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SOCIAL HYGIENE
VOLUME III
PUBLISHED BY
THE AMERICAN SOCIAL HYGIENE ASSOCIATION
Wo WEST FORTIETH STREET
NEW YORK CITY
OFFICE OF PUBLICATION
THE WAVERLY PRESS
BALTIMORE, MD
(SUPPLEMENT TO SOCIAL HYGIENE, VOL. Ill, No. 4, OCTOBER, 1917)
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L31
CONTENTS
BY AUTHOR, TITLE, AND SUBJECT
Advisory Committee on Venereal Dis-
eases. Method of attack on ve-
nereal diseases. 455.
Alcohol.
Prostitution and alcohol. W.
Clarke. 75.
The American Journal of Syphilis.
143.
Amusements.
The public dance halls of Chicago.
400.
Public morals and recreation. C.
W.Hayes. 331.
The Atlanta campaign against com-
mercialized vice. M. M. Jack-
son. 177.
An Australian report on venereal dis-
ease. 145.
Bates, Gordon. The control of vene-
real diseases. 471.
Blaschko, A. The combating of vene-
real diseases in the war. 529.
Blaschko, A. The war and venereal
diseases. 546.
The "block system" of the Juvenile
Protective Association of Chi-
cago. 402.
Boies, Elizabeth. The girls on the
border and what they did for the
militia. 221.
Bois, Jules. The new moral viewpoint
of the French young man. 165.
Brewer, Isaac W. The venereal peril.
103.
The British National Council for Com-
bating Venereal Diseases. 151.
The Brooklyn Hospital Dispensary,
Genito-Urinary Department.
259.
Brown, Louise Fargo. The responsi-
bility of the dean of women for
sex instruction. 372.
The Bureau of Social Hygiene. J. D.
Greene. 1.
Cady, Bertha Chapman. How shall
we teach? The normal schools
and colleges and the problem of
sex education. 367.
Camp mothers and policewomen in
New York. 595.
Chargin, Louis. Recent progress in
New York's venereal disease
campaign. 477.
A city government survey in Colum-
bus, Ohio. 398.
A city that reports its venereal disease
cases. 287.
Clarke, Walter. Prostitution and al-
cohol. 75.
Clinics for venereal diseases. W. F.
Snow. 11.
The combating of venereal diseases in
the war. A. Blaschko. 529.
Commercialized prostitution in New
York city in 1916. 282.
Continued agitation against segrega-
tion in Japan. 135.
The control of venereal diseases. G.
Bates. 471.
Control of venereal diseases in Austra-
lia and Denmark. 290.
Deportations of prostitutes. 292.
Diseases in the war. W. Scholtz. 551.
Disturbing conventions. 142.
England makes progress in combating
venereal diseases. L. R. Wil-
liams. 465.
Exner, M. J. Prostitution in its rela-
tion to the army on the Mexican
border. 205.
Falconer, Martha P. Industrial
schools for girls and women.
323.
Finger, Ernest. Venereal diseases and
the war. 534.
Fischer, W. Venereal diseases at the
front. 564.
The Food and Drugs Act in its relation
to social hygiene. T. C. Mer-
rill. 521.
A French view of social hygiene. 140.
The German campaign against vene-
real diseases. 415.
11
CONTENTS
The girls on the border and what they
did for the militia. E. Boies.
221.
A good editorial and an interesting let-
ter.* 107.
Goodwin, T. H. The venereal diseases
— a world problem in epidemi-
ology. 451.
A great public health problem. 599.
Greene, Jerome D. The Bureau of
Social Hygiene. 1.
Group study courses. 155.
Guardians of the law, take heed. 296.
Hayes, C. Walker. Public morals and
recreation. 331.
A health exhibit for men. F. J. Os-
borne. 27.
Hooker, Donald R. In defense of radi-
calism. 157.
How shall we teach? B. C. Cady.
367.
Illegitimacy.
Disturbing conventions. 142.
In defense of radicalism. D. R.
Hooker. 157.
Industrial schools for girls and women.
M. P. Falconer. 323.
The injunction and abatement law in
Erie, Penna. 139.
The injunction and abatement law in
Indianapolis. 137.
Instruction to soldiers. 597.
Jackson, Marion M. The Atlanta cam-
paign against commercialized
vice. 177.
Johnson. Bascom. What some com-
munities of the West and South-
west have done for the protec-
tion of morals and health of sol-
diers and sailors. 487.
Juvenile Protective Association, Chi-
cago. 402.
Kansas makes venereal disease noti-
fiable. 600.
Klausner, E. War and venereal dis-
eases. 558.
The Lakeside Hospital, Cleveland,
Ohio. 288.
Lawrence, David. Washington, the
cleanest capital in the world.
313.
Legislation.
The Food and Drugs Act in its re-
lation to social hygiene. T. C
• Merrill. 521.
Injunction and abatement law in
Erie, Penna. 139.
Injunction and abatement law in
Indianapolis. 137.
Kansas makes venereal disease
notifiable. 600.
The Mann White Slave Traffic Act.
278.
Matter and method of social hy-
giene legislation. T. N. Pfeif-
fer. 51.
Reporting of the venereal diseases
in New Jersey. 599.
Social hygiene legislation in 1916.
253.
The Western Australia act for the
control of venereal disease. 148.
The life force. 295.
London's campaign against vice. 137.
The Mann White Slave Traffic Act.
278.
Martin Franklin. Social hygiene and
the war. 605.
The Massachusetts State Department
of Health. 405.
The matter and method of social hy-
giene legislation. T. N. Pfeif-
fer. 51.
The medical adviser and his correspond-
ence file. W. F. Snow. 505.
Mendel, Kurt. Prophylaxis of vene-
real diseases at the front. 553.
Merrill, T. C. The Food and Drugs
Act in its relation to social hy-
giene. 521.
Method of attack on venereal diseases.
Advisory Committee on Vene-
real Diseases. 455.
Military measures against the treat-
ment of venereal diseases by
charlatans. 572.
The Missouri Children's Code Com-
mission. 291.
Moral conditions on the streets of
London. 590.
The Morals Court of Chicago. 144.
Mothers' confidential registry letters.
404.
National Education Association. 596.
Neisser, Albert, War and venereal
diseases. 542.
Neisser, Albert. War, prostitution and
venereal diseases. 537.
The new moral viewpoint of the French
young man. J. Bois. 165.
Osborne, Frank J. A health exhibit
for men. 27.
CONTENTS
111
Pappritz, Anna. The spread of vene-
real diseases in the army and its
prevention. 566.
Pfeiffer, T. N. The matter and
method of social hygiene legisla-
tion. 51.
Prevalence of syphilis as indicated by
the routine use of the Wasser-
mann reaction. 288.
The prevention of venereal diseases in
the French army. 414.
The prophylaxis of venereal diseases.
M. P. Ravenel. 185.
Prophylaxis of venereal diseases at the
front. K. Mendel. 553.
Prophvlaxis of venereal diseases in
Prussia. 289.
Prostitution.
The Atlanta campaign against
commercialized vice. M. M.
Jackson. 177.
Commercialized prostitution in
New York City in 1916. 282.
Continued agitation against segre-
gation in Japan. 135.
Deportations of prostitutes. 292.
In darkest Belgium. The fight
against prostitution. P. Schwe-
der. 561.
London's campaign against vice.
137.
The Mann White Slave Traffic Act.
278.
Prostitution and alcohol. W.
Clarke. 75.
Prostitution in the Dutch East
Indies. 128.
Prostitution in its relation to the
army on the Mexican border.
M. J. Exner. 205.
War, prostitution, and venereal
diseases. A. Neisser. 537.
What the press thinks about com-
mercialized vice in St. Louis.
285.
Prostitution in the armies and the
fight against it. K. Scheven.
545.
Prostitution in its relation to the army
on the Mexican border. M. J.
Exner. 205.
The public dance halls of Chicago.
400.
Public morals and recreation. C. W.
Hayes. 331.
The Public Morals Association of Syd-
ney, New South Wales. 290.
Ravenel, Mazyck P. The prophylaxis
of venereal diseases. 185.
Recent progress in New York's vene-
real disease campaign. L. Char-
gin. 477.
The reporting of venereal disease in
England. 412.
Reporting of the venereal diseases in
New Jersey. 599.
Reports on vice conditions in Bridge-
port, Connecticut; Paducah,
Kentucky; and St. Louis, Mis-
souri. 131.
The responsibility of the dean of
women for sex instruction. L.
F. Brown. 372.
Riggs, Charles E. A study of venereal
prophylaxis in the navy. 299.
Rucker, William G. The sword of
Damocles. 173.
St. Louis Public Health League. 592.
Scheven, Katherina. Prostitution in
the armies and the fight against
it. 545.
Scholtz, W. Diseases in the war. 551.
Schonheimer, H. The treatment of
venereal diseases after the war
and physicians' fees. 568.
Schweder, Paul. In darkest Belgium.
The fight against prostitution.
561.
Sex Instruction.
A health exhibit for men. F. J.
Osborne. 27.
How shall we teach? The normal
schools and colleges and the
problem of sex education. B.
C. Cady. 367.
Instruction to soldiers. 597.
The life force. 295.
Social hygiene activities of the
Maine Medical Association. F.
N. Whittier. 91.
The responsibility of the dean of
women for sex instruction. L.
F. Brown. 372.
The University of Wisconsin ad-
vises freshmen. 141.
The Shield. 143.
Smith, Edith Livingston. To all wom-
en and girls. 528.
Snow, William F. Clinics for vene-
real diseases; why we need them;
how to develop them. 11.
Snow, William F. The medical adviser
and his correspondence file. 505.
Snow, William F. Social hygiene end
the war. 417.
Social hygiene activities of the Maine
Medical Association. F. N .
Whittier. 91.
IV
CONTENTS
Social hygiene and the war. F. Mar-
tin. 605.
Social hygiene and the war. W. F.
Snow. 417.
Social hygiene in New South Wales.
416.
Social hygiene legislation in 1916. 253.
A South African report on venereal
• disease. 602.
The spread of venereal diseases in the
army and its prevention. A.
Pappritz. 566.
A study of one hundred and ninety-six
girls under supervision. 401.
A study of venereal prophylaxis in the
navy. C. E. Riggs. 299.
The sword of Damocles. W. C.
Rucker. 173.
Symmers, Douglas. Syphilis, a dis-
ease of diminishing severity.
197.
Syphilis and annulment of marriage.
152.
Syphilis, a disease of diminishing se-
verity. D. Symmers. 197.
Syphilis in the Austrian army. 601.
To all women and girls. E. L. Smith.
528.
Training camps must be clean of vice.
593.
Treatment of venereal disease in the
general hospitals of New York
state outside of New York city.
J. J. Weber. 97.
The treatment of venereal diseases
after the war and physicians'
fees. H. Schonheimer. 568.
The treatment of venereal diseases in
general dispensaries of New
York state outside of New York
city. J. J. Weber. 341.
The University of Wisconsin advises
.freshmen. 141.
Venereal diseases at the front. W.
Fischer. 564.
Venereal disease in the Italian army.
413.
Venereal Diseases.
An Australian report on venereal
disease. 145.
British National Council for Com-
bating Venereal Diseases. 151.
Brooklyn Hospital Dispensary,
Genito -Urinary Department.
259.
A city that reports its venereal
disease cases. 287.
Clinics for venereal diseases. W.
F. Snow. 11.
The combating of venereal dis-
eases in the war. A. Blaschko.
529.
The control of venereal diseases.
G. Bates. 471.
Control of venereal diseases in
Australia and Denmark. 290.
Diseases in the war. W. Scholtz.
551.
England makes progress in com-
bating venereal diseases. L. R.
Williams. 465.
The German campaign against ve-
nereal diseases. 415.
A great public health problem.
599.
A health exhibit for men. F. J.
Osborne. 27.
Kansas makes venereal diseases
notifiable. 600.
The Lakeside Hospital, Cleveland,
Ohio. 288.
The Massachusetts State Depart-
ment of Health. 405.
Method of attack on venereal dis-
eases. Advisory Committee on
Venereal Diseases. 455.
Prevalence of syphilis as indicated
by the routine use of the Was-
sermann reaction. 288.
, The prophylaxis of venereal dis-
eases. M. P. Ravenel. 185.
Prophylaxis of venereal diseases at
the front. K. Mendel. 553.
Prophylaxis of venereal diseases in
Prussia. 289.
Recent progress in New York's
venereal disease campaign. L.
Chargin. 477.
The reporting of venereal disease
in England. 412.
Reporting of the venereal diseases
in New Jersey. 599.
A South African report on venereal
disease. 602.
The spread of venereal diseases in
the army and its prevention. A.
Pappritz. 566.
A study of venereal prophylaxis in
the navy. C. E. Riggs. 299.
The sword of Damocles. W. C.
Rucker. 173.
Syphilis and annulment of mar-
riage. 152.
Syphilis, a disease of diminishing
severity. D. Symmers. 197.
Syphilis in the Austrian army.
601.
CONTENTS
Treatment of venereal disease in
the general hospitals of New
York state outside of New York
city. J. J. Weber. 97.
The treatment of venereal diseases
after the war and physicians'
fees. H. Schonheimer. 568.
Treatment of venereal diseases in
general dispensaries of New
York state outside of New York
city. 341.
Venereal disease in the Italian
army. 413.
Venereal diseases and the war. E.
Finger. 534.
The venereal diseases — a world
problem in epidemiology. T.
H. Goodwin 451.
The venereal peril. I. W. Brewer.
103.
The war and venereal disease in
Germany. 529.
The war and venereal diseases. A.
Blaschko. 546.
War and venereal diseases. E.
Klausner. 558.
War and venereal diseases. A.
Neisser. 542.
War, prostitution and venereal
diseases. A. Neisser. 537.
A Wassermann survey on 500 ap-
prentice seamen. 149.
What England is doing for the
venereally diseased. 229, 407.
What is Chicago doing for the
venereally diseased? 351. *
Venereal diseases and workingmen.
563.
The venereal peril. I. W. Brewer.
103.
Vice.
The Atlanta campaign against
commercialized vice. M. M.
Jackson. 177.
A city government survey in Co-
lumbus, Ohio. 398.
A good editorial and an interesting
letter. 107.
London's campaign against vice.
137.
Moral conditions on the streets of
London. 590.
Washington, the cleanest capital
in the World. D. Lawrence.
313.
Vice conditions and reform in New Or-
leans. 403.
Vice Investigation.
Bridgeport, Conn. 131.
Paducah, Ky. 131.
St. Louis, Mo. 131.
War and Social Hygiene.
Camp mothers and policewomen in
New York. 595.
The combating of venereal dis-
eases in the war. A. Blaschko.
529.
The girls on the border and what
they did for the militia. E.
Boies. 221.
In darkest Belgium. The fight
against prostitution. P. Schwe-
der. 561.
Military measures against the
treatment of venereal diseases
by charla-tans. 572.
The prevention of venereal dis-
eases in the French army. 414.
Prophylaxis of venereal diseases at
the front. K. Mendel. 553.
Prostitution in the armies and the
fight against it. K. Scheven.
545.
Prostitution in its relation to the
army on the Mexican border.
M. J. Exner. 205.
Social hygiene and the war. F.
Martin. 605.
Social hygiene and the war. W.
F. Snow. 417.
The spread of venereal diseases in
the army and its prevention.
A. Pappritz. 566.
Syphilis in the Austrian army.
601.
To all women and girls. E. L.
Smith. 528.
Training camps must be clean of
vice. 593.
Venereal disease in the Italian
army. 413.
Venereal diseases and the war.
E. Finger. 534.
Venereal diseases at the front.
W. Fischer. 564.
The venereal peril. I. W. Brewer.
103.
The war and venereal disease in
Germany. 529.
War and venereal diseases. E.
Klausner. 558.
What some communities of the
West and Southwest have done
for the protection of morals and
health of soldiers and sailors.
B. Johnson. 487.
When the soldiers come to town.
592.
With the United States troops on
the Mexican border. 154.
The war and venereal disease in Ger-
many. 529.
VI
The war and venereal diseases. A
Blaschko. 546.
War and venereal diseases. E. Klaus-
ner. 558.
War and venereal diseases. A. Neis-
ser. 542.
War, prostitution, and venereal dis-
eases. A. Neisser. 537.
Washington, the cleanest capital in the
world. D. Lawrence. 313.
A Wassermann survey on 500 appren-
tice seamen. 149.
Weber, Joseph J. Treatment of ve-
nereal disease in the general hos-
pitals of New York state outside
of New York city. 97.
Weber, Joseph J. The treatment of
venereal diseases in general dis-
pensaries of New York state out-
side of New York. city. 341.
The Western Australia act for the con-
trol of venereal disease. 148.
What England is doing for the vene-
really diseased. 229.
What Great Britain is accomplishing.
407.
What is Chicago doing for the vene-
really diseased? 351.
What the press thinks about commer-
cialized vice in St. Louis. 285.
What some communities of the West
and Southwest have done for the
protection of morals and health
of soldiers and sailors. B. John-
son. 487.
When the soldiers come to town. 592.
Whittier, Frank N. Social hygiene ac-
tivities of the Maine Medical
Association. 91.
Williams, Linsly R. England makes
progress in combating venereal
diseases. 465.
With the United States troops on the
Mexican border. 154.
BOOKS REVIEWED
BY AUTHOR AND TITLE
The adolescent period. Louis Starr.
385.
The- American Journal of Syphilis . 276.
Baker, Newton D. Social Hygiene
Education. 464.
Blackwell, Elizabeth. The purchase
of women. The great economic
blunder. 270.
Bonger, William Adrian. Criminality
and economic conditions. 394.
Boy life and self government. George
Walter Fiske. 385.
Boyology. H. W. Gibson. 385.
Bradbury, Harriet B. Civilization
and womanhood. 582.
Cady, Bertha Chapman and Vernon
Mosher Cady. The way life
begins. 26i4 .
Carson, William E. The marriage re-
volt. A study of marriage and
divorce. 390.
Child, Charles Manning. Individual-
ity in organisms. 122.
Child training. V. M. Hillyer. 116.
Civilization and womanhood. Harriet
B. Bradbury.. 582.
Community action through surveys.
Shelby M. Harrison. 117.
Cooper, Arthur. The sexual disabili-
ties of man and their treatment
and prevention. 588.
Cradles or coffins. James Marchant.
271.
My Creed. Mary R. Rinehart. 504.
Criminality and economic conditions.
William Adrian. 394.
Cunning, Mrs. Joseph and A. Camp-
bell. The healthy girl. 387.
The declining birth rate. National
Birthrate Commission. 388.
The Doctor and the War. William C.
Gorgas. 476.
Downward paths. An inquiry into the
causes which contribute to the
making of the prostitute. 381.
The eugenic marriage. W. Grant
Hague. 269.
Father, mother and babe. Anna Jen-
ness-Miller. 120.
Fifty years of Association work among
young women. Elizabeth Wil-
- son. 122.
Fiske, George Walter. Boy life and
self government. 385.
CONTENTS
Vll
Freud, Sigmund. Three contributions
to the theory of sex. 2&7.
Friendship, love and marriage. Ed-
ward Howard Griggs. 382.
Gallichan, Walter M. The great un-
married. 118.
Gamble, Eliza Burt. The sexes in sci-
ence and history. 577.
Garrett, Laura B. Study of animal
families in schools. 396.
Genetics. Herbert Eugene Walter.
123
Gibson, H. W. Boyology. 385.
Girlhood and character. Mary E.
Moxcey. 275.
Gorgas, William C. The Doctor and
the War. 476.
The great unmarried. Walter M. Gal-
lichan. 118.
Griggs, Edward Howard. Friendship,
love and marriage. 382.
Groves, Ernest R. Moral sanitation.
115.
Hague, W. Grant. The eugenic mar-
riage. 269.
Hamilton, Cosmo. The sins of the
children. 389.
Harrison, Shelby M. Community ac-
tion through surveys. 117.
Hartley, C. Gasquoine. Motherhood
and the relationships of the
sexes. 585.
Hayes, Edward C. Introduction to
the study of sociology. 126.
