respect of such matters is a
terrible indictment of the respectable women. I have
heard such say complacently: "There must be bad
women : if there were not, no woman would be good."
It is a fact that the trade union of "virtuous " women
is made possible by, and requires, prostitution. That
is its condemnation, for nothing could be worse than
prostitution and its results.
Now let us consider the demand. It is almost
axiomatic that the prostitute is not attractive to the
healthy sober man. She is of an inferior class; un-
beautiful ; uncleanly in her habits ; she is undersexed,
often devoid of sexual appetite ; she is out of health, if
not actually diseased; and she invariably drinks.
Apart from a few unfortunate men or boys whose
tastes have been utterly debased by a bad education
or vicious companions, such a woman is disgusting
to any man when sober, unless he is obsessed by sex
and rendered desperate by suppression.
Early instruction in the facts of reproduction, and
a careful suggestion of the wonder, dignity, import-
ance, beauty, and romance of sexual selection, to-
gether with free social intercourse at all ages with
those of the opposite sex would enormously reduce
the demand. Still more would proper instruction in
the dangers of venereal disease and the folly of speak-
ing to a strange woman when partly or wholly intoxi-
cated. For while alcohol does not increase desire, it
does decrease caution, and throws a glamour over the
unbeautiful. The drunken man is not fastidious.
THE SOCIAL MALADIES IN ENGLAND 233
But the great prevention of venereal disease is, of
course, early marriage.
Writing for French parents, who are too much
given to acquiescing in the dangerous sexual adven-
tures of their sons, Dr. Hericourt rather strains the
facts in one respect. While abstinence does no
physical damage to young men, 1 it is capable of
causing terrible moral distress, and in many cases
an absolute physical and mental obsession.
A reform in the direction of early marriage, if
marriage is to mean the setting up of a household and
the rearing of children, must be preceded by a radi-
cal economic reform. But would such marriages be
successful ? Very young people are not fitted for the
responsibilities of family life. Moreover, such mar-
riages would be the result of mere propinquity, or
chance encounter, or of an exasperated appetite; the
man or woman thus chosen might differ in every
respect from the husband or wife who would be
chosen five years later.
It is probable that the real solution lies in the direc-
tion of easy divorce ; perhaps of a special kind of
early marriage; extra-domestic, not involving house-
keeping or child-bearing, and only permanent when
it proves to be suitable. Mr. Bernard Shaw has
suggested something of the kind. Or with the
advance of feminism sexual relations may become
freer.
Here, at least, nothing can be expected from the
State. Some years ago a novel was published which
dealt with this problem. A young man, whose best
friend had acquired syphilis and committed suicide,
1 To women, of course, enforced celibacy is actually physically
harmful.
234 SOCIAL DISEASES
was yet on the point of incurring the same danger,
maddened by the obsession of a suppressed function.
The woman who had brought him up from childhood,
being still young and comely, and equally a victim of
enforced celibacy, offered herself to save him. Most
open-minded people welcomed the book as courageous
and healthy in its tendency. It was seized and
burned by the police, and the possession of a copy
was made an offence.
At the present time there is a recrudescence of
prostitution and disease, owing to the mobilisation of
a huge army. But many of the prostitutes are casual
or occasional; they have not abandoned work in the
day-time ; they will not continue to live as prostitutes.
Meanwhile, the spread of disease has been serious.
On the whole, however, the situation as regards
prostitution and venereal disease is fairly encourag-
ing. There seems a tendency to a rather freer
morality, which, however much the orthodox may
dislike it, is more natural, more dignified, and less
perilous to the race than a system of suppression
based upon prostitution and disease. Whatever the
defects of any alternative system, it could not be
worse than the present one. The most discouraging
aspect of the current situation is the spread of disease
among the general population.
As regards alcoholism the situation is bad. Alco-
holism leads to prostitution and increases venereal
diseases ; it shortens life ; it decreases productiveness.
