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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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