The healthy girl. Mrs. Joseph Cun-
ning and A. Campbell. 387.
The healthy marriage. G. T. Wrench.
587.
Healy, William. Mental conflicts and
misconduct. 576.
Heiner, R. G. Physiology, first aid
and naval hygiene. 378.
The hidden scourge. Mary Scharlieb.
271.
The high school age. Irving King.
386.
Hillyer, V. M. Child training. 116.
Holmes, John Haynes. Marriage and
divorce. 382.
Hyde, William DeWitt. Self measure-
ment. 382.
Individuality in organisms. Charles
Manning Child. 122.
Jung, C. G. Psychology of the uncon-
scious. A study of the transfor-
mations and symbolisms of the
libido. 267.
Jenness-Miller, Anna. Father, mother
and babe. 120.
Kelsey, Carl. The physical basis of
society. 575.
Keniston, James Mortimer. The king-
dom of the mind. How to pro-
mote intelligent living and avert
mental disaster. 267.
King, Irving. The high school age.
386.
The kingdom of the mind. James
Mortimer Keniston. 267.
Lamson, Armenhouie T. My birth.
269.
McManis, John T. The study of the
behavior of an individual child;
syllabus and bibliography. 588.
Marchant, James. Cradles or coffins.
271.
Marchant, James. The master prob-
lem. 579.
Marriage and divorce. John Haynes
Holmes. 382.
The marriage revolt. William E. Car-
son. 390.
The master problem. James Mar-
chant. 579.
The meaning of evolution. Samuel
Christian Schmucker. 124.
Meisel-Hess, Grete. The sexual crisis:
a critique of our sex life. 581.
Mental conflicts and misconduct.
William Healy. 576.
Miner, Maude E. Slavery of prostitu-
tion. A plea for emancipation.
26,3.
Moral sanitation. Ernest R. Groves.
119.
The mothercraft manual. Mary L.
Read. 392.
Motherhood and the relationships of
the sexes. C. Gasquoine Hart-
ley. 585.
Moxcey, Mary E. Girlhood and char-
acter. 275.
My birth. Armenhouie T. Lamson.
269.
National Birthrate Commission. The
declining birth rate. 388.
Obscene literature and constitutional
law. Theodore Schroeder. 393.
Parsons, Elsie Clews. Social rule. A
study of the will to power. 391.
Vlll
CONTENTS
Patrick, George F. W. The psychol-
ogy of relaxation. 121.
The physical basis of society. Carl
Kelsey. 575.
Physiology, first aid and naval hygiene.
11. G. Heiner. 378.
The psychology of relaxation. George
F. W. Patrick. 121.
Population: a study in Malthusianism.
Warren S. Thompson. 388.
Psychology of the unconscious. C. G.
Jung. 267.
Puller, Edwin. Your boy and his
training. 144.
The purchase of women. Elizabeth
Blackwell. 270.
Rational sex ethics. W. F. Robie.
578.
Rend, Mary L. The mothercraft man-
ual. 392.
Readings in social problems. Albert
Benedict Wolfe. 274.
Relative values in public health work.
Franz Schneider, Jr. 394.
Rinehart, Mary Roberts. My Creed.
504.
Robie, W. F. Rational sex ethics.
578.
Robinson, William J. Woman: her sex
and love life. 583.
Scharlieb, Mary. The hidden scourge.
271.
Schmucker, Samuel Christian. The
meaning of evolution. 124.
Schneider, Franz, Jr. Relative values
in public health work. 394.
Schroeder, Theodore. Obscene litera-
ture and constitutional law.
393.
Self measurement. William DeWitt
Hyde. 382.
The sexes in science and history.
Eliza Burt Gamble. 577.
The sexual crisis : a critique of our sex
life. Grete Meisel-Hess. 581.
The sexual disabilities of man and their
treatment and prevention. Ar-
thur Cooper. 588.
The sins of the children. Cosmo
Hamilton. 389.
Slavery of prostitution. Maude E.
Miner. 263.
Social Hvgiene Education. Newton
D. Baker. 464.
Social rule. Elsie Clews Parsons.
391.
To the Soldiers of the National Army.
Woodrow Wilson. 454.
Starr, Louis. The adolescent period;
its features and management.
385.
Study of animal families in schools.
Laura B. Garrett. 396.
The study of the behavior of an indi-
vidual child; syllabus and bibli-
ography. John T. McManis.
588.
Thompson, Warren S. Population: a
study in Malthusianism. 388.
Three contributions to the theory of
sex. Sigmund Freud. 267.
Walter, Herbert Eugene. Genetics;
an introduction to the study of
heredity. 123.
The way life begins. Bertha Chapman
Cady and Vernon Mosher Cady.
264.
Wilson, Elizabeth. Fifty years of As-
sociation work among young
women. 122.
Wilson, Woodrow. To the Soldiers of
the National Army. 454.
Wolfe, Albert Benedict. Readings in
social problems. 274.
Woman: her sex and love life. Wil-
liam J. Robinson. 583.
Wrench, G. T. The healthv marriage.
587.
Your boy and his training. Edwin
Puller. 114.
VOL. Ill JANUARY, 1917 NO. 1
THE BUREAU OF SOCIAL HYGIENE
JEROME D. GREENE
The modern attitude toward social problems is one of many
manifestations of the scientific spirit as applied to the various
affairs of life. In the fields of industry and commerce that spirit
has led to a revolution in method and an enormous increase in
the scope of human activity directed toward the material wel-
fare of the individual and the community. In other words, the
basic human impulse toward acquisition and self -betterment in
material things has taken possession of the scientific method as
an instrument whereby that ancient, universal, and dominating
impulse can accomplish its purposes with far greater efficiency
than ever before. In the same way the impulses, which, with
perhaps more regard for convenience than for philosophical
accuracy, we may describe as social or philanthropic, are now
taking possession of the scientific method as the most effective
means of accomplishing their objects. In one respect the ap-
plication of the scientific method to social betterment is pecul-
iarly significant : the desire for material gain is practically uni-
versal and almost always dominant in one form or another.
Self-interest will always stimulate the human animal to secure
as many of the material necessities and luxuries of life as he can
get, but the desire for social betterment, while possibly univer-
sal, is often rather latent, or subordinate, than dominant, and
depends for its forceful and insistent expression upon the leader-
ship of selected individuals constituting a relatively small pro-
portion of the whole community. Its appeal to the community
i
2 SOCIAL HYGIENE
is largely through the emotions, and, as these are usually spas-
modic in their expression, the motive power behind social re-
form is likely to be intermittent, fitful, and sometimes hysterical.
The scientific spirit, on the other hand, is steady, persevering,
untiring, whether it be directed toward the discovery of truth,
or toward the rational application of ascertained truth to the
affairs of life. Science furnishes the chart and compass and the
means of steady propulsion to the ship of social reform, enabling
it not only to profit to the utmost by the favoring winds of public
emotion and sympathy, but also to keep on through the gales
of anti-social opposition and the even more ominous calms of
public apathy.
In no field of social reform has the need of the scientific method
been more manifest than in that of the evils associated with pros-
titution. Flagrant as those evils have always been, and bru-
tally as they have outraged the finer sensibilities of the race in
their antagonism to health and moral fiber, and thus to all that
goes to make up "the durable satisfactions of life," they have
been so inseparably linked with the enduring human passions
of lust and greed that the periodic emotional attack upon them,
however strongly sanctioned by ethical and religious consider-
ations, has accomplished but little toward their suppression.
Thoughtful persons have for some years past given much
attention to the problem of directing into some steady and
effective channel the unquestionably general, if often ineffective,
public opinion that exists against prostitution, especially hi its
commercialized forms, and useful committees have been formed
in many cities with this object in view. The Committee of
Fourteen in New York City is an admirable example. Its
usefulness has been directly proportioned to the continuity of its
activity, which has fortunately endured long after the upheaval
of popular feeling in which it had its origin. The very experi-
ence of such committees has, however, demonstrated the need
of another kind of agency which should be equipped to deal in a
more fundamental manner with the same general problem of
prostitution in all its varied aspects. What are the facts as to
the nature and prevalence of the evil in this and other countries,
THE BUREAU OF SOCIAL HYGIENE 3
in this and other times? What are its moral, physical, and social
consequences, and what are the measures by which society
has sought to defend itself against them? How have these
measures worked? What have been the apparent factors of
their success or failure? What relations, if any, exist between
the prevalence of prostitution and industrial and social con-
ditions, and to what extent may these conditions be modified
so as to reduce the evil? It was for the purpose of providing
public opinion and the agencies representing it with an armory
of reliable facts and tested methods that the Bureau of Social
Hygiene was founded in New York in 1911 by Mr. John D.
Rockefeller, Jr. The purpose of the Bureau, as subsequently
stated in its Articles of Incorporation (1913), is "the study,
amelioration, and presentation of those social conditions, crimes,
and diseases which adversely affect the well-being of society,
with special reference to prostitution and the evils associated
therewith. "
In setting itself resolutely to attack this formidable program,
the Bureau adopted a policy of careful opportunism which has
proved to be almost ideal from a logical and strategic point of
view. As adventurers in what was to them a new field, the
members of the Bureau sought a first acquaintance with the
problem in the community with which they were most familiar,
namely, New York City. In many respects the evils to be
investigated might be expected to present their typical forms
hi a great metropolitan center, and the influence of any lessons
learned from a study of New York was sure to be widely felt.
In the next place, the Bureau was able to secure in the person
of Mr. George J. Kneeland an investigator whose ability, integ-
rity, and experience qualified him in an almost unique manner
both for the skillful handling of an extremely delicate and diffi-
cult task, involving the choice of competent assistants, and
for the critical use of the data secured — data which would be
almost valueless in hands not specially fitted for their appraisal.
The lot of the investigator of vice is so hazardous, and his work
is so susceptible of being discredited, that the standardization
of this kind of special investigation in such a way as to make
4 SOCIAL HYGIENE
its results largely trustworthy, is a public service for which
alone great credit should be given. To Mr. Kneeland was
assigned the study of commercialized prostitution in New York
City, and the fruit of that study was a volume issued in the
latter part of 1913 as the first publication of the Bureau of Social
Hygiene.1
Mr. Kneeland's volume was noteworthy for two reasons : first,
because it set a new standard for all efforts to ascertain the facts
as to the varied forms and extent of vice in an American city
and as to the commercial methods pursued; second, because it
furnished an effective background of facts, and an excellent
introductory experience for the subsequent studies of the Bureau;
and third, as will be remarked later, because for the first time
it provided a fairly accurate basis for measuring the efficacy of a
new police administration in New York City in respect to its
success in actually reducing the volume of immoral traffic as
conducted in resorts of various types or as promoted in the streets.
Included in this volume is a chapter by Dr. Katharine B. Davis,
formerly superintendent of the State Reformatory for Women
at Bedford Hills, recording the results of a study of prostitutes
committed from New York City to that reformatory. The
Bureau of Social Hygiene has established at Bedford Hills,
in connection with the State Reformatory, a Laboratory of
Social Hygiene under the direction of Dr. Davis. "In this
laboratory," according to the official statement issued by the
Bureau, "the physical, mental, social, and moral side of each
person committed to the reformatory is being studied. When
the diagnosis is completed, treatment is recommended which
seems most likely to reform the individual; if reformation appears
to be impossible, permanent custodial care is suggested. Further-
more, reaching out beyond the individuals involved, it is be-
lieved that important contributions may thus be made to the
knowledge of conditions ultimately responsible for vice." The
Laboratory of Social Hygiene presents a unique opportunity of
studying some of the more fundamental problems, social, med-
1 Commercialized Prostitution in New York City. By George J. Kneeland.
The Century Company, New York, 1912. 334 pp.
THE BUREAU OF SOCIAL HYGIENE O
ical, and penological, that have to do with prostitution, espe-
cially in its relation to crime. The Bureau has been fortunate
in securing the services of a group of eminent advisers for this
branch of its work, and the hope is warranted that far-reach-
ing results will be secured. The danger in all such enterprises
is that problems lying near the surface will be mistaken for fun-
damental ones, and this is especially true of an enterprise con-
trolled by laymen. It is seriously open to question whether our
knowledge of the really basic factors of behavior as manifested
in the higher vertebrates, as well as in man himself, is yet suf-
ficient to provide a stable foundation for sociological studies,
and it is to be hoped that the Bureau of Social Hygiene will
fully realize the opportunity it has of developing this vitally im-
portant field of study.
While the material for Mr. Kneeland's work on commercial-
ized vice in New York City was being collected and studied, the
Bureau of Social Hygiene enlisted Mr. Abraham Flexner now of
the General Education Board in a study of the general problem of
prostitution in Europe. Nearly two years were devoted to this
task, and the result was a volume issued in the latter part of
1913 under the title, Prostitution in Europe.2 It is not too much
to say that this volume constitutes the .most valuable single
contribution to the solution of the problem of prostitution in this
country. This remarkable result was achieved, not by any
dogmatic enunciation of theories new or old, and least of all
by the discovery of any panacea for the evils associated with
prostitution; it was achieved by a simple, clear, straightforward,
and impartial presentation of the facts of European experience
with regard to the prevalence of the evil, the various methods of
dealing with it, and the results apparently attributable thereto.
Since the appearance of Mr. Flexner's book, it has become im-
possible for any intelligent person in this country, professing a
desire for a practical as distinguished from a sentimental or
puritanical attitude toward the problem of prostitution, to refer
to European methods of regulation and toleration, or to their
2 Prostitution in Europe. By Abraham Flexner. The Century Company,
New York, 1914. 455 pp.
6 SOCIAL HYGIENE
supposed result in limiting the extent of vice and disease, as
offering the only key to the rational handling of the problem
in this country. Mr. Flexner has shown us that regulation does
not regulate, that segregation does not segregate, and that
systems of medical examinations are not only a farce, more or
less honestly administered, but are probably worse than useless.
To have established these facts as clearly as Mr. Flexner has
done, would have been an achievement amply justifying the es-
tablishment of the Bureau of Social Hygiene and the expenditure
of many times the amount of money that has been devoted to
its work. But Mr. Flexner has done much more than to break
down a false reliance upon the supposed teachings of a some-
what mythical European experience. By his critical observa-
tion of the result of various attitudes assumed in different parts
of Europe toward the subject of prostitution, ranging from the
most complacent toleration to various forms of regulation and
repression, he has established a conclusion so important that it
should be stated in his own words: —
"Whatever one may hold as to ultimate dealings with the subject, it
is clear that prostitution is at any rate a modifiable phenomenon. For
example, no matter what conditions exist at this very moment, they are
capable of aggravation. If bordels are established and allowed a free
hand in procuring inmates and business, if a community ceases to be
concerned as to the condition of the streets, as to the conduct of the
liquor and amusement traffic, there is no doubt that under these cir-
cumstances the number of prostitutes and the volume of business
transacted by them would at once increase, and in consequence, also
the amount of waste and disease traceable thereto.
"The converse of the proposition is equally true. If prostitution
and its evils can by social arrangements be increased, they can also
by social arrangements be lessened. If unhampered exploitation and
prominence make matters worse, then interference with exploitation
and prominence makes matters better."
The one inescapable conclusion from a study of the facts which
Mr. Flexner has put before us with the most scrupulous absten-
tion from argument or dogmatic assertion, is that prostitution
is a modifiable phenomenon, and that the question whether its
THE BUREAU OF SOCIAL HYGIENE 7
total volume, and consequently the volume of all its attendant
evils, shall be held to a minimum, depends upon whether there
is a well-sustained attitude of antagonism on the part of the
community. The police are an important factor in the expres-
sion of this antagonism, but the capacity of even the best police
force in the world to do more than the community wants it to
do, has limits that must not be ignored. The roots of prosti-
tution, as Mr. Flexner points out, "strike deep socially and
individually," and the problem of eradication, and even of con-
trol, goes far beyond the question of mere repression; and yet
repression, intelligently conceived and adapted to the varying
conditions of different communities, is one, clear, first step.
It is not too much to assert that the conclusions to be drawn
from Mr. Flexner's studies have given heart and confidence to
police administrations and other social agencies hi many cities
of this country in pursuing a policy of unyielding antagonism
to prostitution, and that in so doing they are responding to,
and gaining the support of, public opinion to an extent that has
never been possible before.
While recognizing that the problem of prostitution goes far
beyond the question of police control, the Bureau of Social
Hygiene has attached great importance to the efficiency of
police administration as one of the principal means by which
the will of the community in regard to prostitution is carried
into effect. For this reason, Mr. Raymond B. Fosdick of New
York, formerly Commissioner of Accounts, was enlisted in the
service of the Bureau. He began by making a careful study of
European police systems, especially those of London, Berlin,
Paris, and Vienna. The result of his study was an admirable
volume issued early in 1915 under the title, European Police
Systems.3 The book contains much that is of great value and
interest in regard to the recruiting, administration, and methods
of work of the various branches of the police in the principal
countries of Europe. From a technical standpoint it has been
recognized as a valuable contribution to the theory and practice
J European Police Systems. By Raymond B. Fosdick. The Century Company,
New York, 1915. 442 pp.
8 SOCIAL HYGIENE
of police administration. To the general reader, the one strik-
ing conclusion of this work is that the United States has almost
everything to learn from the widely different types of police
service in Europe regarding the maintenance of the integrity
and efficiency of the police force, and especially regarding the
importance of recognizing the highly technical and professional
character of the more responsible police officials.
Fortunately for the City of New York, it has had during the
past three years a mayor and a police commissioner actuated
by the highest ideals of administrative efficiency, and by an
ambition to promote the professional and technical efficiency
of the police force by every means in their power. The result
has been that a unique opportunity has been provided for study-
ing the effect upon vice conditions in New York of a police
administration that has been actuated, not by a spasm of re-
form but by an intensely practical, open-minded and conscien-
tious spirit, and that has tried to apply, as well as local conditions
permit, the most effective policies suggested by the experience
both of this country and of Europe. In general, it has been
evident that the attitude of the New York Police Department
under Mayor Mitchel and Commissioner Woods, has been in
accord with the conclusions to be derived from the Bureau's
studies of prostitution in Europe. In other words, the policy
has been one of vigilant and uncompromising hostility to com-
mercialized vice, with the result that the way of exploiters of
vice has become more and more difficult and unprofitable. A
comparison made by the Bureau of Social Hygiene between
the conditions in regard to disorderly resorts and street conditions
as shown by the Kneeland report and by a second examination
made in 1915, affords an illuminating and unanswerable con-
firmation of Mr. Flexner's statement regarding the "modifi-
ability" of prostitution.4 After giving statistics showing, for
example, the reduction in the number of a certain type of resort
from 142 to 23, and of their inmates from 1686 to hardly more
than 50, the Bureau's report states:—
4 Commercialized Prostitution in New York City. A comparison between 1912
and 1915. 1915. 15 pp.
THE BUREAU OF SOCIAL HYGIENE 9
"The method of conducting the business of prostitution in these
resorts has changed to a marked extent. The commercialized aspects,
such as the sale of liquor, sale of clothes to inmates at exorbitant
prices, the promiscuous and open methods of advertising and stimu-
lating the trade, the excessive charges to inmates for board, the buying
and selling of shares in houses, the activity of real estate agents in
renting houses for immoral purposes at advanced rentals, the long
hours of service demanded of inmates, and other features of exploita-
tion have been practically eliminated."
The Bureau announces that the results of an examination of
the police organizations and methods of American cities will be
published during the present year, and that a report on prosti-
tution in the United States is also in course of preparation.
The activities of the Bureau of Social Hygiene during the first
five years of its existence offer ground for confidence that its
methods of careful and impartial investigation and its wise
policy of publishing the results of investigation will be of great
service to this country and to other countries as well. While
the Bureau has already accomplished much more than enough
to justify its establishment, even if it should now cease to exist,
a large factor in its potential usefulness to the community is
to be found in the continuity of its labors. As Mr. Rockefeller
stated in the introduction to the first volume published by the
Bureau, the forces of evil are never greatly alarmed at the organi-
zation of investigating or reform bodies of an ephemeral character.