Already, owing to the insane " ca' canny " policy of
the trade unions, the American worker produces three
times as much as the British worker. A dry
America will be soon more efficient. Our workers,
while bent upon shortening the hours of work
THE SOCIAL MALADIES IN ENGLAND 235
and reducing the amount of work done, have
threatened "direct action" if their drink supply is
curtailed.
The economic education of the British worker is so
rudimentary that he is convinced that money is
wealth. He has never realised that commodities are
the only wealth, and that only a highly productive
country can be wealthy.
Mr. F. W. Taylor, the famous American labour
expert, had under his control a machine imported
from England. A gang of English artisans was
engaged to work the machine. The rate of produc-
tion was low ; the English workers refused to raise it.
If they did the employers would make more money.
After preaching elementary economics to them for
some years Mr. Taylor discharged them. Before
long a specially trained gang of American workers
was producing ten times as much as the Englishmen
had consented to produce.
If the British worker could be converted to the
necessity of intensive production, and induced to
accept piecework, he would see that it is to his interest
to decrease his drink bill and to cease drinking during
working hours : for experiment shows that alcohol
greatly reduces the capacity for exertion. Every
walker or cyclist knows this. The British working-
man, on the other hand, believes that he cannot work
without beer. This is to confess himself a confirmed
alcoholic.
The figures relating to alcoholism are truly alarm-
ing. The deaths directly due to alcoholism in the
period 1902-06 were 12,184. This gives an annual
average of 2,437. If to this figure we add the annual
deaths from cirrhosis of the liver we obtain an annual
236 SOCIAL DISEASES
average of 6,400. But for one death attributed
directly to alcohol how many are indirectly due to it?
The alcoholic catches cold, and dies of broncho-pneu-
monia ; he breaks a limb, and dies of pneumonia ; he
contracts a fever, and dies. The death-rate of the
alcoholic is enormous.
Perhaps no figures are more convincing than those
relating to the rejection of recruits in Sweden, where
a system of local option resulted in an enormous re-
duction of drunkenness. This reduction is expressed
in the following figures :
Rejection of Recruits in Sweden.
Years. Per Cent.
1831-40 357
, 1841-50 36-4
1851-60 357
1861-70 27-8
1871-80 237
1881-90 20-4
Again, the reports of the Sceptre Life Association
show that in the general class of insured persons the
ratio of actual deaths to expected deaths was, in
1904-8, 80 per cent. The ratio among abstainers was
48 per cent. The death-rate of certain " temperance "
insurance societies is 53 per cent, of the general
death-rate.
It is most unlikelv that the British working-classes
would accept Prohibition. Thev have stated in no
uncertain voice that thev would not. And Prohi-
bition is not as a rule successful ; it leads to the secret
drinking of vile spirits, and is a tyrannous restriction
THE SOCIAL MALADIES IN ENGLAND 237
on the liberty of the strictly moderate drinker.
Probably the best results would be obtained by a law
permitting the sale of spirits only upon presentation
of a medical prescription ; while light wines should be
imported free of duty and sold at popular prices.
Beers should be reduced to the strength of lagers.
The removal of the duty on wines imposed to favour
our brewers and distillers would also stimulate a
most lucrative trade with France.
As for the cause of alcoholism, the great cause is
degeneracy. Pleasure is defined as the mental con-
comitant of the natural functioning, within the limits
of repair, of a fully nourished nervous structure. The
degenerate's nerves are underfed. He is unhappy,
restless, discontented, tormented by malaise or
fatigue. Alcohol, a stimulant, increasing the cellular
combustion, makes him for the time the equal of the
normal man. His work fatigues him; he seeks alco-
hol. His leisure bores him ; he seeks alcohol.
Slowly poisoned, his nervous system becomes more
and more under-nourished, and the craving increases
until it becomes continual.
Degeneracy causes alcoholism ; alcoholism causes
degeneracy. It is a vicious circle. Similarly, volun-
tary sterility of the upper classes results in the pre-
ponderance of a degenerate lower class. This means
higher taxation ; which means more voluntary
sterility.
Vicious circles can be broken only by radical
measures by the introduction of a third factor.
Education and the application of all possible measures
that may prevent degeneracy may break the bonds of
alcohol.
We now come to sterility. The remedy for the
238 SOCIAL DISEASES
actual sterility due to venereal disease and alcoholism
is obvious. But the problem of voluntary sterility
is by no means the same in England as in France.
France is actually becoming depopulated, the
fundamental reason being the worship of money
which is responsible for her marriage-system. Her
very existence has lately been threatened. It may be
threatened again ; and then, if her population is not
larger, she may perish.
Dr. He"ricourt is therefore correct in stating that
for France quantity is of greater importance than
quality ; since in time of national peril even the unfit
are mobilised.
But in England what would be the result of volun-
tary sterility if wisely applied ? How is it applied
now?
The great danger of voluntary sterility is that it
is usually adopted by the very classes whose multi-
plication is desirable, while it is ignored by those
whose reduction or extinction is desirable. It results
in the selection of the unfit.
There is no particular propaganda one way or the
other in this country. Books recommending the
restriction of the birth-rate are advertised ; appliances
are freely sold. But they reach the wrong class.
Some time ago an attempt was made in America to
convert the lower classes to Neo-Malthusianism. The
problem of poverty and unemployment was becoming
more and more terrible. Having restricted foreign
trade by an insane system of tariffs, the American
manufacturers were always over-producing, and
" closing down." In every great city there was a
vast floating population of the unemployed. And
immigration was always adding to the population.
239
Certain reformers, alarmed at the rapid increase of
the backward foreign element as compared with the
Anglo-Saxon American, and hoping to alleviate
poverty, started a Neo-Malthusian propaganda.
In America the "big businesses" subscribe largely
to the Churches, as they do to any cause that will
support them. The Churches are bound hand and
foot to the millionaires.
Now the millionaires were alarmed by the Neo-
Malthusian propaganda. They desired a permanent
population of unemployed persons living in dire
poverty as the surest means of keeping wages low.
Such a state of affairs enabled them to defy the
Unions.
They took counsel. They bribed the Legislatures
and spoke softly to the Churches. The result was a
law forbidding the publication, sale, or postage of
any Malthusian propaganda ; with the result that
young women of culture interested in social reform
were sent to prison.
As a result, the alien populations of the United
States continued to multiply like mice or rabbits.
And when the venom of Bolshevism has infected
them the millionaires will probably rue their and-
Malthusian campaign.
The problem of France is special. Elsewhere there
has been too much of the unrestricted multiplication
of the inferior elements of the population. In Eng-
land, a generation ago, two reformers were im-
prisoned for advocating restriction. The ground of
objection was then immorality. Sexual intercourse
not intended to produce children is immoral it is
still the attitude of some of the clergy. It is of course
sheer hypocrisy : else these reverend gentlemen would
240 SOCIAL DISEASES
separate from their wives on the second day of the
honeymoon.
To-day the objection may be raised that a populous
country is strong and wealthy. Within limits this is
true. But it cannot feed itself, and may be starved
by an enemy.
As a matter of fact we are already over-populated
and are sending emigrants to the Colonies. But that
is not the question. The real objection to restriction
is that it is in the hands of the wrong class a point
to which we shall presently return.