The establishment of the Bureau was based on the conviction
that "in order to make a real and lasting improvement in con-
ditions, a permanent organization should be created, the exist-
ence of which would not be dependent upon a temporary wave
of reform nor upon the life of any man or group of men, but
which would go on, generation after generation, continuously
making warfare against the forces of evil." By this pledge of
persistent and unremitting activity, the Bureau of Social Hygiene
has established itself as the permanent ally of all other agencies
through which the social hygiene of the community is being
advanced.
GET HOME FROM THIRD1
The Detroit News some time ago printed a baseball editorial
about Moriarty and how he won a game for the Tigers by steal-
ing home from third. Here is part of it: —
"Don't die on third!
"What are you doing to win the score that life is ready to mark
up against your name? Third base has no laurels on which
you can rest. What are you doing on third? Are you waiting
for someone to "bat you in?" Suppose he misses; his miss is
yours, too. If you place all your dependence on someone else,
his failure spells yours. What are you doing on third? Wait-
ing for " something to turn up?" Don't — nothing turns up,
but the thumbs of the thousands of men who watch you may
turn down, and make you a permanent failure. Moriarty
wouldn't have scored had he waited, for Mtillin didn't hit the
ball — and that run was absolutely necessary to save the game.
That run was gained in an unmeasurable fraction of time, but
the difference between success and failure is very, very often
measured in seconds.
"Don't die on third.
"Had Moriarty been out the night before, he would have
played the game according to routine; but Moriarty doesn't
carouse. He doesn't smoke or drink. He is old-fashioned
enough to go to church on Sunday. He knows that a clean life
means a clear head. He knows that legs that tread the path of
irregularity cannot win when running 90 feet against a swift
ball that travels 60 feet. He respects his body and his mind,
and they in turn serve him up to the last fraction of their power.
Moriarty's run was not a foolhardy dash. It wasn't a toss-up
with luck. It was deliberate, mathematical work. Any fool
could have led off spectacularly, but only a trained body and
an alert mind could have stolen home right under the nose of the
catcher whose hands were closing over the ball. Even a game
means work. Work itself is a game and has its rules as its
sudden openings. So, don't die on third. Bring to third every
bit of your honest strength; study conditions; postpone thinking
of your luck until you hear the umpire call 'safe.'
"Then you'll score all right."
1Get Home from Third. Reprinted by the Pennsylvania Lines, Passenger
Department.
10
CLINICS FOR VENEREAL DISEASES1
WHY WE NEED THEM; How TO DEVELOP THEM
WILLIAM F. SNOW, M.D.
General Secretary of the American Social Hygiene Association
I
The venereal diseases are so prevalent, so insidious in their
attack, and so indirect in their methods of maiming and killing
their victims that the public is still without an organized de-
fense against them. The continuance of this state of unpre-
paredness is favored by the complicated relations between the
medical and the moral aspects of their eradication. For the
present purpose it is desirable to present the venereal diseases
as a preventive medicine problem, and on that basis to emphasize
the strategic position held by the dispensaries and hospitals.
TEN SANITARY AXIOMS
Sir Ronald Ross in his ten sanitary axioms applicable to the
prevention of all diseases holds that, next to the maintenance
of the state, it is the duty of scientific government to endeavor
to control widespread endemic diseases; that, for economic
reasons alone, governments are justified in spending for the
prevention of such diseases a sum of money equal to the loss
which they inflict on the people, and that in general the money
thus spent should be apportioned in accordance with the amount
of sickness and mortality caused by each; that it is the duty of
governments to make and enforce ordinances required for the
prevention of diseases, and the duty of the people to comply
fully with the provisions of such laws; that other things being
equal, those sanitary measures are the wisest which cause the
public the least inconvenience, the most practicable which can
1 Presented at the meeting of the American Hospital Association, Philadelphia,
Pa., September 26, 1916. Printed by courtesy of The Modern Hospital.
11
12 SOCIAL HYGIENE
be administered with a minimum demand upon the thoughts,
efforts, or compliance of private persons, and the most economi-
cal which confer for unit of cost the widest benefits on the public.
Finally, that a suitable expert organization is always required
for the prevention of diseases on a large scale, and it is advis-
able to carry out accurate and repeated measurements of the
prevalence of the disease which we propose to prevent, of the
cost of the adopted measures, and of the results obtained.
SCIENTIFIC KNOWLEDGE OF VENEREAL DISEASES ADEQUATE FOR
ACTION
In the abstract these axioms are acceptable to the public,
but in their concrete application to the venereal diseases not one
of them is in force. Syphilis and gonococcus infections are
communicable diseases due to identified organisms; their methods
of transmission are known, and practical laboratory and clinical
technique has been worked out for diagnosing each of them; they
are widely prevalent throughout the world among individuals
of every race, sex, age, and condition of people; they find their
chief opportunity for dissemination in the intimate personal
contact of infected individuals with other individuals who are
susceptible, they are largely but not exclusively transmitted
through the promiscuous sex relations defined as prostitution
and condemned by society as harmful alike to the health, the
morals, and the social progress of a people; recent methods of
therapy make practicable the shortening of the period of in-
fectivity and improve the chances of ultimate recovery of the
patient submitting to early and thorough treatment; once con-
tracted, they may run their course to practical recovery with or
without medical assistance, but under present conditions an
unknown and large percentage of those infected never completely
regain their health or cease to be carriers, and, therefore, are a
continuous menace to society. Syph'lis in its early stages is
especially a public danger, while in its late manifestations the
danger is largely confined to the individual himself; gonorrhea,
on the contrary, while a public danger at all times, is particularly
CLINICS FOR VENEREAL DISEASE 13
damaging to the individual in its early acute development, and
later becomes an insidious danger to those intimately associated
with him, especially within his home and family.
THE LINES OF ATTACK THE SAME AS FOR OTHER DISEASES
In a word, we know the cause of these diseases; we know that
human carriers afford their chief mode of dissemination; we
know that in prevalence and injury to the people they are not
outranked by any others of the communicable disease group;
and we know that theoretically we should proceed to apply
these facts exactly as we apply the similar facts concerning other
preventable diseases. Reduced to simplest terms this means
the adoption and enforcement of (1) measures for the dis-
covery, treatment, and control of individuals already infected;
(2) measures for the elimination of conditions of environment
favoring the dissemination of the infection; (3) measures for
the protection of individuals not yet infected. In practice the
application of such measures is exceedingly difficult, and cannot
proceed more rapidly than the formation of public opinion upon
the importance of eradicating these diseases.,
EARLY DIAGNOSIS FAVORS SUCCESS BOTH IN TREATMENT AND IN
PREVENTION
The need for laboratory examination for evidence of syphilis
and gonococcus infections has been one of the first practical
measures to obtain public recognition, and facilities for this
purpose are being rapidly supplied through health departments
and other public or private agencies. Other methods of en-
couraging the discovery of persons infected are being tried out.
Announcements of free advice and treatment service for venereal
diseases have been printed in newspapers, posted as signs, and
circulated in instruction leaflets. Examinations for evidence of
infectious diseases (including syphilis and gonococcus infections)
have been requested or required of candidates for employment
in many occupations. Regulations requiring the reporting of
venereal diseases have been enacted in thirteen states, and three
14 SOCIAL HYGIENE
cities in other states. Health certificates, whose major require-
ment is evidence of freedom from venereal disease, have been
demanded by the officiating clergyman or as a state regulation
for license to marry. An increasing number of parents are
demanding similar evidence as a protection to their daughters in
arranging marriage. The army and navy recruiting stations
have made their examination for these diseases more rigid, and
after enlistment failure to report the earliest appearance of
infection or even exposure is followed by severe penalities and
reduction in pay. Some of our colleges and universities are
beginning to use the opportunity to protect their students and
the homes from which they come by examination for these dis-
eases and treatment of those found infected. Similarly, several
hospitals have instituted measures, including a Wassermann
examination for all patients admitted. Physicians are becom-
ing interested in the social aspects of the problem and are finding
it feasible to report cases.
ESSENTIAL TO KEEP PATIENTS UNDER SUPERVISION UNTIL COM-
PLETION OF TREATMENT
A large number of infected individuals, having been discovered
through these various agencies collectively, there immediately
arises the demand for adequate treatment facilities. Only a
small proportion of these cases can afford to become private
patients; for those remaining, proper dispensary and hospital
facilities are urgently needed. From the preventive medicine
point of view discovery and initial treatment are useless unless
all the detected cases can be kept under treatment until no
longer infectious, and can be so controlled in their homes and
occupations that measures for the protection of their associates
will be carried out. This necessity for treatment facilities is
slowly becoming recognized by the public, and here and there
encouraging work has begun. Free and pay clinics with both
day and evening services are being established. Departments
of syphilology have been created and departments for genito-
urinary, gynecological, and dermatological diseases are giving
more attention to the subject. Regulations for discharge of
CLINICS FOR VENEREAL DISEASE 15
patients, measures for keeping patients under treatment until
thus discharged, and active social service follow-up methods,
during this period, have been devised. While this work is only
in its beginning, enough has been accomplished to complete
the proof that a practical program exists for the first group of
measures for the reduction of venereal diseases, i.e., measures
for the discovery, treatment, and control of individuals already
infected.
The second group — those measures dealing with the elimina-
tion of environmental conditions favoring the dissemination of
syphilis or gonococcus infections — is largely concerned with
the repression of prostitution, since the men and women who
practice promiscuous sex intercourse are the human carriers
on whom these diseases chiefly depend for transmission. Logic-
ally, the red light districts of commercialized vice challenge the
attention of health departments and other forces cooperating
in health conservation as strongly as tenement districts with
their poverty and overcrowding. A new kind of clean-up
campaign is being added to those already devised in behalf of
the battles against tuberculosis, malaria, hook-worm, and other
endemic diseases. Ways and means of gradually limiting the
commercial gains from manipulation of the supply and demand
of prostitution have been demonstrated. The segregated vice
district, with medical inspection of prostitutes, has been proved
inadequate as a practical public health measure and all but two
or three among our large cities have abandoned the policy of
segregation. The rear room of the saloon used as a meeting place
between prostitutes and patrons and the hotel for transients,
which often more or less openly and completely take the place
of closed vice districts, are slowly being eliminated. The
citizens of even the unaffected residential sections are learning
the importance of participating in this new campaign on joint
medical and moral issues and are being equipped with such
effective weapons as the injunction and abatement law. As
16 SOCIAL HYGIENE
prostitution moves out of the hostile city to invade country
roadhouses and nearby towns in its effort to remain accessible
to the city and yet retain the use of alcohol and the host of other
aids to stimulation of the demand, county officials and residents
are gradually joining the fight. State and federal forces have
also been enlisted in the campaign, especially in limiting the
supply. In all of these attacks on venereal diseases through
control of environment, the dispensary and the hospital have
opportunity to educate their patients on the social aspects of
venereal infections and to enlist the cooperation of these pa-
tients with the health and police authorities. The wide extent
to which this invaluable service may be carried out has been
demonstrated by the medical and social service staffs of a few
institutions.
PERSONS NOT YET INFECTED MUST BE PROTECTED
The third group — measures for the protection of individuals
not yet infected — involves another field of opportunity for the
hospital and dispensary. Control of sex impulses based on
sound knowledge is one of the chief weapons with which the
individual man or woman may be equipped to combat these
infections. Experiments by dispensary officers and visiting
nurses in distributing instruction pamphlets upon the medical,
hygienic, social, and moral aspects of these diseases have en-
couraged many persons not only to regulate their own living
conditions and conduct for the protection of others, but to
become educators of public opinion in regard to these matters.
SEXUAL CONTINENCE THE PRINCIPAL PROPHYLACTIC MEASURE
Undoubtedly through such service much may be done to
encourage the most effective prophylactic measure, which is
sexual continence outside of marriage. The success of parents
and school authorities in promoting sex education, the pro-
vision of wholesome recreation facilities for all ages and con-
ditions of people, and the progress of other welfare efforts in
establishing normal, happy homes and family life may also be
aided by the dispensary staff.
CLINICS FOR VENEREAL DISEASE 17
SEGREGATION OF THE SEXES LIMITS THE OPPORTUNITY FOR
VENEREAL INFECTION
The compulsory segregation of the mentally incompetent
who cannot control their sexual acts under ordinary conditions
of freedom, the military segregation of troops in isolated camps
or on shipboard, the segregation of large numbers of laborers
in occupations which necessitate living in distant quarters, the
enforced segregation of prisoners, delinquents, and charity
wards of the state — all the varied social and economic measures
by which men and women are separated from each other — reduce
the spread of venereal diseases because they restrict for con-
siderable periods of time the freedom of many who are most
prone to become active carriers when they live in communities
where opportunity for promiscuous sexual intercourse exists.
The medical and nursing staffs of institutions and hospitals
dealing with these classes during their isolation can accomplish
an important educational work calculated to have a favorable
influence.
MEDICAL PROPHYLAXIS MAY PROTECT THOSE NOT INFECTED
Medical prophylaxis presents an unsolved problem in which
the dispensary particularly can render a great service. There
is evidence to indicate that medical measures intelligently ap-
plied by the individual immediately upon exposure to infection
have influenced in some degree the reduction of venereal dis-
eases. This is particularly true where it is possible, as in the
army and navy, for competent officers to instruct men individ-
ually and to enforce a program for prophylaxis. Medical pro-
phylaxis is more difficult in application to women and is further
complicated by the classes of women to be protected. The
prostitute plying her trade under the cheapest, most sordid
conditions of the vice district has little time or inclination to
cooperate in any prophylaxis program; the clandestine prosti-
tute endeavors to avoid discovery and is difficult to reach with
any advice; the inmates of the so-called higher class houses can
ill afford to offend their patrons by refusing those men who are
probably infected or by adopting protective procedures best
18 SOCIAL HYGIENE
calculated to protect others; the married woman is usually kept
in ignorance of danger from her husband who has become in-
fected. It seems apparent from a study of present conditions
and limitations that medical prophylaxis can wisely be em-
ployed only under the advice of physicians who are fully in-
formed of the circumstances in each case, and have opportunity
to follow-up each individual until the danger of infection has
passed. The private practitioner, the dispensary chief, the
military surgeon and the health department official comprise
the qualified persons to work out the extent and method of this
factor in prophylaxis. Science gives little promise as yet of
prophylaxis through practical methods of immunization against
syphilis or gonoccocus infections.
SUMMARY OF VENEREAL DISEASES AS A PREVENTIVE MEDICINE
PROBLEM
To summarize the practical attack on venereal diseases, it
may be said that the first line of attack, consisting of the dis-
covery, treatment, and control of infected individuals should be
led by the health departments cooperating with clinics, hospitals,
and the private practitioners; the second, comprising the efforts
to eliminate environmental conditions favorable to then* dis-
semination by human carriers, must be led by the police depart-
ments cooperating with courts, law enforcement agencies, and
the citizens; the third, directed toward protecting the unin-
fected, can best be led by the school departments cooperating
with moral and social agencies and the parents. In all the
diverse activities of these three major lines of conducting this
health conservation battle, there stands out prominently the
need for enlisting the forces of the dispensary and the hospital.
This is so largely because the association between treatment
and prevention is more intimate in this than in any other group
of diseases. It is necessary that the members of the medical
profession as well as other leaders of the community shall fre-
quently review these facts in order that they may have the cour-
age and the persistence to convert this problem from one of the
conspicuous failures of public health to the conspicuous success
which science has made possible.
CLINICS FOR VENEREAL DISEASE 19
II
If the need for venereal disease clinics and hospital facilities
be conceded, the question arises, how may they be developed?
This of course depends on what they are to accomplish, who the
patients are, and what foundation already exists for their estab-
lishment. Reverting to the "sanitary axioms" outlined it may
be said that ample warrant exists for spending any amounts
of money required either by public or private effort to combat
these diseases. The clinic is the complement of the practitioner
in the diagnosis and treatment of infected individuals, restoring
them to health and efficiency on the one hand, and on the other
protecting the public through shortening periods of infectivity
and lessening the contacts of patients with members of the com-
munity. Thus the clinic occupies a strategic position on the
battle line midway between the health department and the
medical profession. It is undoubtedly true that that clinic
which causes the least inconvenience and a minimum demand
on the thoughts, efforts, and compliance of individuals will
most readily secure patients and be the most successful. It is
also true that the lowest unit of cost for the widest benefit to
the public should govern the economical rating of the clinic,
and that this rating should be frequently checked up by accurate
measurement of the results obtained. As yet only a few com-
prehensive experiments in developing venereal disease clinics
have been made. From these the following seem to stand out
as essential factors in the success of such clinics: —
1. A Specialized Department of the General Dispensary is a
Present Need
Each dispensary or out-patient department of a hospital
which proposes to establish adequate treatment for venereal
diseases and render the greatest service to society must correlate
the work particularly with that of its geni to-urinary, gynecologi-
cal, and dermatological clinics. The administrative plans which
have thus far found favor are of two general types: (a) pro-
vision for all venereal diseases of men by the genito-urinary
20 SOCIAL HYGIENE
division and of women by the gynecological division; (b) pro-
vision for gonorrheal cases by these divisions, but transfer of
syphilis cases to a special division of syphilology or dermatology
and syphilology. The haphazard treatment of venereal dis-
eases, especially in their late stages, in whatever clinic the cases
may have been discovered, is no longer approved, although it is
still frequently the practice. Separate venereal disease clinics
are practical, but have not been favored in this country. This
is due partly to lack of recognition of the social aspects of these
diseases but largely to the necessity for avoiding in either clinic
or hospital anything which tends toward publicly distinguish-
ing the patients under treatment for this class of diseases. It is
possible that eventually there may be evolved a plan for a sepa-
rate venereal disease clinic administered by salaried officers and
organized as a major division of the dispensary, but receiving
all its patients through nominal registry in the other clinics
prior to transfer. Until some such solution is offered rapid
progress cannot be made.
2. Adequate Equipment and Personnel are Essential
It is self-evident that adequate equipment for diagnosis,
treatment, and reexamination is essential for efficient work, but
this is only slowly being realized in practice. What this equip-
ment should comprise in addition to the consultation rooms,
furniture, sterilizing apparatus, dark-field microscope," examina-
tion and treatment instruments, and supplies depends on the
extent of cooperation with other clinic divisions, the laboratories,
and the hospital in-patient and social service departments.
Probably in no other class of diseases is it so important, to base the
diagnosis, treatment, and discharge on the combined testimony
of the patient's history, repeated clinical examination, and the
findings of the laboratory. If the pathological and bacteriologi-
cal laboratories provide their services, and the preliminary
history-taking is provided by other clinic divisions, the necessary
equipment is greatly lessened, especially as to personnel.
CLINICS FOR VENEREAL DISEASE 21
3. The Command of a Number of Hospital Beds is Requisite
The venereal disease clinic ought to have always available as a
part of its equipment or under the direction of its staff several
hospital beds for observation purposes, the temporary care of
acutely contagious or urgent surgical cases, and the adminis-
tration of salvarsan or its substitutes to many individuals. In
some institutions this service can be supplied by the in-patient
department in return for services of the venereal disease staff
in surgical, ophthalmic, neurologic, or other hospital cases in
which syphilis or gonococcus infections are a factor. The
hospital is of course the lesser factor in considering treatment
in relation to the eradication of venereal diseases in general,
because early diagnosis and provision for ambulatory cases are
the essentials. But the hospital is the major factor hi many
individual cases, and is necessary in certain cases where removal
of a patient from his home is necessary for the protection of
others.
4. The Clinic must Attract Patients and Earn their Respect
If the clinic is to be of service in preventive work it must
secure patients at the beginning of their infections and hold
them under treatment until danger from them as active carriers
has passed. This means, first, adaptation to the needs of the
patients through convenient clinic hours, privacy, and prompt
meeting of appointments. Evening clinics particularly are
required, attended by a sufficient number of physicians to en-
sure a reasonable equivalent of the personal attention given to
patients in private practice. Considering each clinic as a unit
in the general scheme for combating venereal diseases, it is
desirable to study the area which it can advantageously serve
and organize its staff, schedule of hours, and fees with due regard
to the prevailing nationalities, occupations, and social status of
residents, and facilities for private practice within that area.
Supplementary units to serve other areas or classes of patients
should be encouraged under the same or other management.
22 SOCIAL HYGIENE
5. The Clinic must hold its Patients until Treatment is Completed
The development of practical regulations for determining
the progress of treatment and for discharge is a necessity if
patients are to be held under treatment. It is equally vital
for this purpose that a comprehensive system of follow-up be
applied to those cases in which the patient fails to return as
instructed. A number of dispensaries have made remarkable
progress in this direction.
6. Every Patient needs Education Concerning his Disease
Clinic patients should receive full instruction concerning the
nature of their diseases and methods of protecting others with
whom they associate. The opportunity for this service is com-
mensurate with the time and attention the staff may devote to
it. Certain aids are desirable. Appropriate signs, leaflets, and
pamphlets have been demonstrated to be of great value. Some
dispensaries require printed matter in a dozen languages to be
intelligible to all of their patients. The selection of orderlies,
social workers, and clinicians who collectively speak the lan-
guages the patients know best and who are required to cooperate
hi the latters' instruction is one of the most encouraging of recent
developments in this field of preventive medicine. Printed
statements specially designed to interest the practitioner should
be sent at intervals to every physician in the administrative
area, informing him of the facilities of the clinic, its hours, and
its plans for cooperation with him.
7. Serviceable Records are Indispensable
Simple and complete records of all cases are necessary for the
efficient administration of the clinic and should be readily
available for all proper uses by the health authorities, other dis-
pensary staffs, and others who in the course of any patient's
history may become responsible for his treatment or the pro-
tection of the public. It is only necessary to read the disheart-
ening report of any one of the recent surveys of venereal dis-
ease facilities to be convinced that this vital factor hi clinic
CLINICS FOE VENEREAL DISEASE 23
efficiency is almost completely ignored in our American institu-
tions. The technical equipment and requirements for record-
ing and filing histories and other data cards have been so simpli-
fied that there is now no sound argument in defense of continued
failure in this part of clinic work.
8. Pay Clinics as well as Free Clinics are Desirable
As a matter of economy and good citizenship all patients who
can pay something toward their treatment should be encour-
aged to pay. This end seems to have been best promoted thus
far without embarrassment to patients by the provision of free
and pay clinic hours, and the establishment of advisory consulta-
tion offices under independent auspices, such as the health de-
partment or a social hygiene society, where individuals may go
or be referred for free advice upon how to secure proper diagnosis
and treatment. The clinic has a great opportunity to work
out for venereal diseases the practical methods by which the
commonwealth may secure adequate and fair treatment for all
infected individuals of whatever social status, residence, or
financial resource.
9. Provision should be made for Social Service and Clinic Exten-
sion Work
Every patient who comes to the clinic offers a starting point
for cooperation with a host of social agencies not only in his
restoration to physical health, but in his social and moral re-
habilitation which are essential if he is to avoid reinfection and
consequently further exposure of the public to the spread of his
disease. The social service departments of a few dispensaries
and hospitals that have seriously studied this problem have
demonstrated this to be a most fertile field for service and for
increasing efficiency through reducing abuse of clinic privileges
and the frequency of application for treatment. Cooperation
particularly with official departments of health, charities, and
correction along these lines and in providing convalescent homes
and occupations, especially for syphilitics, has presented encour-
aging possibilities.
24 SOCIAL HYGIENE
As the socialization of medicine proceeds, the work of the
dispensary will receive greater emphasis as a factor in health
conservation. The venereal disease clinic will then become an
administrative center from which a varied extension service is
conducted. Experience shows that the closest cooperation is
desirable between the dispensary staffs and the medical profession.
It is possible that gradually the clinic will add to the staff within
its area of service a number of private practitioners as associate
clinicians, each of whom agrees to advise in their homes or at a
branch dispensary office a limited number of clinic patients who
are under supervision and require periodic examination and
possible return to the clinic for salvarsan or other treatment.
In line with this same idea of extension service, it is probable
that some plan will be worked out whereby the clinic for pur-
poses of advice and treatment may follow the patients to their
places of employment hi certain industries which do not have a
medical director, but whose owners will cooperate in the estab-
lishment of this form of field dispensary service.
10. Stale Cooperation in the Supervision and Support of Venereal
Disease Clinics is Desirable
Here and there the practical importance of the venereal dis-
ease clinic to the public health has so impressed itself on students
of preventive medicine that the establishment of such clinics
by health departments is advocated and hi a few instances is
being tried out. As a substitute proposition it has been sug-
gested that the health department license all clinics offering
treatment for venereal diseases and require them to maintain a
specified standard of efficiency. One such standard has been
carefully worked out by the Associated Out-Patient Clinics of a
large city. In some form it is probable that public supervision
will be established. This will undoubtedly be followed by the
demand of dispensary and hospital authorities for public assist-
ance which should be forthcoming, for there is scarcely room for
argument as to the immediate public benefit to be derived from
properly conducted clinics for this class of diseases.
CLINICS FOR VENEREAL DISEASE 25
Thus may the venereal disease clinic be developed into what
has been called "a militant force for prophylaxis." There are
now approximately nine hundred general dispensaries in the
United States. The majority of these in some degree touch this
problem, but less than fifty are at present wholeheartedly and
hopefully grappling with it. Statistics, estimates of cost, and
accurate data upon the experiments now in progress are being
slowly gathered for publication and more clinics may confidently
be expected to enter this field of service. If success can be
attained in the gradual eradication of syphilis and gonococcus
infections — the last among the great plagues of world-wide prev-
alence which afflict mankind unchallenged — the costs, however
great in money, educational effort, and regulation of personal
conduct, will be immeasurably exceeded by the gains. Clinicians
and hospital directors hi common with public health admini-
strators have the opportunity to cooperate in a service to society
as great as that of conquering yellow fever and uncinariasis if
they but see the vision.
SOLDIERS' FIELD*
On you, and such as you, rests the burden of carrying on this
country in the best way. From the day of John Harvard down
to this hour, no pains or expense have been spared by teachers
and by laymen to build up our University, .... and thus
educate you; and for what end? For service to your country
and your fellow-men in all sorts of ways — in all possible callings.
Everywhere we see the signs of ferment — questions social,
moral, mental, physical, economical. The pot is boiling hard
and you must tend it, or it will run over and scald the world.
For us came the great questions of slavery and of national
integrity, and they were not hard to answer. Your task is
more difficult, and yet you must fulfill it. Do not hope that
things will take care of themselves, or that the old state of
affairs will come back. The world on all sides is moving fast,
and you have only to accept this fact, making the best of every-
thing, helping, sympathizing, and so guiding and restraining
others, who have less education, perhaps, than you. Do not
hold off from them; but go straight on with them, side by side,
learning from them and teaching them. It is our national
theory and the theory of the day, and we have accepted it, and
must live by it, until the whole world is better and wiser than
now. You must in honor live by work, whether you need
bread or not, and presently you will enjoy the labor. Remember
that the idle and indifferent are the dangerous classes of the
community. Not one of you would be here and would receive
all that is given to you, unless many other men and women
had worked hard for you. Do not too readily think that you
have done enough, simply because you have accomplished some-
thing. There is no enough, so long as you can better the lives
of your fellow-beings. Your success in life depends not on
talents, but on will. Surely, genius is the power of working hard,
and long, and well.
1 Soldiers' Field, an address by Major Henry Lee Higginson, at the dedication
of Soldiers' Field, Harvard University. Houghton, Miffiin Company, Boston,
1915.
26
A HEALTH EXHIBIT FOR MEN
AN EDUCATIONAL EXHIBIT ON VENEREAL DISEASE CONTROL
AND PREVENTION PRESENTED AT CONEY ISLAND BY
THE NEW YORK SOCIAL HYGIENE SOCIETY
FRANK J. OSBORNE
Executive Secretary of the New York Social Hygiene Society
Educational exhibits in the social hygiene campaign are not
new either in idea or fact, as witness the most recent and suc-
cessful one by the American Social Hygiene Association at the
Panama-Pacific Exposition. Neither is an exhibit devoted
entirely to the medical and moral aspects of the so-called
venereal diseases altogether unknown, for as far back as 1910
such a one was prepared and conducted by the California
Society for the Study and Prevention of Syphilis and Gonor-
rhoea. Until the New York Social Hygiene Society opened its
Health Exhibit for Men at Coney Island on July 21, 1916, how-
ever, there has never been an exhibit of this nature with attend-
ance limited to men and offering a medical advice service, except
the well-known anatomical museums and medical institutes con-
ducted as " feeders" for quack doctors and so-called "men's
specialists. " That such an attempt was not made before has not
been due to lack of an appreciation of its possibilities, for both
the Department of Health of the City of New York, through
Dr. Charles Bolduan, Director of the Bureau of Public Health
Education, and Dr. William F. Snow, General Secretary of the
American Social Hygiene Association, had outlined such a plan,
but had not taken steps to carry it into effect. It remained
for the reorganized Society of Sanitary and Moral Prophylaxis
under its new name, the New York Social Hygiene Society, to
start the machinery which transformed this idea into a reality.
The Society enjoyed the active cooperation of both the Ameri-
can Social Hygiene Association and the City Health Department,
27
28 SOCIAL HYGIENE
together with the Public Health Committee of the Medical
Society of the County of Kings and the Genito-Urinary Depart-
ment of the Brooklyn Hospital Dispensary, the staff of which
conducted the medical advice service under the direction of
Dr. Alec Nicol Thomson, chief of one of the Dispensary divisions.
The original purpose of this exhibit was to fight the medical
fakir and lying charlatan by replacing the vagaries and mis-
representations of quackery with exact medical facts, and by
supplying a clinical reference center which would direct the
infected man either to his private physician or to a reputable
MIE^ILTIEI lE^MIKlTT IFCDM MIEKT
PREPARED BY AND UNDER THK AUSPICES OF
TME KTEW YOKK SOCIAL MYGIENE SOCIETY
COOPERATING WITH
DEPARTMENT OF HEALTH, THE CITY OP 2VEW YORK
THE AMEKICAX SOCIAL HYGIEXE ASSOCIATIOIV
PUBUCC HEALTH COMMITTEE.
THE MEDICAL SOCIETY OP THE COUXTY OF KKVGS
BOWERY NEAR KENSINGTON WALK. CONEY ISLAND
OPEN 1-1 1 P. M. DAILY— ADVISOR'S HOURS 8-11 P. M.
SUPPORTED BY VOLUNTARY CONTRIBUTIONS
SOCIAL,, CIVIC AND HEALTH EDUCATION ADMISSION FREE
FIG. 1. CABD DISTRIBUTED TO VISITORS AT ENTRANCE
dispensary for proper treatment. Thus the exhibit became
an experimental attempt to dispel the cloud of ignorance and
misinformation surrounding the whole subject of the causes,
treatment, and effects of syphilis and gonorrhea but we feel
that we succeeded not only in demonstrating the practical
utility of the exhibit method for such purposes but also to
many of our visitors the fundamental facts of sex with their
social and moral implications. As outlined on the card which
was given out to every man who attended the exhibit (see Fig.
1), our ami was to dispense "social, civic, and health education"
in a vigorous, human manner without becoming preachy.
A HEALTH EXHIBIT FOR MEN
29
The only available stand to be found at Coney Island after the
exhibit was planned was a small building (IT by 30' by 10') on
the Bowery a short distance in front of Steeplechase Park.
This was rented for the season for $800 and a glance at figure 2
will give a fairly good idea of its location and its immediate
neighbors. Across the front of the building were several signs.
At the top was a large HEALTH EXHIBIT sign while another
FlG. 2. EXTERIOR OF THE HEALTH ExilliilT ON THE BoWEUY AT CONEY ISLAND
A TYPICAL SUNDAY AFTERNOON CROWD.
over the door read " HEALTH EXHIBIT; FOR MEN ONLY; AD-
MISSION FREE," and on the doors were the names of the co-
operating organizations and signs stating that there was no
admission charge and " Absolutely Nothing for Sale."
Figure 3 shows the character and general arrangement of the
exhibit material used inside the building. A long, rectangu-
lar exhibit room with a small (8' by 10' by 10'), consultation
30
SOCIAL HYGIENE
room for use by the medical advisor was all the available
space; this made it necessary to crowd the material together
and impossible to display it to the best advantage. The whole
wall space was used for the serial presentation in colored panels
of the social and medical stories of typical cases of syphilis and
gonorrhea, advertising material and literature illustrating the
FIG. 3. INTERIOB OF BUILDING, SHOWING CHARACTER AND GENERAL ARRANGE-
MENT OF EXHIBIT MATERIAL.
methods of quacks and advertising specialists, and information
relative to ophthalmia neonatorum. A central table served
the double purpose of directing the crowd in at one door and
out at the other and supporting educational panels bearing
directly upon the problem of venereal disease control. All the
panels were of a uniform size (30" by 40 ").
On the right hand wall, beginning at the entrance door, was
A HEALTH EXHIBIT FOR MEN 31
placed a double series of colored panels, arranged one series
above the other, picturing case histories of gonorrhea with
proper methods of treatment contrasted with those treated by
improper and dangerous methods (see Figs. 4-15). These
pictures were cartoons in color done by R. Phillipps Ward.
These series were preceded by two introductory pictures rep-
resenting a very common prelude to infection with this disease.
First was shown a stag party with its wine and suggestive
stories which tend to break down the normal resistance against
such temptation as is shown in the second picture which rep-
resents a common street phase of prostitution. After careful
consideration it was decided to represent two men as, at the
outset, on the same moral plane, and then beginning with these
infected men of like social status to carry out the parallel stories
of early, persistent, scientific treatment with its probable re-
sults contrasted with ignorant, indifferent treatment with its
probable results. If it be true that the great majority of men
do, at some time or other during their lives, lay themselves open
to gonorrheal infection, this presentation certainly should be
most effective as a means of causing them to stop and consider;
if this assumption be untrue, the fact still remains that there is
an appalling amount of gonorrhea in our country and nothing
but good can come of a strong, pointed message on the causes
of this disease, the vehicles of transmission, the dangers to self,
family, and society of careless and casual treatment, and the
necessity for prompt and continued treatment of every case
diagnosed as gonorrhea.
It has been suggested that by pointing out that this disease
is curable in the great majority of cases if early and persistent
treatment is applied, we are breaking down one of the most
potent deterrents against illicit intercourse. But when objectors
are questioned as to what part fear of consequences plays
as a deterrent from promiscuous sex activities they do not
hesitate long before ruling it out as an important factor; with
it disappears any ground for argument which may have been
contained in their original criticism to the effect that to point
a cure makes exposure to infection more likely. It might be
32
SOCIAL HYGIENE
FIG. 4
A Stag Party. Wine and Smutty Stories,
which lead to improper thoughts of women.
FIG. 6
A. "Yes, it is Gonorrhoea You must remain
under treatment until cured."
FIG. 5
Excited by Drink and Lewd Stories, two from
the stag party nick up prostitutes and become
infected with Gonorrhoea (clap).
FIG. 7
B. "What! A dose? Nothing t9 it. Come
over and see Jake. He'll fix you up in no time."
A HEALTH EXHIBIT FOR MEN
33
A. "My doctor sent me to you because I
could no longer afford private treatment. I
want to be cured."
FIG. 10
A. "The microscope shows no germs. Come
back in one month for a final test."
FIG. 9
B. "Jake's capsules haven't helped me. This
Doctor advertises a quick cure."
FIG. 11
B. "That morning drop means nothing
You are cured."
34
SOCIAL HYGIENE
FIG. 12
A. "I liavo made every test. I think
may safely marry."
you
A.
FIG. 14
A happy family. The result of consci-
entious treatment.
FIG. 13
B. "If any man can show just cause why
they may not lawfully be joined together, let
him now speak, or else hereafter forever hoi I
his peace."
FIG. 15
B. Gonorrhoeal rheumatism, infant blind-
ness, invalidism. The result of ignorance,
indifference and neglect.
A HEALTH EXHIBIT FOR MEN 35
pertinent to ask at this point whether the knowledge that diph-
theria and even tuberculosis are curable or that actual prophy-
lactics against infection by smallpox and typhoid fever are
known, has made persons more careless about laying themselves
open to such infections or inhibited them from developing all
reasonable methods of prevention? And by those who have
given special attention to this disease as a socio-medical problem
it is realized that the danger is not that gonorrhea shall be looked
upon as reasonably certain of cure under proper treatment;
but that it shall, and at present is, considered unimportant,
"no worse than a hard cold," and cur, able without help or under
inexpert treatment. For that reason did we emphasize the dan-
gers of drug clerk and quack treatment and the necessity for
the use of the microscope and other tests before a person, once
infected, can safely enter upon the responsibility of matrimony or
be certain that his own health has been restored. We feel
that this message has been successfully impressed upon those
who have visited this exhibit. It is impossible to believe that
any man could view the results of "ignorance, indifference and
neglect," as depicted in Figure 15 of this series, without experi-
encing a determination not to be a party to such a tragedy if
he can possibly prevent it. And whether his method of pre-
vention be by extra-marital continence, medical prophylaxis, or
treatment to a certain cure, society has gained inestimably
in economic, health, and moral conservation, even though the
whole problem has not been solved.
On the opposite wall was a series of eight double panels illus-
trating the possible course of syphilis infection under similarly
contrasted conditions, presented, however, in a somewhat differ-
ent manner. (See Figures 16-23.) Where the story of gonorrhea
had been told by realistic drawings this material was posterized,
giving somewhat the same impression and creating something of
the same interest that is exhibited in advertising posters in trolley
cars and on billboards. Also, instead of conversational, colloquial
captions such as were employed in the previous series, simple,
explanatory statements were used. In other words, while the
same parallel arrangement of two infected men undergoing
36
SOCIAL HYGIENE
FIG. 16
FIG. 18
FIG. 17
FIG. 19
A HEALTH EXHIBIT FOR MEN
37
EAR LATER
A, HAVING WISE-
LY FOLLOWED
THE PHYSICIAN'S
ADViCE, MARRIES
WiTH ft CLEAN t
BILL OF HEALTH
B.iHPATiENTOVttTHi
ANO SCEM1NC TO ALL
WElL.MABWfS ACAiHST
1i5 tXKTOR'5 AOViCEJ
FIG. 20
FIG. 22
HEAD OF A
~AM«LY,THE
OF A COiY
CMC, AND A MAN
" PDOMiNENCE
i MIS COMMUNITY
Ss ISHOOriliSLViNSA
WiTO MKSiS, WHILE Hi5
WirE.WHOSTUCKTOTHE
TOEATMEMTS 'Til CURED
MANAGES TO EKE OUT;
FIG. 21
FIG. 23
38
proper and improper treatment with the consequent results was
used, there was enough variety in the details of presentation so
that no attention value was lost.
This series was the work of Ernest Hamlin Baker. The ex-
hibit owes much to Mr. Ward and Mr. Baker and their interest
in it as a social experiment.
Our method of approach in this series attempted to take away
the venereal stigma which has been so powerful in preventing
adequate control of this disease by the public health authorities.
While, in the gonorrhea series, it was felt necessary to suggest
the importance of alcohol and prostitution as twin allies of
evil in the spread of that disease, the syphilis series was intro-
duced by the statements seen in Figure 3. "A LARGE PER-
CENTAGE OF SYPHILIS IS CONTRACTED INNOCENTLY.
IT MAY BE NECESSARY FOR ANYBODY TO UNDERGO
TREATMENT FOR THIS DISEASE AT ANY TIME."
Then instead of showing any source or mode of infection, the
series opens with the two infected men reading signs in public
comfort stations— one a Health Department sign urging men
to consult the Department for diagnosis and advice; the other
an advertisement of a quack or medical institute.
The emphasis in this, as in the gonorrhea series, was upon
early and continued treatment, for while the initial chancre
and rash, if noticed, are usually attended to with great diligence,
after the acute stage is past and the primal fear has subsided,
treatment is often neglected until the later, tissue-destroying
manifestations appear. Therefore this series showed that no
hope of a permanent cure can be held out until after one year
of treatment and another year of careful observation with peri-
odic Wassermann tests, and that even then it is advisable to wait
and watch at least another year before considering marriage
or ceasing medical and laboratory supervision.