There is unfortunately one form of voluntary
sterility which is practised by the lower classes, in
England as in France. That is abortion. In France
there is usually an accomplice. There the unfortu-
nate national ideals of economy to put it brutally,
the worship of wealth and the tyranny of the family
have made the crime almost respectable. But in
England there is a reluctance to meddle with a serious
legal offence. It is true that in the North of England
many chemists openly sell drugs to procure abortion,
while seedy practitioners make a practice of " help-
ing " women; and I could name a watering-place
where the leading chemist sells suitable drugs, while
the oldest doctor is always ready to oblige a woman
in trouble. But these are local conditions : as a rule
the Englishwoman has her own methods, so that it
is impossible to take legal proceedings. She does not
divulge the particulars to her physician, but is ready
enough to confide in sympathetic employers, social
workers, neighbours, etc. In many a working-class
family a yearly or half-yearly abortion is as ordinary
an event as the yearly birth of a child in other
families. The expedients employed from striking the
THE SOCIAL MALADIES IN ENGLAND 241
body against a sharp corner to jumping from heights,
and the use of all manner of improvised implements or
strange drugs are hair-raising. And sooner or
later they fail : illness alarms the woman and pre-
vents their repetition ; and a sickly, deformed, or
insane child is born.
It is the woman who " goes out to work " who is
the chief offender. At thirty she is old, toothless,
yellow, withered. The abuse of stewed tea and
abominable cookery are partly responsible; but it is
chiefly abortion that turns the fresh if anaemic young
girl of twenty into the hag of twenty-five or thirty.
Terrible as are the results of abortion, they are not
very widespread. The lower classes are still far more
fertile than the classes above them. And before we
condemn Neo-Malthusianism as altogether unholy, let
us return to its actual effect.
Its danger, as we have seen, is that it is wrongly
applied. It makes for the fertility of the lower types
and the extinction of the higher.
At any time the excessive multiplication of the
lower classes is unfortunate. It may lead only to an
industrial tyranny, as was intended in America. But
it may threaten the existence of civilisation.
Let there be no mistake about it. The " lower
classes" are not down-trodden equals; they are
inferiors. They are the descendants of backward
and conquered races. Inequality does not arise from
our economic system ; the latter arises from in-
equality.
It should be possible to establish legal and political
equality. It should be possible to establish economic
equality. If children were taught not by persons
drawn from their own class, but by the very finest
242 SOCIAL DISEASES
types available, it is conceivable that equality of
manners, or social equality, could be attained. But
equality of ability, of physical perfection, of brain-
power, can never be obtained save by a crossing that
would debase the race. Bishops and other reformers,
speaking of housing reforms, express themselves as
though a healthy, beautiful generation must needs be
born into a world of model dwellings. Yet they
would not expect to turn mongrels into prize grey-
hounds by giving them a spacious kennel. The
inferior cannot be made superior. But he can be
made to outnumber, overwhelm, and destroy the
superior. The process has already begun.
The French Revolution, crossing Germany,
arrived in Russia as Marxism. A gang of outcasts
political criminals, Jews, degenerates erected it
into the doctrine of Bolshevism.
Now anyone who will take the trouble to read the
published writings of Lenin and Trotsky will dis-
cover that they have, in the last resort, only two ideas.
One is the "dictatorship of the proletariat " actually
the dictatorship of a small body of cunning rascals
over the proletariat. The other is " the class war "
the deliberate murder or starvation of the whole of
the upper and middle classes.
Bolshevism is the creed of degeneracy and in-
feriority. The diseased proletariat has become " class
conscious." It has seen itself. "Class conflict" is
only a phrase, a pretext ; the reality of Bolshevism is
inferiority's hatred of itself, and of all that makes it
conscious of its own inferiority. Whatever makes it
conscious of itself it seeks to destroy. We saw the
process in the French Terror and the Commune. We
see it now in Russia ; and to the shame of Europe the
THE SOCIAL MALADIES IX ENGLAND 243
superior classes of other countries have passed by on
the other side. We shall see it wherever the middle
and upper classes, by restricting their birth-rate while
the degenerate and backward continue to increase,
become too weak to hold their own in the class
war.
The position in England is one of danger. Many
newspapers are curiously tender to the Bolshevik
cause. Vast sums of money are being spent by the
Bolshevik emissaries in our midst. Caliban is pre-
paring his revenge.
The British working-man and I am not now
speaking of the degenerate has lately become con-
scious of his own powers, as Germany became
conscious of hers in 1870. He has read a few books,
and is in the bumptious stage, as Germany was be-
fore the war. He is convinced that he is as good as
anyone, and better.