The fear has been expressed that we are here too sanguine in
the claims made for present day syphilis therapy; that we can-
not positively say that salvarsan and mercury will cure all
cases of syphilis. We must, of course, admit that any demon-
stration or exhibit which has to do with the education of the
A HEALTH EXHIBIT FOR MEN 39
public toward personal or community health is subject to many
limitations since we are dealing not with exact, mathematical
data but with biological and human factors many of which are
beyond our control. Still, there are some things, which, while
not reducible to exact proof, are reasonably certain and to be
depended upon in the great majority of cases; and one of these,
relying upon the history of past experience, is that syphilis
is a curable disease if treatment is begun early in the course
of the infection and carried out faithfully with frequent Was-
sermann tests under competent syphilographers.
We were confronted in the preparation of this exhibit with the
task of overcoming the two main obstacles which have stood in
the way of any real progress in combating the ravages of this
disease — first, the attitude of the infected individual and second,
the attitude of the public.
The infected man (or woman) is of two types; either one who,
through ignorance of the way in which the disease develops,
mistakes a quiescent period for a real cure, and then ceases
treatment; or one who, having been led to believe that syphilis
is an incurable disease, simply ignores treatment entirely and
proceeds to make his peace with God in anticipation of an
early and ignominious demise. The first of these attitudes we
strove to correct by educating these men and replacing their
misconceptions by pointing out the three stages of the disease
and impressing them with the facts that the apparent cure in
which they trust is very likely to be no cure, and that a definite
and extended system of treatment under a trained specialist
is essential to a real cure; and the second we tried to change by
holding out in the strongest way possible, the hope of an ulti-
mate cure.
The attitude of the public we hoped also to influence on behalf
of medical science, — the public which for so many years has
passively watched the effects of this disease for the most part
without comprehending them, has built and maintained insane
hospitals, institutes for the blind, and almshouses largely for the
syphilitic dependents instead of recognizing this disease as one of
the main causes of such dependency and endeavoring to stop the
40 SOCIAL HYGIENE
flood at its source. Success in changing this attitude of the public
is also a step on behalf of the host of women and children (and,
may I add, men), who have been innocently infected. No " holier
than thou" attitude or the belief that these afflictions are sent as
a part of the scheme of the universe in the dispensations of
Divine Providence in just punishment for a law violated should
longer be tolerated. We can see faint glimmers which tend to
show that this public attitude is slowly changing. By fearless
and truthful education on the part of the medical profession and
others interested in the social hygiene movement, the ignorance
and misconceptions surrounding syphilis are beginning to be dis-
pelled. When this has been done it remains only properly to
equip and man clinics in each city and town to control in large
part the spread of this infection.
On a shelf directly under this syphilis series was a row of
colored cuts and photographs taken from Jacobi's and Wechsel-
mann's works. These showed various lesions — non-venereal,
and primary, secondary, and tertiary stages of syphilis, together
with the wonderful transformation in the appearance of the
same lesions and rashes after salvarsan injections.
These went far towards correcting certain exaggerated ideas
gained from quack museums by replacing misinformation with
exact medical knowledge. This was further carried out in our
exposure of the fallacies in quack literature. By taking certain
sections on seminal emissions and other subjects used for the
purpose of frightening young men into treatment by the special
methods put forth as sure cures by these men, and selecting
matter from medical text-books on the same subjects, the truth
was brought out in a most effective manner. These were cap-
tioned as follows: "WHAT THE QUACK SAYS; WHAT THE
FACTS ARE." Immediately under these panels was a large
poster made up of quack signs taken from the toilet-rooms of
saloons at Coney Island in the course of a survey made as a
preliminary to the exhibit by representatives of the New York
Social Hygiene Society and the City Department of Health.
Such signs were removed from seventy-two saloons and replaced
by announcements of the diagnostic clinic of the City Department
A HEALTH EXHIBIT FOR MEN 41
and the facilities for treatment offered by the Brooklyn Hospital
Dispensary. They served as a basis for much discussion and did
as much as anything to put the men who saw them on their guard
against these practitioners and their methods. (See Fig. 24.)
The great menace of the quack is that by showing apparent quick
cures and discharging patients as cured he not only wrongs the pa-
tient but endangers others by engendering in the patient a false
BEWARE OF THE DOCTORS
WHO ADVERTISE TO CURE YOU
AND OF THEIR HALF-BROTHER, PATENT MEDICINE
LOOK OUT!
IT is YOUR MONEY THEY ARE AFTER
WATCH YOUR HEALTH!
DON'T BE FOOLED BY THEIR FALSE STATEMENTS
BEWARE OF THE DOCTOR THAT ADVERTISES
FIG. 24. POSTER REGARDING ADVERTISING SPECIALISTS1
sense of security which causes him to cease taking precautions
against infecting his companions.
The educational material on the central table was apparently
read with great care and interest. (Figs. 25-30.)
Another exhibit which attracted much attention was one con-
taining all the posters and signs which could be secured referring
to diagnostic and treatment facilities throughout the country
and labelled, "WHAT IS YOUR HEALTH DEPARTMENT
DOING?" As a fair index of what boards of health are actu-
ally doing in this respect it may be interesting to state that
1 Signs advertising treatment or medicine for venereal disease by unscrupu-
lous medical specialists may be found in most communities.
42
SOCIAL HYGIENE
in reply to three hundred and twenty-five letters sent to health
departments and health officers requesting such posters and in-
formation from towns and cities in New York, Connecticut,
Rhode Island, New Jersey, and Eastern Pennsylvania only eight
HELP
LOWER
LUNACY STATISTICS
DECREASE
MENTAL DEFICIENCY
AID IN THE
PRODUCTION OF HEALTHY CHILDREN
SAVE THE EYE-SIGHT
OF NEW-BORN INFANTS
INCREASE THE WHOLE NATIONAL
MORALE
GET INTO THE FIGHT
PREVENT
SYPHILIS AND GONORRHOEA
FlG. 25
REMEMBER
GONORRHOEA (CLAP)
AND
SYPHILIS (POX)
ARE GERM DISEASES AND
CURABLE ONLY BY
STRICT ADHERENCE TO THE ADVICE
OF A
RELIABLE DOCTOR
FIG. 27
DON'T TAKE A CHANCE
The Detroit Board of Health in an
examination of 2S4 prostitutes found
that 94 per cent had Gonorrhoea or
Syphilis. Of these women 40 per cent
had both these diseases.
An investigation of New York Venereal
Clinics showed that about 90 per cent of
infected men did not remain under treat-
ment until cured.
ARE YOU WELL?
FlG. 26
THE ONLY POSSIBLE WAY
TO ELIMINATE PROSTITUTION
IS TO
DESTROY THE DEMAND;
THIS MEANS YOUR DEMAND
Much, however, can be done to limit
the supply by laws properly enforced
and sex education wisely taught.
FIG. 28
signs were received, five from cities in northern New Jersey
and three from New York.
Two other very suggestive colored panels loaned by the
American Social Hygiene Association were displayed. The
first of these represented in colored drawings the causes of
A HEALTH EXHIBIT FOR MEN
43
venereal diseases, i.e., the organisms; the carriers, i.e., prosti-
tutes; and the sufferers. The other showed the agencies for con-
trol of the infected individual : the diagnostic clinic, dispensary,
and hospital, and the social service nurse.
The photographs prepared by the Department of Health of
the City of New York showing the methods of diagnosis of these
diseases as employed by its laboratories were also most in-
structive.
While, as was said before, other exhibits dealing with certain
phases of venereal diseases have been held, we are not aware
PROSTITUTION REDUCED TO SIMPLEST
TERMS
WHAT HE BOUGHT
Temporary Animal Pleasure
PRICE HE PAID
An Insignificant Fee; Much Self Respect
POSSIBLE RETURNS ON THE
INVESTMENT
An Abnormal Sex Appetite
A Distrustful Wife and Family
Loss of Respect of Friends and Associates
A Ruined or Lost Home
A Loathsome Disease (often incurable
or uncured)
A Blunted Social Conscience
IS IT WORTH THE GAMBLE?
/ MONEY
1 BUSINESS
YOUR \ ECONOMIC
) AND
V SOCIAL INFLUENCE
AFFECTING PROSTITUTION AND
THE SOCIAL EVIL?
Kic. 2!)
FIG. 30
of any attempt having been made before to supply expert medi-
cal consultation and advice upon this subject at any such ex-
hibit. And, again, it is rather difficult to see why this has not
been done. Old Dr. Quack knows that the time to supply such
information and attention is at the time the demand is aroused
immediately after the prospective patient has seen the models
in the museum or read the book which brings the possibility of
infection or sexual derangement forcibly to his mind. We,
therefore, acted upon and applied this psychological fact by
providing two genito-urinary specialists who were in attend-
44 SOCIAL HYGIENE
ance three hours every evening and an additional afternoon hour
on Sundays and holidays. This service was performed without
pay by Dr. Thomson and members of his staff and constituted
one of the most whole-hearted cooperative enterprises ever
enjoyed by this Society.
During the two months this exhibit was open it was visited
by 19,390 persons, 64 of whom were women from a woman's
FIG. 31. INTERIOR OF MEDICAL ADVISOR'S OFFICE.
organization in the city that petitioned Mayor Mitchel to use
his influence in getting it opened for women on certain dates.
This experiment proved most valuable and we feel that an ex-
hibit of this nature might well be used in bringing home to women
not only the dangers of these infections but also woman's re-
sponsibility in the great fight against their spread.
Of those who consulted the attending physicians, there were
found 183 infected men, 137 of recent origin, and 46 who desired
A HEALTH EXHIBIT FOR MEN
45
information because of old infections. Ninety-one specimens
were taken for diagnosis and sent to the Health Department for
examination, with reports as follows:
FOB WASSEBMANN
FOB COMPLEMENT
FIXATION
QONORRHEAL
SMEAR
Positive
8
4
25
Negative
19
13
11
Doubtful
1
3
1
Imperfect specimen
2
0
4
30
20
4T
Of these 183 cases, 33 were syphilis and 150, gonorrhea. Of
the 33 cases of syphilis, 17 were Americans; 9, Italians; and 7
of other nationalities. The 150 gonorrheal cases were divided
as follows: American, 97; Italian, 19; and other nationalities, 34.
Those designated as Americans were almost equally divided
between those of Jewish extraction and others. There were
but 7 married men among the 33 syphilis cases and 12 among the
150 infected with gonorrhea. One in each group had been di-
vorced. These 183 men contracted their infection in the fol-
lowing manner: from public prostitutes, 109; clandestine pros-
titutes, 54; friends, 15; other persons or information refused, 5.
Of the 183 infected men interviewed, 153 were referred for
treatment as follows: 101 to the Brooklyn Hospital Dispensary;
31 to other dispensaries; and 21 to their family physicians.
The practice was to refer the man to the approved clinic, on the
Health Department list, which was situated nearest his home.
Forty of the 101 cases referred to the Brooklyn Hospital Dis-
pensary actually appeared for treatment, each case being acknowl-
edged by the division chief on the date it appeared at the dis-
pensary. While the other clinics were also requested to acknowl-
edge any patients that came to them for treatment from this
exhibit, no such acknowledgments were received, though
estimating from the numbers that appeared at the Brooklyn
Hospital Dispensary, 40 per cent., or 12 other cases, should have
gone under treatment. It is an open question whether we should
not endeavor to get this other 60 per cent, under treatment by
46 SOCIAL HYGIENE
sending out follow-up notices and even by the use of social serv-
ice workers, for surely if treatment can and will be provided for
these infected individuals, they should be prevailed upon to
take advantage of it.
Aside from these 183 men who came to the physicians for
personal information in regard to their infections, 408 other men,
mostly young fellows, came for information on other sexual
matters, or for conditions they feared were of a venereal nature.
For instance, it was not at all uncommon for a group of three
or four young men, after reading the "Four Sex Lies" chart to
come in with questions relative to the Sexual necessity fallacy;
or after having seen the manner in which the text-books treated
the quack's scare literature in regard to nocturnal emissions to
come in for more specific information bearing upon their own
cases. Masturbation, one of the subjects touched upon in one
of the pamphlets given out at the door, " Sexual Hygiene for
Young Men," was another subject of evident great interest
as were also the causes and effects of varicocele and enlarged
prostate glands. Cases of scabies, acne; and other diseases
thought to resemble syphilis were also somewhat in evidence.
As the season waned and the crowds dropped off we began to
give lectures in the form of short talks on certain parts of the
exhibit material or on questions asked by those present. These
proved most successful in gaining the interest of visitors and
showed beyond doubt the great mass of ignorance and mis-
information with which we must contend in educating the public
on this subject. We feel that much was done in this respect
both by the exhibit, the lectures, and the literature which was
distributed, amounting to no less than 80,000 pieces during the
summer. The Brooklyn Hospital Dispensary booklet on these
diseases, the pamphlet by Dr. W. T. Belfield on " Sexual Hygiene
for Young Men," and the Health Department's advice circular,
all of which were furnished by the Hospital and the American
Social Hygiene Association, or reprinted for us by that Depart-
ment, must have gone far toward instructing those who read
them as to the nature and dangers of syphilis and gonococcus
infections and the fundamental facts of sex hygiene in general.
A HEALTH EXHIBIT FOR MEN 47
Many interesting comments were overheard during the sum-
mer and some most encouraging statements written in the record
book by our visitors. This was a very typical remark often
heard in some form or other: As three young fellows passed
through the exit one was heard to say, "I'm going to call that
date off tonight. No more going out for me; I've seen enough."
Another incident showed how the exhibit tended to advertise
itself after it had been in operation a few weeks: Three fellows
were passing along the Bowery when one of them suddenly
stopped and was overheard urging the others to come in. He
said, "Come on in here, Bill, it's worth your while to see this.
Its great stuff." They came in.
The following remarks are fairly representative of the im-
pression made upon the pleasure resort type of man: —
"Some pictures, believe me!"
"That will never get me."
"This exhibit is splendid. Should be more of them."
"Excellent idea. Ought to be more of such exhibits in and
about New York City."
"This shows the need of teaching sex hygiene to boys and girls
early. "
"The schools should teach more of this."
"The pamphlets are very instructive. I never knew such
things before. "
"Never again for me. "
Many very deplorable experiences were recounted about per-
sonal treatment by quacks. To their sorrow several fellows
were acquainted with some of those whose signs we displayed.
One told of reading an advertisement in a paper which caused
him to call upon the "doctor" for consultation in regard to an
old gonorrheal infection. A specimen of his blood was taken
and he was later told that the examination showed that he had
syphilis. He did not see the report but was promised a cure for
$150. After having three injections of something, he was shown
a negative blood report. The patient gave no history of syphilis,
only of gonorrhea five years ago. In this case the deception
was bad enough; but if the patient had actually been suffering
48 SOCIAL HYGIENE
from syphilis, it is reasonable to suppose that he would also
have been discharged when his money was gone and actually
have been pronounced "cured" in six weeks.
Another young man, with pimples on his face, went to one
of New York's " medical institutes." A venerable and fatherly
looking doctor came up to him and said, "Well, you've got it."
"Got what?" asked the frightened boy.
"Why syphilis. That is a syphilitic rash on your face."
He was then told what a horrible disease he had but was
promised a cure for $100. The boy was charged $5 for that
visit and some medicine which he was told to take and a few
days later came into our exhibit. Noticing the sign in regard
to free advice, he came to the doctor and told this story. A
diagnosis of scabies was made and the other $95, besides much
needless and dangerous worry, were saved to the boy.
Many men wrote their personal views of the exhibit and its
usefulness in the record book and while these remarks were not
always grammatically perfect they at least voiced the principal
point which the writer wished to express as shown in the following :
"Exhibits of this nature that you so vividly show at Coney
Island, if they were distributed throughout the city, would do
more towards eradicating venereal diseases than anything else."
"The hour here tonight was well spent."
"Having visited this institution, I consider that it will pre-
vent more than the diseases, it will prevent men from exposing
themselves to the risk."
"A most* excellent exhibit and should be made permanent."
These suggestions of a wider use of this material and the
establishment of permanent exhibits were repeatedly expressed
and are significant of the attitude of many of our visitors.
It is our hope that this will be made possible by a demand for
reproductions of these serial pictures. They can be reproduced
by lithography at a very reasonable cost provided twenty to
thirty copies are made at the same time. We feel that such
reproduction would be useful for social hygiene societies, health
departments, and other agencies interested in the control of
A HEALTH EXHIBIT FOB MEN 49
venereal disease through educating the individual and community
attitude. Modifications of our experiment for improvements
in the exhibit material, for auxiliary features designed to add
to its interest and practical effectiveness, or for other develop-
ments of our plans likely to increase its usefulness are sure to
suggest themselves to those acquainted with exhibit work and
we shall be pleased to receive any constructive suggestions.
CHANGING STANDARDS1
Moreover, it is not unlikely that as knowledge multiplies in
regard to matters involving sex morals and problems of domes-
tic relationships there will come in certain directions modifica-
tions in social policy. Illegitimacy, for instance, rightly is con-
demned by public opinion, for children should not be born into
the world except under conditions set by moral standards based
on experience and scientific knowledge. Yet it is possible that
in the future society may look compassionately on mother and
child under such circumstances, but visit its sternest disappro-
bation on the father, compelling him to set aside a proportion-
ate share of his income for the support of the child, and publicly
to acknowledge it as his offspring. Public opinion also in the
case of the prostitute may be inclined to forbear from condem-
nation and, on the other hand, to incarcerate as criminals those
who tempt women to sin and who pander to human lust. Again,
in further illustration, under present conditions a poor widow
having minor children is punished for her motherhood by priva-
tion and excessive toil through her endeavor to support them
in decency, whereas a proper policy would cheerfully support
them as a united family, not out of charity but as a right due
to the mothers of the next generation. Indeed, it is not un-
likely that the state under a complete insurance system may
supply an annual pension to the mothers of minor children, as
a policy far more socially justifiable than pensions allotted for
services in war.
1 The Family in its Sociological Aspects. By James Quayle Dealy. Hough-
ton Mifflin Company, Boston. 1912.
50
THE MATTER AND METHOD OF SOCIAL HYGIENE
LEGISLATION
TIMOTHY NEWELL PFEIFFER
Attorney for the American Social Hygiene Association
Social workers regard legislation as an important factor in
the solution of the problems to which they are addressing them-
selves. Faith in its potent efficacy as an aid in righting social
wrongs shows no signs of abatement and is, indeed, by way of
increase. Perhaps this faith would be more justified if attention
were devoted in greater measure to the form of statutory en-
actments and the means and feasibility of enforcing them. Such
care as that which has been bestowed upon many labor and
sanitary laws has aided materially toward the building of a
code of consistent, well-drawn, and properly classified legislation,
besides indicating in what ways the law needs to be changed or
amplified for the further protection of the public welfare. The
field of social hygiene is particularly fruitful for the study of
what can and what cannot be accomplished through legislation,
because it includes legal conceptions upon which the legislative
mind has played for centuries, as well as certain ideas of social
polity whose implications are wholly modern, and because it is a
matter which touches everyday life and business at many vital
points.
Social hygiene has in its present interpretation a three-fold
aspect, law enforcement, public health, education. Viewed from
no one of these points, has any definite, long-abiding opinion
about social hygiene taken root. A problem as old as the hills,
for which a new solution is almost annually sought! Shall
prostitution be repressed, shall it be regulated, or shall it be
ignored? Shall the veil of silence and ignorance be torn from
venereal diseases or shall they remain the hidden scourge? Shall
sex be taboo or shall ifc be considered as a normal phenomenon
of life?
51
52 SOCIAL HYGIENE
The public, with the whole subject becoming more or less
popularized, does not know its own mind. The only thing of
which it is at all certain is that something ought to be done and
the encouraging as well as novel point in this latter day unrest
is the feeling which accompanies it, that the matter is one well
worth serious study and research into comparative experience as
a basis for constructive action. Prostitution, like poverty,
is gradually being lifted out of that hazy, undiscriminating cate-
gory to which the supposedly insoluble is usually assigned —
"human nature." This gain has been accomplished principally
by differentiating the factors involved, and by recognizing the
necessity of dealing with each constituent problem in accord-
ance with its peculiar difficulties. All three factors involve
legislation, vastly differing, however, both in matter and in
means of enforcement. The failure to realize the prime impor-
tance of this fact sometimes causes the poor draftsmanship but
more often the worse provisions of many statutes. Legal chaos
follows. In New York "A prostitute may now be convicted
and committed under a bewildering number of statutes, among
others, the New York Consolidation Act, Code of Criminal
Procedure, the Inferior Criminal Courts Act, State Charities
Law, Tenement House Law, Penal Law, Chapter 439 of the
Laws of 1912, and Chapter 353 of the Laws of 1886. Likewise,
the keeper of a bawdy house makes herself liable to punishment,
under the Penal Law, Code of Criminal Procedure, Liquor Tax
Law, Tenement House Law, Public Health Law, White Slave
Traffic Act, and the Immigration Laws.":
Public opinion, never unanimous about anything, varies all
the way from the white heat of anger against the man who, by
force or fraud, drives a girl into prostitution, to cool indifference
toward eugenic marriage laws. One of the first questions
confronting the legislator, therefore, is how much unanimity is
requisite for the enforcement of a law. This will hang largely
upon the purpose of the law and the method provided for its en-
forcement.
1 Laws Relating to Sex Morality in New York City. A. B. Spingarn. New
York: Century Company, p. xi.
SOCIAL HYGIENE LEGISLATION 53
Clearly then a social hygiene law needs classification. What
is its purpose? It may be a law to enforce public opinion.
The punishment of certain common law, criminal offenses against
sex morality, such as rape and seduction, for centuries has had
public sanction because such offenses involve force or fraud. It
is quite proper, therefore, to attack them directly by prohibition.
Keeping a disorderly house for purposes of prostitution has
been a misdemeanor from time immemorial in England and
America, but the prohibition has been more notorious for its
breach than its observance. A theory of equal longevity and
general prevalence was that of masculine sex necessity. Public
opinion backed the latter theory much more often than the
former, but not always, as the outbreaks against the prostitute,
recurrent throughout history and accompanied frequently by
torture, testify.
Or it may be a law to formulate public opinion, though the
classical school of publicists deny that this is a proper function
of legislation. Most social workers insist that public education
on many points is most quickly and completely achieved by
means of legislation. Ostensibly enacted for other purposes,
so-called eugenic marriage laws and laws for the compulsory
reporting of venereal diseases find justification in the minds of
their supporters because of their educational value. If, however,
it turns out that these reporting laws are not enforced or, as is
claimed in the case of the marriage "health certificate" laws,
actual evasion is deliberately practised, such justification is
unwarranted, whatever the excellence of the general theory upon
which they were based.
On the other hand, many public health measures concerning
the prevalence of diseases and the popular dissemination, through
official channels, of knowledge about their causes and treatment
are undoubtedly valuable educationally. The distinction lies
in the fact that, as regards the marriage health certificate and
compulsory reporting laws, the public is either opposed to their
enforcement or is indifferent and will probably remain so until
its attention is focussed upon them and until reasonable and
effective methods of administration have been demonstrated;
54 SOCIAL HYGIENE
while, as regards the more definitely educational measures,
public interest is already aroused, as evinced by numerous
"Health Weeks" and "Public Health Trains." So, for the
successful operation of a social hygiene legislative measure, it is
well to sound out in advance the attitude of those who are to
enforce it. And since the program of social hygiene legislation
is very largely made up of measures whose execution will fall
chiefly on a selected group, i.e., doctors, public health officials,
state and municipal inspectors, or law enforcement leagues, the
preliminary task (the education of the selected group) should
be measurably achieved before the enactment of legislation.
If the statute relates to a crime, the police primarily, but the
public ultimately, through courts and juries, will determine its
workableness. The necessity of an honest and efficient police
administration cannot be over-emphasized. Time and again
the people of a community have given their active assent to a
policy of vigorous law enforcement; but the excitement dies,
and it becomes again the routine duty of the policeman to
suppress law breaking. If his superiors are negligent, corrupt,
or politically compromised, the "reform" will be a thing of the
moment and the whole movement to repress commercialized vice
may be adversely affected. San Francisco, Chicago, Philadel-
phia, and Kansas City are examples among our larger cities
whose histories furnish ample illustrations of the sensitive nature
of the "underworld." Loose police policies seem to be divined
by those who hope to profit thereby even before the policeman
has learned to know what is expected of him by his superiors.
The establishment of special courts for cases involving pros-
titution has, in some cities, become an accepted means for the
more vigorous and just enforcement of the laws. Special courts,
such as the Women's Night Court in New York and the Morals
Court of Chicago, have done noteworthy work, especially in
evolving standards for judicial action in such cases. Judges are
assigned permanently to these courts, thus obviating in a large
measure the personal idiosyncrasies of a constantly changing
judiciary. Psychopathic laboratories have been established in
connection with them and the doctor confers with the judge
SOCIAL HYGIENE LEGISLATION 55
regarding the imposition of sentence. The offender, not the
offense, claims the chief attention. These courts are also com-
ing to have an educational value by means of the statistics
which are being compiled concerning recidivism, mentality, and
the social histories of thousands of prostitutes. The practice
of fining prostitutes was brought to its end in New York by
agreement of the judges of the Night Court even before its
prohibition by statute. The success of their efforts in individual
cases is, however, dependent upon an efficient probation system
for the women and girls who are capable of profiting by it, and
secondly upon institutions such as farm colonies and custodial
asylums in which hardened offenders and the mentally deficient
may be segregated. The value of women police officers lies
in their ability to protect the young more effectively than police-
men can. Whatever bearing moving picture theaters, dance halls,
and parks may have upon the recruiting of prostitutes, policewomen
are more capable of ascertaining that bearing than are men.
So-called morals police, that is to say, a body of officers
specifically charged with the suppression of criminal offenses
against sex morality, have been set up in Europe, but with in-
different success. Mr. Flexner has pointed out the reasons why
a morals police is no more likely to deal intelligently and effect-
ively with the problem than is the regular force, while they are
subjected to increased opportunities and temptations to act
dishonestly.2 It may be that a specially detailed group of
officers, if its personnel is frequently changed, can effectively
supplement the vigilance of the patrolman in repressing prostitu-
tion on his beat; it is more than doubtful whether such a group
should supersede the patrolman altogether and relieve him of
all responsibility for this class of crime.
Such laws as the Injunction and Abatement Law, the tin
plate ordinance, and statutes prohibiting the publication of
obscene literature depend for their enforcement largely upon the
activity of an unofficial law enforcement agency constantly
seeking evidence of their violation. Though the first two of
* Prostitution in Europe. Abraham Flexner. Century Company, New York,
1911. pp. 270-2, 341-2.
56 SOCIAL HYGIENE
these laws give officials a powerful weapon for the repression
of vice, they are reluctant to use them because they involve new
procedure or a new method of attacking prostitution and district
attorneys also claim that they cannot enforce the Injunction
and Abatement Law because they do not possess the means of
obtaining evidence. A notable instance of the possibilities of an
unofficial agency is the work now being done by the Law En-
forcement League of San Francisco, where, by the institution of
suits under the Injunction and Abatement Law, the use of prop-
erty in connection with commercialized prostitution is becoming
legally dangerous.
Nearly every state recognizes, in one way or another, the
far-reaching evils that grow out of the prevalence of venereal
diseases, and their prevention and cure are coming to be viewed
as public health problems. Frequently, however, measures are
proposed and enacted with little regard to the fact that the state
must rely upon the cooperation of the medical profession for the
success of any comprehensive plan for the prevention and control
of gonorrhea and syphilis. Public health officials are recruited
from among physicians and are deeply affected by the opinions
and prejudices prevailing in their profession. The effectiveness
of public health measures is often marred because they are
enacted by statute or ordinance, rather than by the regulation
of a state or municipal board of health. Such boards are in-
clined to take a hostile attitude toward the enforcement of
legislation enacted without consultation with them or against
their judgment. Then, too, the amendment of a statute or
ordinance is a more difficult matter than changing a board of
health regulation, so that in some states obsolete or inadequate
medical theories and practices encumber the statute books and
hamper the work of boards of health. The public health is
much more likely to be conserved and improved by bestowing
broad powers upon boards of health to lay down the details of
their program through their own regulations, easily and quickly
modifiable in accordance with increasing scientific knowledge,
than by the enactment of haphazard and comparatively per-
manent statutes by state legislatures or city councils.
SOCIAL HYGIENE LEGISLATION 57
For the enforcement of laws concerning immigration, labor,
licensing, and sanitation, for the provision of adequate educational
and recreational facilities, and for the segregation of the socially
unfit, reliance must be chiefly placed upon state and municipal
inspectors whose intelligence and social vision will determine
the wisdom of their recommendations, and it is their recom-
mendations for amendments to statutes which should be of
fundamental importance, for social legislation assuredly has
not yet passed out of the experimental stage. Such inspectors
often are mere political appointees with slight qualifications
for the arduous tasks set before them, with the result that
amendments are framed and new laws proposed by a multitude
of unofficial organizations which are prone to forget, in their
zeal, the relation of their particular field of activity to social
welfare in general.
Nor do these considerations of purpose and enforcement
exhaust the problems to be considered in working out an ade-
quate program of social hygiene legislation. Under the law
as it exists today, the crime of prostitution is committed by the
woman only, because the law's definition of prostitution, as well
as the dictionary's, is "to give up to lewdness for hire," and it is
only the female who does this. Yet no one hopes to suppress
prostitution by attending solely to the prostitute. The act of
the man in accepting the offer of the woman's body is certainly
offensive to public decency, even if not in the same degree as
the act involved in the woman's offer. But the Massachusetts
experiment in making fornication a crime proves how futile such
a law is when public opinion, as expressed through police, judges,
and juries, is opposed to its enforcement. Occasionally to fine the
man ten dollars for fornication is only a little less to be desired
as a policy for suppressing prostitution than is the fining of the
prostitute. Adultery, both as a matter of morals and, because
of the possible infection venereally of a wife, as a matter of public
health, is a greater offense than fornication. But Massachusetts
makes not a pretense of enforcing its statute against adultery,
though the records of its divorce cases supply abundant evidence.
A recent statute in Connecticut makes it an offense to be a
58 SOCIAL HYGIENE
frequenter of a house of prostitution. It will be interesting to
watch the convictions under this law and the penalties imposed.
Another recent statute is that enacted in New York which declares
a person to be a vagrant, "who loiters in or near any thorough-
fare or public or private place for the purpose of inducing, entic-
ing, or procuring another to commit lewdness, fornication,
unlawful sexual intercourse, or any other indecent act, or who
in any manner induces, entices, or procures a person who is in
any thoroughfare or public or private place to commit any
such act." Now, not even by a legal fiction is it good public
policy to class the casual consort of a prostitute with the tradi-
tional "hobo," and the only effect of this law has been to make
possible the conviction for vagrancy of pimps and panders
upon evidence which would be insufficient for conviction under
the pandering act. A good end, but a confusing means of achiev-
ing it.
There is no likelihood of holding the man criminally responsible
for the act of sexual intercourse with a consenting female of
mature years, whether with or without a money consideration,
until greater unanimity of public opinion refuting masculine
sex necessity is brought about. Until such time, education,
not penal legislation, is the proper field of social action, for as
long as a very considerable proportion of men believe in mas-
culine sex necessity, it is impossible to enforce such legislation,
depending for its enforcement, as it does, upon the consent
of the general public.
It is an altogether different matter in the case of the third
person who profits financially as a result of the act of sexual
intercourse. The public generally is quite willing to wage war
on pimps, procurers, the owners and lessees of houses of pros-
titution, and the proprietors of disorderly saloons. Direct pro-
hibitory laws are capable of enforcement against the operations
of such persons.
Still another difficulty is the rapid change in the forms which
prostitution assumes when attacked. No sooner is the segre-
gated district abolished than the suburban road house springs
up and automobiles are used as places of prostitution. In the
SOCIAL HYGIENE LEGISLATION 59
West prairie wagons have served a similar purpose and in most
cities massage and bath parlors and "call houses" as well as
assignation hotels are now common. The telephone is another
means, secret and always accessible, of bringing the man and
the woman together. With each change sufficient evidence
to convict under existing laws becomes harder to obtain and new
legislation is frequently necessitated. To rely on the police
to ferret out these new forms of prostitution is to invite their
continuance. A vigorous, resourceful law enforcement committee
of private citizens, working in cooperation with the police
whenever possible, is the most efficient way to repress com-
mercialized prostitution. It is entirely within the power of the
police to root out the traffic in women and girls, to close houses of
prostitution, and to prevent street walking, but cities are slowly
learning that it is only the unofficial law enforcing agency that
can be counted on to follow prostitution into its new and less
public lairs.
Closely related to commercialized prostitution is the traffic
in liquor and habit-forming drugs. The illegal sale of liquor is
the inevitable concomitant of the house of prostitution, and a
considerable proportion of seductions, the victims of which
ultimately become prostitutes, are accomplished when girls
are under the influence of alcohol. Disorderly saloons are
the meeting ground of prostitutes and their customers. The
most notable instance of the effect of unwise liquor legislation
upon prostitution is the Raines Liquor Law in the state of New
York. How this statute actually stimulated the commerciali-
zation of prostitution and metamorphosed saloons into assigna-
tion hotels is clearly set forth in the annual reports of the Com-
mittee of Fourteen of New York City. Investigations pre-
ceding the enactment of the Harrison Anti-Narcotic Law, a
federal statute restricting the importation, manufacture, and
sale of habit-forming drugs, and of various state statutes en-
acted for the same purpose showed that the female users of such
drugs tended to drift into prostitution as the final stage of their
moral disintegration, because that was the only means available
for obtaining money with which to purchase drugs. The extent
60 SOCIAL HYGIENE
to which prostitutes become drug addicts has never been care-
fully ascertained. But studies made at institutions like the
New York State Reformatory at Bedford provide some data
on the use of alcohol and drugs by prostitutes.3
The provision in statutes of extreme penalties adds to the
difficulties of law enforcement. Juries are loath to convict
except of the grossest kinds of offenses against sex morality
where they know that judges may and sometimes must impose
penalties unnecessarily harsh. In most Southern states rape
is punishable by death or life imprisonment. Such statutes are
unenforced except as against negroes. In 1915, two statutes
were enacted in California concerning perversion; one made sex
perversion a felony, punishable by imprisonment for not less
than twenty years, the other provided that sex perverts, when
so declared after a 'hearing by the court, should be committed
to the state hospital for treatment! Another bill introduced
in the same session of the California legislature provided that
rape should be punishable by imprisonment for not less than
twenty nor more than fifty years. In England very few crimes
are punishable by long prison terms, but, partly at least, because
of the swiftness and greater certainty of convictions, less crime
is committed there than in America.
The character of the evidence required by the courts and
juries in cases involving sexual crime, unless the element of
force or fraud or extreme youth of the girl is present, is a sharp
deterrent to aggressive police action. Mr. Frederick H. Whitin,
in an article in SOCIAL HYGIENE,4 has stated the details of the
courts' requirements in New York, and the same holds true
for most other American j urisdictions. It is enough to add that
no satisfactory improvement can be expected until criminal
procedure, including the whole body of the law of evidence, has
been thoroughly revised in accordance with modern, scientific
concepts.
3 Commercialized Prostitution in New York City. George J. Kneeland. Century
Company, New York, 1913. p. 186.
4 Obstacles to Vice Repression. Frederick H. Whitin, Secretary of the Com-
mittee of Fourteen, New York City. SOCIAL HYGIENE, April 1916.
SOCIAL HYGIENE LEGISLATION 61
Finally, legislation will be expedited and its quality vastly
improved when some coordination in formulating a program
of desirable social measures is achieved by the agencies pro-
moting such legislation. The enormous number of bills annually
introduced in legislatures through the efforts of social workers
is witness to the willingness of legislators to cooperate; it is
witness also to the fact that the organizations which have under-
taken to lead popular thought in the reconstruction of our social
and economic institutions have not yet even formulated a com-
prehensive, constructive program of legislative action.
The establishment of a legal bureau, representing the many
national social agencies, which should not only draft bills but
also should determine the times when and the states in which
such bills could be most advantageously introduced and urged
for passage, has become a necessity.
The following program of social hygiene legislation does not
represent a final conclusion. It is merely a composite of various
measures, now in force in one or more states or cities, which
seem to give promise of successful operation at the present tune.
Practically every state already has enacted all of the criminal
statutes. The Injunction and Abatement Law is now in opera-
tion in twenty-seven jurisdictions. Adultery and fornication are
statutory offenses in many states, but these laws have not thus far
been enforced. Sterilization laws exist in several states and are
popularly classed with social hygiene legislation but have only
a slight bearing on either the repression of prostitution or the
eradication of venereal diseases. The so-called marriage "health
certificate" laws have a more practical bearing on the reduction
of these diseases but, like the existing laws for reporting them,
have either been unfortunately drafted or have not been followed
by the development of effective administrative regulations. The
measures suggested below have all been tried and where the ad-
ministration has been efficient, have proved their worth.
1. STATE STATUTES
Commercialized Prostitution
White slavery; Keeping disorderly house (criminal); Injunction and abatement
law (civil); Street soliciting; Disorderly saloons and hotels.
62 SOCIAL HYGIENE
Offenses involving Sex
Age of consent; Seduction; Rape; Abduction; Desertion; Illegitimacy; Obscene
literature.
Venereal diseases
Detention of persons in public institutions till cured; Prohibition of advertise-
ment of "cures" for venereal diseases; Physician may disclose to prospec-
tive spouse.
Miscellaneous
State vice commission; Provision for department of education and publicity of
state and municipal boards of health; Laws affecting labor, housing, immi-
gration, licenses., and sanitation; Regulation of liquor and drug traffic; Segre-
gation of feeble-minded and persistent prostitutes.
2. STATE BOARD OF HEALTH
Appropriation to study; Free diagnosis and salvarsan; Free literature; Public
exhibits; Compulsory hospital facilities; Compulsory examination of cer-
tain classes of employees, including civil service; Prohibition of employ-
ment in industries where infection may result; District nurses; ''Unpro-
fessional conduct" for physicians to advertise treatment of venereal diseases;
Compulsory reporting (see discussion below;.
3. MUNICIPAL ORDINANCES
Municipal vice commission; Licensing of all rooming houses, hotels, massage
and bath parlors, and private amusement places; Provision of municipal
recreational facilities; Regulation of liquor traffic; Creation of special courts
for disposition of cases of prostitution.
4. MUNICIPAL BOARD OF HEALTH
Free and pay clinics; Compulsory examination of civil service employees;
Examination of other employees on request; Free literature; Public exhibits;
District nurses.
The great undeveloped field is that which relates to venereal
diseases. Here the board of health, the law-enforcing agency for
most measures for the prevention and cure of these diseases, must
not only administer such measures, but generally must impro-
vise them. It is probable that marked advance will be made
in this direction. One of the essentials of such progress is an
adequate system of reporting, the details of which, however,
will necessarily be quite different from those governing the re-
porting of other communicable diseases. A sufficient number of
experiments have been tried to indicate that it is only a matter
SOCIAL HYGIENE LEGISLATION 63
of time and education before these details are worked out. If,
instead of attempting to legislate as to details, legislatures should
place venereal diseases on the reportable list by some such act
as that in the subjoined foot note, the educational value of the
statute would be secured and health departments challenged
to work out ways and means of obtaining reports without en-
countering the inevitable difficulties attending more specific legis-
lation at this time.5
The extent and variety of legislation which has been enacted
in the attempt to control venereal diseases is illustrated by the
following list of statutes, ordinances, and regulations of boards
of health.
STATR LAWS AXD REGULATIONS OP STATE BOARDS OF HEALTH REGARDING
VENEREAL DISEASES
The following states, either by law or regulation of the state board of health,
forbid the employment of a person having a venereal disease in —
Food-handling Establishments
Arkansas— Bd. of Health, May 16, 1913.