At the same time, he is uneasily aware of his own
defects, and he hates all that makes him so aware.
He is dangerous because he confuses the brainworker
anyone, indeed, with a clean collar and a clean
accent with the " capitalist." His enemy is the
whole cultivated class. He is biding his time.
Bamboozled by lawyer politicians and a corrupt
newspaper trust, he and his wife whom the adroit
politician gave a vote that the newspapers might lead
her by the nose have elected a Parliament of un-
scrupulous " interests." Already disillusioned and
indignant, he is threatening "direct action."
The revolution may come to-morrow or twenty
years hence. When it comes it will, as always, be
captured by the degenerate, the outcast, the criminal ;
because they will be inspired by a living passion
244 SOCIAL DISEASES
hate and will know exactly what they want the
destruction of all that makes them feel their hideous-
ness.
In country after country, where the inferior strains
are degenerate, and outnumber the superior, de-
generacy and poverty will revenge themselves upon
civilisation. And in the process it may well be that
all that has made civilisation possible, or can make
it possible in future, will perish from off the earth.
For it has taken all time to make us what we are ; and
what has once been taken from a race can never be
added to it again.
Only one thing can avert the danger the increased
fertility of the finer strains. At present the situation
is far from hopeful. Feminism has made it less so.
Yet in feminism or at least in our women our only
hope seems to lie. The slender girls, the slim young
matrons whose chief aim appears to be to conceal the
fact that they are physically adapted to nurture their
young, would, we may be sure, bear children for the
nation as cheerfully and pluckily as they drove
motor-cars or dressed hideous wounds or toiled at the
lathe or fitting-bench during the war. To enlighten
them is a matter of propaganda.
They of all women must renounce sterility. And it
is a question whether their less fortunate sisters
should not be the object of a contrary propaganda.
But what we need for without faith no propaganda
can be long effective is a new religion. Christianity,
interpreted by Paul, a worn-out Oriental, has contained
a fatal discord : it has not allowed for sex. We need
a religion of beauty, of perfection. It would be a
simple matter to teach children to worship perfection
rather than hate it because it reveals their own
THE SOCIAL MALADIES IN ENGLAND 245
imperfection. For we cannot teach what beauty is
without making plain the hideousness of egoism.
Beauty is the outward and visible sign of health
perfection virtue. Pleasure is the perception of
beauty, or some of its elements. What makes for
the fullness and perfection of life, for beauty and
happiness, is good; what makes for death, disease,
imperfection, suffering, is bad.
These things are capable of proof, and a child may
understand them. Sin is ugly and painful. Perfec-
tion is beautiful and gives us joy. We have appealed
to the Hebraic conscience for two thousand years in
vain. Let us appeal to the love of life and beauty
which is innate in all of us. A beauty-loving people
could not desire to multiply a diseased or degenerate
strain, or hate men and women because they were
strong and comely and able. We have reached a
point where only the frank worship of life a religion
of kindness, generous admiration, and fine work
can save us from the orgy of hatred and the love of
hideousness which is the Nemesis of Russian tyranny
and the Industrial Revolution. The balance of
the races is overset, and only the abandonment of
voluntary sterility by the fit, and its adoption by the
unfit which is eugenics can save us.
It will be seen that in various directions the social
maladies confront us in England with problems not
wholly the same as those which confront the French.
For the solution of these problems and on this the
fate of civilisation rests we must trust to clear
courageous thought and resolute propaganda. We
have the right to look to the State for a lead : but we
shall look in vain if we do not think out these prob-
lems for ourselves, and elect, to represent us, men
246 SOCIAL DISEASES
fitted to deal with them, in place of allowing an
alliance of the Bar and the Press to force upon us the
secret henchmen of corrupt interests. It is for us to
save democratic parliamentary government, and to
avert the so-called democracy, but actual tyranny of
the lowest, which would only aggravate the social
maladies that threaten to destroy us.
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