California — Laws 1909, page 151.
Colorado— Laws 1913, ch. 128.
Illinois — Approved June 5, 1911, Sec. 10.
Indiana— Burns' Annotated Stat. (1914) sec. 7637h.
Iowa — Sanitary Law, Sec. 2527h.
Kansas— State Bd. of Health, Mar. 31, 1909. Reg. 7.
Maryland— Laws 1914, ch. 678, Sec. 2 (e).
Minnesota — Gen. Stat., Sec. 3731.
5 It shall be the duty of every physician in this state, and of every superintendent
or manager of a hospital or public institution in this state, immediately to report
to the local (or state) board of health every case of venereal disease which he is
called upon to treat or which is in such hospital or public institution, and every
such physician, superintendent or manager shall make such reports as may be
required by the rules and regulations of the state board of health and shall
comply with all the rules and regulations made by the said state board of health
to prevent the spread of venereal diseases; provided that, if a person having a
venereal disease is regularly treated therefor during its infectious stages by a
duly licensed physician, the name and address of such person may be omitted
from the report by said physician to the local (or state) board of health, and
instead thereof a serial number shall be included in the report.
64 SOCIAL HYGIENE
Missouri — Laws 1911, Sec. 8, Foods and Drugs Act.
Nebraska — Sanitary Food Law, Sec. 9840 x 8.
New Hampshire— Bd. of Health, May 9, 1911
New Jersey — Laws 1912, ch. 127.
New York — Sanitary Code, Sec. 146.
North Dakota— Comp. Laws, Sec. 2969.
Ohio — State Dairy and Food Dept., Reg. 7
Oklahoma— Bd. of Health.
Rhode Island— Laws 1910, ch. 576, Sec. 26.
Tennessee— Laws 1909, ch. 473, Sec. 8.
Wisconsin— Bd. of Health, April 6, 1914.
Wyoming— Laws 1913, ch. 108.
Barber Shops
Arkansas— Bd. of Health, May 16, 1913.
Colorado— Laws 1909, ch. 138.
Connecticut — Gen. Stat., Sec. 4672.
Illinois — Approved June 10, 1909, Sec. 11.
Kansas— Laws 1913, ch. 292, also Bd. of Health, Reg. 26.
Louisiana — Sanitary Code, Sec. 128.
Michigan— Laws 1913, Act 387, Sec. 10.
Minnesota — Gen. Stat., Sec. 5056.
Missouri— Rev. Stat., Sec. 1186.
New York— Public Health Council, Mar. 1, 1915.
North Dakota — Comp. Laws, Sec. 565.
Oregon— L. O. L., Sec. 4821.
Rhode Island — Gon. Laws, ch. 113.
South Carolina— Bd. of Health, Dec. 16, 1913.
South Dakota— Bd. of Health, July 25, 1913.
Texas — Declared unconstitutional.
Virginia— Bd. of Health, May 5, 1916.
Washington— Wash. Code, Title 45, Sec. 19.
Wisconsin— Bd. of Health, Aug. 26, 1915.
Bakeries
Connecticut — Gen. Stat., Sec. 2570.
New York— Laws 1913, ch. 463, Sec. 113a.
Oklahoma— Rev. Laws (1915) Sec. 3756B.
Indiana— Burns' Ann. Stat. (1914) Sec. 7634.
Pennsylvania — 1 Purdon's Digest, p. 398. •
Washington— Wash. Code, Title 37, Sec. 15.
Rhode Island— Laws 1910, ch. 576, Sec. 26.
Wisconsin— Wis. Stat. (1915) Sec. 1636-62, Sec. 4.
Mississippi— Bd. of Health, Aug. 20, 1912.
New Hampshire— Bd. of Health, May 9, 1911.
Meat Shops
New Hampshire— Bd. of Health, May 9, 1911.
School Hack Drivers
Indiana— Bd. of Health, Dec. 17, 1913.
SOCIAL HYGIENE LEGISLATION 65
Public Eating Places
Pennsylvania — Laws 1915, No. 281.
Laundries
Colorado— Bd. of Health, Feb. 7, 1916.
Manicure or Chiropodist Shop
Virginia— Bd. of Health, Maj' 5, 1916.
MISCELLANEOUS PROVISIONS
Detention in Prison Till Cured
Connecticut— Laws 1911, ch. 220, Sec. 2975.
Massachusetts — Laws 1906, ch. 365.
Four Thousand Dollars Appropriated to Diagnose
Massachusetts — Laws 1914, ch. 295.
Hospital Facilities Required
Massachusetts — Laws 1906, ch. 365.
Syphilitic Prisoners Segregated
Massachusetts — Laws 1908, ch. 365.
Ten Thousand Dollars Appropriated for Manufacture or Purchase of Preventive
Medicine Jor Free Distribution
Massachusetts — Laws 1916, ch. 47.
Appropriation of Seven Thousand Five Hundred Dollars for Serum Diagnosii
New York— Laws 1915, ch. 725-726.
Person Who Has, as Result of Prostitution, Is Vagrant
New York — Criminal Code, Sec. 887, subdiv. 3.
Physician Permitted to Disclose that Person about to be Married Has
Ohio— Laws 1915, p. 177.
Twenty Thousand Dollars Appropriated for Support of Females under Twenty-
one Who Have
Oregon— Laws 1915, ch. 335, 351.
Board of Health to Provide Free Treatment and to Distribute Literature
Vermont— Laws 1913, No. 218.
Pupil Having not to Attend School
California— Public Health Act, Sec. 17.
Separate Ward for Venereal Cases in Industrial Home for Women
Wisconsin — Laws 1915, ch. 347.
Distribution of Literature Concerning Venereal Diseases
Florida— Bd. of Health, June 10, 1913.
Free Wassermann Test
California — Bd. of Health.
Massachusetts — Laws 1914, ch. 295.
Oregon— Bd. of Health.
South Carolina — Laws 1916, Act 551.
Utah— Bd. of Health.
Wisconsin — Laws 1915, ch. 307.
Wilful Communication Penalized
Iowa— Laws 1913, ch. 212.
Oklahoma— Rev. L., Sec. 2766.
Vermont— Laws 1915, No. 198.
66 SOCIAL HYGIENE
Use of Surimming Pools Forbidden
Louisiana — Bd. of Health, Feb. 26, 1913; Amend, to Sanitary Code, Sec. 589,a.
Use of Public Baths Forbidden
Kansas— Bd. of Health, Reg. 26.
MUNICIPAL ORDINANCES AND REGULATIONS OF MUNICIPAL BOARDS or HEALTH
REGARDING VENEREAL DISEASES
From January 1, 1910 to November 1, 1916
The following cities, either by ordinance or regulation of the municipal
board of health, forbid the employment of a person having a venereal disease in —
Bakeries
Cincinnati, O. Bd. of Health, Sec. 10, May, 1911.
Seattle, Wash. Ordinance 26066, Sec. 10, June 30, 1910.
Augusta, Ga. Ordinance, Sec. 1, July 30, 1912.
Elyria, O. Ordinance, July 28, 1911.
Bayonne, N. J. Bd. of Health, Jan. 20, 1912.
Bellevue, O. Bd. of Health, Mar. 21, 1912.
Cincinnati, O. Bd. of Health, July 24, 1912.
Des Moines, la. Ordinance 2055, Nov. 13, 1912.
Mobile, Ala. Ordinance, Sec. 8, July 9, 1912.
Akron, O. Bd. of Health, Sec. 13, Nov. 1913.
Cleveland, O. Bd. of Health, Sec. 11, July 28, 1913.
Schenectady, N. Y. Ordinance, Sec. 3, Aug. 13, 1913.
Spokane, Wash. Ordinance C. 1848, Jan. 4, 1915.
Norwood, O. Bd. of Health, Feb. 6, 1915.
Springfield, 111. Ordinance, Mar. 23, 1915.
Newport News, Va. Bd. of Health, Mar. 5, 1915.
Evanston, 111. Ordinance, Mar. 26, 1915.
Chicago Heights, 111. Ordinance, Sept. 8, 1915.
North Yakima, Wash. Ordinance A-205, Apr. 10, 1916.
Lynn, Mass. Bd. of Health, July 26, 1916.
Decatur, 111. Ordinance 270, Apr. 10, 1916.
Barber Shops
Altoona, Pa. Bd. of Health, Rule 52, Mar. 30, 1911.
Chelsea, Mass. Bd. of Health, Rule 71, May 10, 1910.
Cincinnati, O. Bd. of Health, Sec. 14, May 1911.
Bayonne, N. J. Bd. of Health, June 20, 1912.
Bellevue, O. Bd. of Health, Mar. 20, 1912.
Cincinnati, O. Bd. of Health, July 24, 1912. No. 63.
Augusta, Ga. Bd. of Health, Sec. 28, Sept. 29, 1914.
Johnstown, Pa. Ordinance 20, Sec. 85, Mar. 17, 1914.
Paterson, N. J. Bd. of Health, Sec. 14, Nov. 10, 1914.
Bloomfield, N. J. Bd. of Health, May 26, 1915.
Greenwich, Conn. Bd. of Health, Oct. 15, 1915.
Hotels and Restaurants
Bellevue, O. Bd. of Health, Mar. 21, 1912.
Spokane, Wash. Ordinance C, 1548, Sec. 9, Nov. 17, 1913.
Decatur, 111. Ordinance 270, Apr. 10, 1916.
SOCIAL HYGIENE LEGISLATION 67
Food Handling Establishments
Toledo, O. Bd. of Health, June 19, 1912. Sec. 2.
Wilmington, N. C. Ordinance, June 1, 1912.
Danville, Va. Ordinance, Dec. 13, 1913.
Evanston, 111. Ordinance, June 3, 1913. Sec. 7.
Hamilton, O. Ordinance 946, Sees. 14 and 26, Mar. 6, 1913.
Lexington, Ky. Ordinance 149, Sec. 8, July 9, 1913.
Oklahoma, Okla. Ordinance, Jan. 28, 1913, Sec. 235.
Wilmington, N. C. Ordinance 198, Feb. 28, 1913.
Haverhill, Mass. Bd. of Health, Sec. 42, May 17, 1914.
Houston, Texas. Ordinance, Sec. 181, Jan. 26, 1914.
Huntington, W. Va. Ordinance, Sec. 8, May 25, 1914.
New Hanover County, N. C. Bd. of Health, Sec. 91, Sept. 2, 1914.
Spokane, Wash. Ordinance C. 1548, Jan. 4, 1915.
Toledo, O. Bd. of Health, Apr. 29, 1915.
Freeport, 111. Ordinance 5, Feb. 1912.
Tacoma, Wash. Ordinance 6078, Mar. 24, 1915.
New York, N. Y. Dept. of Health, Mar. 30, 1915, Dec. 21, 1915.
Bellevue, O. Bd. of Health, Mar. 21, 1912.
New Britain, Conn. Ordinance, July 5, 1916.
North Yakima, Wash. Ordinance A-205, Apr. 10, 1916.
Mt. Vernon, N. Y. Bd. of Health, Jan. 10, 1916.
Milk
Memphis, Tenn. Ordinance, Aug. 19, 1910.
Jackson, Tenn. Ordinance, Dec. 14, 1911.
Cairo, 111. Ordinance 25, Sec. 8, Rule 11, Sept. 10, 1913.
Charles, La. Ordinance, Sec. 6, June 12, 1913.
Mobile, Ala. Ordinance, Sec. 12, June 5, 1913.
Perth Amboy, N. J. Bd. of Health, Art. 7, Sec. 9, Sept. 17, 1913.
New Hanover County, N. C. Bd. of Health, Sec. 102, Sept. 8, 1914.
Kansas City, Mo. Ordinance 23,314, July 17, 1915.
Hackensack, N. J. Bd. of Health, Dec. 28, 1915.
Morristown, N. J. Bd. of Health, Apr. 10, 1916.
North Yakima, Wash. Ordinance, July 5, 1916.
Laundries
Spokane, Wash. Ordinance C. 1848. Jan. 4, 1915.
North Yakima, Wash. Ordinance A-205, Apr. 10, 1916.
Meat Handling
Savannah, Ga. Ordinance, Sec. 16-f, Dec. 10, 1913.
Waycross, Ga. Ordinance, Sec. 16-f, Feb. 17, 1914.
MISCELLANEOUS PROVISIONS
Swimming Pools
Seattle, Wash. Ordinance, Sec. 4, May 15, 1911.
Houston, Texas. Ordinance, Art. 9, Sec. 84, Jan. 26, 1914.
Municipal Clinic Established
San Francisco, Cal. Ordinance, Feb. 14, 1911. (This ordinance provided
for a segregated district and medical inspection of prostitutes.)
68 SOCIAL HYGIENE
Medical Examination of Prostitutes
Cincinnati, O. Bd. of Health, No. 73, Oct. 30, 1912.
Reports of Venereal Diseases Required from Public Institutions
New York City. Bd. of Health, Feb. 20, 1912.
Public Institutions to Report Venereal Diseases, and Bd. of Health to Establish
Free Clinic
Montclair, N. J. Bd. of Health, Jan. 28, 1913.
Communicable Diseases Except Venereal Reportable
Manchester, Conn. Bd. of Health, 2, Jan. 27, 1914.
New Britain, Conn. Ordinance, Sec. 2, Sept. 1, 1914.
Persons Having Venereal Disease to Take Proper Treatment for Cure or to be
Isolated
Montclair, N. J. Bd. of Health, Art. 10, Sec. 5, Dec. 8, 1914.
Children's Homes Examined to Detect Venereal Diseases in
New York City. Bd. of Health, July 28, 1914.
Children Having Venereal Diseases Excluded from Homes
Orange, N. J. Bd. of Health, Aug. 25, 1914.
Food Handling in County Institutions, Homes, and Camps by Persons Having
Venereal Diseases Forbidden
New Hanover County, N. C. Ordinance, Sec. 161, No. 31, Sept. 8, 1914.
Dispensaries Must Report
Chicago, 111. Ordinance, June 8, 1907.
Venereal Diseases Reportable
Pittsburgh, Pa. Ordinance, 119, Apr. 29, 1915.
New York, N. Y. Sanitary Code, Sec. 88.
Rochester, N. Y.
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73
THE SOCIAL ASPECTS OF SYPHILIS1
The medical profession is, I venture to believe,
more keenly interested in the social aspects of the problem than
any other group of the community, for the reason that it has a
more intimate knowledge of the perils and misery of syphilis.
But the social problems involved in the control of syphilis are
not problems on which medicine can pretend to speak with
the greatest authority. These problems belong to sociology. I
dare to urge, however, that if syphilis is ever to be controlled
it will be by attacking it as a sanitary problem.
I am far from any desire to minimize the importance of the
efforts to control syphilis and the other venereal diseases by
methods of social and moral prophylaxis. It would seem to
be the bounden duty of right-minded parents to have their
children properly informed about the obvious facts of sexual life
and about the dangers of the venereal diseases. How important
it is that the knowledge of the dangers of the venereal diseases
should be gained in youth, is shown by the fact that of all times
of life the age between 18 and 24 years represents the period at
which syphilis is most frequently contracted by both sexes. There
can be no doubt of the usefulness of the efforts to educate the
adult public also with regard to the formidable dangers of syphilis
and gonorrhea. It surely makes for the reduction of venereal
diseases to inculcate the importance of high standards of moral-
ity and the hygienic value, to say nothing of other things, of
clean living. It is the duty of society to protect its youth and
its young manhood and womanhood, as far as possible, from the
temptations that arise from improper suggestions and surround-
ings and associates.
Last and most important of all, society should awaken to the
danger that arises from the later and later postponement of
marriage, and should make some effort to modify the conditions
of life which render it economically impossible for most young
men and many young women to marry. It should recognize
that the tendency to postpone marriage until well along in adult
life is a direct play in favor of the venereal diseases.
1 Syphilis as a Modern Problem. By William Allen Pusey, M.D. American
Medical Association, Chicago. 1915.
74
PROSTITUTION AND ALCOHOL1
WALTER CLARKE
Field Secretary of The American Social Hygiene Association
Intoxicating drink has been associated with prostitution from
the earliest times. Through the pages of social history, alcohol
figures as the evil genius of sex life almost from the beginnings
of civilization. St. Jerome called wine and youth the two fires
of lust. Ivan Bloch says: " Alcohol everywhere in the most
diverse conditions prepares the way for prostitution." Dr.
Prince A. Morrow declared: "Alcohol relaxes the morals, while
it stimulates the sexual impulse." Modern scientists, such as
Dr. William Healy, hold that alcohol plays a notorious part in
prostitution. Every Commission that has studied prostitution
agrees with the Chicago Report which refers to alcohol as the
"most conspicuous and important element next to prostitution
itself." The exploiters of vice are keen to take advantage of
the intimate, subtle association of intoxicating drink and sexual
immorality and to utilize it in commercializing the weaknesses of
human nature.
The psychological effect of alcohol upon the sex impulse pre-
sents a difficult scientific problem. Introspective observations
are unsatisfactory because the observer is himself affected by
the conditions of the experiment. The analyses from observa-
tion of the conduct of drunken men and women are largely
suppositional, and can not be regarded as final. Little labora-
tory work has been done, and the most modern experiments in
some degree overthrow the results of the older researches.
Physiologists have observed that profound changes take place
1 Based upon personal investigations in the disorderly resorts of many Ameri-
can cities, work in connection with the Wisconsin Vice Commission (1914-1915),
a field study of the child labor problem for the Massachusetts Board of Labor
and Industries (1913), a careful examination of the authorities upon the subject,
and conferences on the psychological aspects of alcoholism and prostitution.
75
76 SOCIAL HYGIENE
in the brain and nerve centers of chronic alcoholics, and have,
according to Rosenthal, discovered that the effect of alcohol upon
nerve centers is similar to that of other narcotics, such as chloro-
form and morphine. They have concluded that alcohol has a
selective effect upon the reproductive organs.2 Some have
thought that alcohol actually causes temporary physiological
changes in blood pressure and in the sensations of the repro-
ductive organs, thus creating subjective mental images and arous-
ing the sex passions. However, though there are possibilities of
this sort, physiological or psychological experiments have not
yet shown what actually happens, and further research must be
awaited for definite conclusions.
The findings of some of the older psychologists should not be
overlooked, though they may not be in agreement with present
or future experimental conclusions. They held that the func-
tions of the brain were, under the influence of alcohol, gradually
benumbed, paralyzed, depressed, the higher functions being af-
fected first. Thus Ribot, in describing the order of the "emo-
tional decline," gave the following sequence:—
The first to go are the "disinterested emotions— -esthetic and
higher forms of the intellect;" second, "altruistic — social and
moral;" third, "ego-altruistic — sexual love and religion;" fourth,
"purely egotistic — anger, fear, nutrition." Dr. George R. Cutten
says that the principles of self-abnegation, modesty, love, patience,
fortitude, self-criticism, and self-control are lost, and correspond-
2 Bertholet studied the influence of alcoholism on the histological structures
of sperm glands, and found atrophy of the testicles in more than one-half of 75
alcoholics. He concluded that the atrophy was due to chronic alcoholism. E.
Bertholet, Ueber Atrophie des Hoden bei chronischem Alkoholismus, Centralbl.
f. allg. Path. u. path. Anal., Jena 1909, xx, 1062-1066. "The sexual desire is
diminished and indeed abolished in alcoholic patients."
Doctor Thomeuf, Alcoholism in Women, Wood's Medical and Surgical Mono-
graphs, vol. vii, No. 2, p. 350. "Alcohol at first heightens the activity of the
sexual instincts, while at the same time it decreases the power of sexual satis-
faction."
H. J. Berkeley, Mental Diseases, p. 253; "Probably a direct toxic action is exer-
cised on the reproductive elements. Testicular atrophy has been observed, and
in women addicted to alcohol, menstruation ceases prematurely and the ovaries
atrophy." L. G. Robinvitch, Infantile Alcoholism, Quarterly Journal of In-
ebriety, xxv, 231.
PROSTITUTION AND ALCOHOL 77
ingly, self-sufficiency arises. And again Rosenthal remarks that
in women, there is a diminution or total loss of shame.
Rraepelin dug deeper into the effects of alcohol, confirming
by his experiments the conclusions of common observation. He
found " impairment of perception," increasing to the point of
insensibility of sense organs; "slowing of association processes,"
with the consequent effect upon conduct; changes in the quality
of associations, producing "shallowness of mental operations;"
"easier release of the impulse to action," with the commonly
observed results in ill-considered conduct; "loss of resistance"
to suggestion of word or example. "With this side of the
effects of alcohol is to be connected the fact that under its
influence those restraints which we call timidity, embarrassment,
perplexity, disappear; that all those numberless considerations
which at other times so finely regulate the speech and action of
men in their intercourse with one another, lose their power
over us. We become artless, spirited, reckless; we speak plainly,
express our opinions rudely, without taking the trouble to think
about the effect of our words, tell our secrets, and unveil the
most intimate emotions of our soul without restraint to the most
indifferent strangers."
Dr. George T. W. Patrick remarks: "Alcohol acts as a nar-
cotic and depressant upon all the nervous elements. Its action
among the delicate cells of the brain is that of a rough, intrud-
ing agency, and its paralyzing effect is most felt in those brain
centers which are phylogenetically newer and least stable. It
inhibits the inhibitory centers and slightly paralyzes the powers
of control and coordination, and this, in a way, sets free all the
older impulses and instincts."
"All motor reactions," says Professor Hugo Miinsterberg, in
discussing the relation of alcohol to crime, "have become easier,
all acts of apperception worse, the whole ideational interplay has
suffered, the inhibitions are reduced, the merely mechanical
superficial connections control the mind, and the intellectual
processes are slow. Is it necessary to demonstrate that every
one of these changes favors crime? The counter ideas awake
too slowly, hasty action results from the first impulse before
78 SOCIAL HYGIENE
it can be checked, the inhibition of the forbidden deed becomes
ineffective, the desire for rash, vehement movements becomes
overwhelming."
The work of Dodge and Benedict on the Psychological Effects
of Alcohol is the result of the finest and ripest experience of
modern experimental psychology. The amazing complexity of
the problem of the effect of alcohol is made evident to the reader
of their report and to the visitor in their laboratory. Their
experiments test the simplest and most easily measured phe-
nomena. Their results indicate in brief, the following conclu-
sion: The general effect of alcohol upon the processes measured
was that of a depressant. The most marked effect was upon
the knee-jerk; the second largest was upon the eyelid reflex; the
third largest upon the sensory threshold; the fourth upon the
eye movement; the fifth upon the speed of reciprocal innerva-
tion of the finger; the sixth and seventh upon the reaction time
of the eye and speech organs; and the eighth a negative result
in memory. "The natural grouping of the processes with re-
spect to the magnitude of the percentile effects of alcohol, viz.,
first, the two reflexes; second, the sensory threshold; third, the
two motor coordinations; fourth, the two elaborated reactions;
and fifth, the memory, is too consistent to be accidental. It is
confirmatory evidence of the reliability of our results, that simi-
lar processes yield similar results."
In contrast with the conclusions of Kraepelin, Dodge and
Benedict found that "Taken altogether, our data leave no doubt
that alcohol shows a real difference of incidence in its effects
on different levels of the nervous system of both normal and
psycopathic subjects. The lowest centers are depressed most
and the highest least. This is entirely contrary to our tradi-
tions. But as Professor Hunt remarked in an informal discus-
sion of these results: 'If alcohol had selectively narcotized the
higher centers it would have been used as an anesthetic years
ago.' ' "The regular and self-consistent data" of their experi-
ments indicate "that the simplest possible movements are much
more seriously depressed by alcohol than the more distinctly
intellectual processes." "It is to be noted," says the report
PROSTITUTION AND ALCOHOL 79
in chapter IX, "that the greatest and most persistent change
consequent to alcohol is in the processes which are most com-
pletely withdrawn from voluntary reinforcement and voluntary
control. The higher centers alone show a capacity for autogenic
reinforcement."
This sort of result throws grave doubt upon the statements
of the older investigators, and seems to discredit the simple
explanation that the effect of alcohol follows what is thought
to be the phylogenetic order of the development of brain func-
tions, for it does not appear that the more recently evolved
functions are affected first. Thus Ribot's classification, quoted
above, becomes merely a guess at the effects of alcohol.
But " There can be little doubt," say Dodge and Benedict,
"That in small experimental doses along with and as a part of
the general depression, we have clear indications of a paralysis
of inhibitory or controlling factors It seems prob-
able, too, that we have herewith come upon the grounds for a
wide variety of effects which are commonly observed in the
social use of alcohol, when circumstances give the reinforcement
and alcohol reduces the inhibitions."
It is upon this important and significant point that the most
careful of experimental studies seem to agree. The most clearly
defined effect of alcohol is upon the inhibitions. As Patrick says,
alcohol "inhibits the inhibitions." In this particular, experi-
mental evidence and observation agree, the data of the labo-
ratory explaining, in a "way, the conduct which may be seen in
the barroom or brothel. Whoever has closely observed a drunken
man or woman, has seen the emotions, the physical instincts,
bubble to the surface, and the restraints of discretion, fore-
thought, morals, and the like disappear. It is not so much
that evil or brutal passions are stirred by alcohol. Often the
intoxicated person is entirely harmless and very easily con-
trolled, generous to the point of foolhardiness, gay, unrestrained,
and boisterous. But as a result of the suppression of inhibitions,
the intoxicated person becomes suggestible, open to the flood
of his or her own emotions and to the stimulations of various
factors in the immediate environment.
80 SOCIAL HYGIENE
It is this condition of emphasized, accentuated suggestibility
that accounts in part at least for the tremendous influence of
alcohol in sex morals. As Bloch says, alcohol "prepares the
way" for moral lapses. In case there is, in the mind of the
intoxicated person or in the moral atmosphere of the group in
which the drunken man finds himself, a tendency toward cer-
tain conduct, that individual's will is very frequently incapable
of withstanding suggestion, even if the meaning of such sugges-
tion is taken into consideration by him. What more common
method is employed in bringing about moral lapses in young
men or girls than the use of strong drink in an environment
suggestive of immorality?
The well-known methods of the pander or procurer who plans
the entanglement of a particular man or woman are founded
upon this weakening result of alcohol upon ordinary restraints.
It is related that a pander who worked among the students of
a large university was accustomed to take young men, with
whom he scraped a casual acquaintance, to some wine room
where a dinner would be served and drinks liberally indulged in.
The pander was careful to arrange the journey back to the
students' quarters so as to pass the brothel for which he was a
runner. When near this resort, the pander would suggest to
his half-intoxicated companions a visit to the resort. In his
testimony before a vice commission, he stated that very few of
the young men upon whom he tried this plan were able to with-
stand the suggestion. It was his endeavor to secure young men
who had previously had no such experience.
The reports of vice commissions give numerous instances of
parallel cases among girls. It is partly because the intoxicated
man or woman is unable, on the one hand, to control the native
sex impulse, and on the other hand, unable to withstand urgent sug-
gestion, that alcohol contributes so substantially to immorality.
But other psychological factors must play a very large part—
a part, which though confused with alcohol, is not simply of
alcoholic origin. There is beneath the surface of the well-ordered
conduct of every normal (and many abnormal) individual, the
great fact of sex. The impulse of this instinct is, especially in
PROSTITUTION AND ALCOHOL 81
youth, never far below the threshold of consciousness. If this
urgent passion is bent on satisfaction, there is always in drink
an easy and almost unconscious liberation from the scruples
that hold one to the straight and narrow path. But the young
man who must be more or less under the influence of alcohol
before he can so completely discard his virtues as to enter a
house of prostitution or seduce some foolish girl, . can hardly
advance the alcohol excuse. It was something in his character,
in his mind before alcohol was taken, that determined his action.
Alcohol is clearly a factor but it is the accessory, not the cause.
It facilitates and makes easier the overthrow of any uncomfort-
able conscientious objection.
There are occasionally girls who, without knowledge of the
dangers that lie about them, are taken to drinking resorts, become
the victims of drugs, and are forcibly carried away to disorderly
houses and there debauched. These are the typical " white
slave" cases. In such cases, alcohol plays a disastrous r61e.
The luxurious cafes or the low dives that lend themselves to
such abuses are part of the network of vicious influences that
propagate and protect prostitutes and panders. The sale of
liquor in conjunction with immorality is a part of the daily busi-
ness of such places. But the motive in the white slave case is
the profit which the procurer expects to reap, alcohol being
merely an instrument, a tool with which to work. Drink and
the disorderly place in which it is sold, facilitate and provide
the opportunity for the carrying out of a vicious design, which
is only indirectly influenced by liquor itself.
The more ordinary type of experience is that of the girl who
drifts from bad to worse associates, frequents questionable dance
halls and cafes, acquires the drink habit, and falls gradually
into immorality. From illicit relations with one man, she be-
comes what is known as a ''charity girl," picking up a man
here and there for an evening's excitement and dissipation. The
step from "charity girl" to common prostitute is a short one.
It involves on the part of the girl a recognition of the fact that
by commercializing her immoral conduct, which previously she
had followed for pleasure and excitement, money can be earned.
82 SOCIAL HYGIENE
A variety of outside considerations may influence such un-
happy careers, but almost from the beginning of such a career,
as is summarized above, intoxicating drink is an important
factor. It loosens the bands of restraint, and over and over
again permits the passions to expend themselves in the most
dangerous ways. Meanwhile a desire for alcohol grows up.
Acts first committed under its influence are, after a while, com-
mitted for the sake of drink itself, and the victim becomes accus-
tomed to relationships against which formerly horror would be
felt. Desire for drink has long been recognized as playing an
important part in the drift toward prostitution. "It will be
conceded," says Sanger, "that the habit of intoxication in woman,
if not an indication of the existence of actual depravity or vice,
is a sure precursor of it, for drunkenness and debauchery are
inseparable companions, one almost invariably following the
other." Parent-Duchalet, speaking of the prostitutes, says
"They insensibly accustom themselves (to the liquor habit)
until the practice becomes so strong as to preclude all chance of
returning to a better state, and finishes by plunging them into
the lowest state of brutality."
But even in the cases of girls who have had such experiences,
the actual causes lie deeper. First, it must be considered that
many drift into prostitution and drunkenness partly because of
mental defect. In a careful study of one hundred chronic alco-
holics, Dr. V. V. Anderson found feeble-mindedness in 37, epilepsy
in 7, and insanity in 7. Of the remaining 49, 17 showed evidence
of alcoholic deterioration, and 32 evidenced psycopathic constitu-
tion. Dr. William Healy remarks, that "Many of the trouble-
some drinkers who cost society dear are primarily inferiors, and
alcohol just turns the balance against maintaining themselves as
non-criminalistic citizens." Professor Olaf Kinberg makes the
following significant statement: "Criminal chronic alcoholics
are, in great proportion, originally inferior individuals who
are attracted to alcohol as the moths are to the flame." When
such inferior individuals, hastened by the use of alcohol, drift
into a life of prostitution, it can not, without error, be said
PROSTITUTION AND ALCOHOL 83
that alcohol is the cause of such degeneracy. The fundamental
cause, in so far as any single one may be advanced, is the mental
defect which makes impossible the normal control of conduct,
or which gives a predisposition toward dangerous habits. Here
again, alcohol is the instrument; it facilitates and prepares the
way to sexual irregularity.
Furthermore, very many girls of the type under discussion
come from communities where moral standards are low, or
where immorality is daily before the eyes of mere children.
Facts are available, indicating that a large number of prosti-
tutes have come from families in which the father or mother,
or both, used alcoholic liquors habitually. Studies of delinquent
girls in New York and other cities have brought to light the fact
that ideals of chastity are practically non-existent among some
groups, their experience having been, from earliest childhood,
such as to rob them of the most common elements of self-respect
and modesty. Many such girls have become accustomed to
drink at an early age. Many have so often seen their parents
and friends in a state of intoxication that there is no longer, if
there ever were, any revulsion at the spectacle of drunken-
ness. For many such girls the step from casual immorality to
which they have almost unconsciously, in many cases, accus-
tomed themselves, to commercialized immorality, is but a short
one.
The alcoholism of such families is rather a symptom than
the disease itself. It may be a symptom of physical or mental
inferiority, of industrial defeat, of any one or all of numerous
difficulties. Notwithstanding the fact that we can scarcely refer
to alcoholic drink as a fundamental cause of family demoraliza-
tion, it is to such a degree associated with poverty and disease
that one aggravates and complicates the other. Alcohol blocks
the path of the family toward health and prosperity, and clears
the way to greater depths of disease and poverty; and they in
turn invite more confirmed alcoholism. From the grip of such
an environment the girl has but little chance to escape and
many are plunged into the life of prostitution.
84 SOCIAL HYGIENE
The business of prostitution invariably has identified itself
with vicious drinking resorts. The numerous saloons that per-
mit women to solicit men who in many cases come primarily
for drink; the cafes that are equipped with pandering waiters
and prostitutes for the asking; the public dance hall where liquor
is sold and where prostitutes and pimps solicit :3 these resorts, with
variations, are the common agencies of prostitution. They drum
constantly for business. They draw in the willing and the
unsophisticated. They stimulate the demand and augment the
supply. Often they mark a borderland between decency and
degeneracy through which young men and girls go on their way
to the house of prostitution. Much of the strength of commercial-
ized prostitution lies in its partnership with the commercialized
liquor traffic carried on in such questionable places. The com-
bination of drink, panders, and prostitutes is sufficient to cause
the moral collapse of a very large number of young men and
women who are, at first innocently enough, seeking recreation
and pleasure. Drunkenness and prostitution stand in the rela-
tion of aid and abettor to each other. Both profit enormously.
It is this vicious partnership of degenerative influences that
gives alcohol its most damaging power, so far as sex morals are
concerned. It is because of the surroundings and the conditions
under which liquor is sold, as well as because of the loss of con-
* During the period between November 13, 1910 and March 9, 1911, the Juve-
nile Protective Association of Chicago visited 328 dance halls in Chicago and
reported on conditions attending 278 dances. The following is a summary of
the results of this investigation, in part: "It shows that the public dance halls
of Chicago are largely controlled by the saloon and vice interests. The recre-
ation of thousands of young people has been commercialized, and as a result
hundreds of young girls are annually started on the road to ruin, for the saloon
keepers and dance hall owners have only one end in view, and that is profit."
"The conditions existing in the dance halls and in the adjoining saloons trans-
form naturally the innocent desire for dancing and for social enjoyment into
drunkenness, vice, and debauchery. Saloon keepers and prostitutes are in many
cases the only chaperons, and, in a majority of the places, even the young girls
and boys fresh from school are filled with alcohol and with the suggestion of
vice until dances cease to be recreation and become flagrant immorality." —
Our Most Popular Recreation Controlled by the Liquor Interests. Pamphlet pub-
lished by Juvenile Protective Association, Chicago, 1911.
PROSTITUTION AND ALCOHOL 85
trol which intoxication entails, that liquor frequently makes the
road to prostitution straight.4
There is no place where the relation, already discussed, be-
tween alcohol and sexual license is so skillfully used as in the
house of prostitution. Here alcohol is used in four distinct
ways. First, to attract a clientele; many men drop into dis-
orderly houses for a drink and to see the sights, and not with
the pre-determination to patronize the house further. Second,
as a means of incitement; with men under the influence of
liquor the prostitute is likely to accomplish the purposes of
her solicitation. Third, as a stimulant to the women; with-
out drink the prostitute would be stupid and spiritless. When
partially intoxicated she becomes more or less vivacious and
lively. Fourth, and most important, as a source of profit to
the madam. This phase of the subject has been treated in
a paper by Mr. George J. Kneeland in an earlier number of
SOCIAL HYGIENE in which he shows that madams make very
large profits from the sale of liquor in houses of prostitution.
He says: "One of the madams declared that her average profit
from the sale of beer each month was from $1200 to $1500.
. . . . A madam of a $1 house said she and her partner (a
man) made $2000 per month from the sale of beer at 50 cents
per bottle, and 'champagne' at $3 In nearly all of
these houses, the madams gave the inmates a certain commis-
sion on the drinks they induced men to buy One
madam said her inmates each earned from $35 to $40 per week
from such commissions. This particular city maintained three
4 "During the period of its investigation the Commission has secured definite
information regarding 445 saloons in different parts of the city. The investi-
gators have counted 929 unescorted women in these saloons, who by their actions
and conversation were believed to be prostitutes. In fact, they were solicited by
more than 236 women in 236 different saloons, all of whom, with the exception
of 98, solicited for rooms, 'hotels,' and houses of prostitution over the saloons."
The Social Evil in Chicago, 1911, pp. 34-35. "A very large constituent in what
has been called the irresistible demand of natural instinct is nothing but sug-
gestion and stimulation associated with alcohol, late hours, and sensuous
amusements, and deliberately worked up for the profit of third parties —
pimps, tavern-keepers, bordel-proprietors, etc." — Abraham Flexner, Prostitution
in Europe, p. 45.
86 SOCIAL HYGIENE
segregated districts. The total number of houses was 216, with
approximately 1871 inmates. Assuming that the annual profit
from the sale of liquor in each one of these houses was $5000,
and that each inmate earned $10 per week on commissions, the
total profit from beer and champagne would be $2,052,920 in
the 216 houses. To what extent this amount of alcohol stimu-
lated immorality can never be computed. How much venereal
disease followed in its wake will never be known."
Drunkenness is almost universal among confirmed prostitutes,
and drinking is quite as general among the frequenters of dis-
orderly houses. "Not 1 per cent.," Dr. Sanger states, "of the
prostitutes in New York practice their calling without partaking
of intoxicating drink," and the first solicitation in a house of
prostitution is to buy the drinks. When liquor is taken away,
the inmates are dull, irritable, disinclined to service, difficult to
manage, and even less attractive than when under the influ-
ence of alcohol. Drink is the life, the raison d'etre of the
prostitute.
The effect of closing out liquor from houses of prostitution has
been carefully noted in various cities. As an adjunct to the
business, it is so important, both as a source of income and as a
stimulant to the business of prostitution itself, that when liquor
is excluded from houses of prostitution, the business decreases
about one-half. The Chief of Police of Cincinnati stated in a
personal conference with the writer that the removal of liquor
from the houses of prostitution in Cincinnati was followed by
the closing of half of the houses. Those remaining are having
great difficulty, due to the decrease of their business. A madam
testified before the Wisconsin Vice Commission in 1914 that when
liquor was closed out of her house in Superior, her custom de-
creased 50 per cent. Other cases confirm these statements.
The expenses for rent, hush money, runners, and the personal
extravagances of the inmates, are so great that when alcohol,
the ally of prostitution, is removed, the business of many madams
must come to an end, and in a large number of cases, madams
have been obliged to give up their holdings in a city having
rigid enforcement of the law regarding the sale of liquor in ho uses
of prostitution, and have moved to less exacting communities.
PROSTITUTION AND ALCOHOL 87
In cities that have long been dry, commercialized vice is at a
minimum. Topeka, Oklahoma City, and Grand Forks, are as
regards prostitution, among the cleanest cities in the United
States. It may be true that the public opinion which will not
tolerate the licensed saloon is far less patient with the openly
exploited house of prostitution, regardless of the relation of
liquor to vice, but the originally good public opinion is pre-
served and strengthened by the development of a citizenry which
has not been hampered by vice and drunkenness. A few years
ago, Devil's Lake, North Dakota, was reputed to be the worst
town in the state. It was overrun with vice and crime. Then
the prohibition law was enforced. At a recent meeting of the
North Dakota Sunday school convention, twenty-five preachers
were lodged in the county jail at Devil's Lake, hotel accommo-
dations in the town being scarce, and the jail being entirely
without inmates. The dives and houses of ill-fame are gone.
Other North Dakota cities have had a similar experience. Presi-
dent F. L. McVey of the University of North Dakota says
that since the sale of liquor has been stopped in Grand Forks,
the problem of immorality among the students has become
much simpler. In Oklahoma City and Topeka conditions are
the antithesis of those in many wet cities of the same size.
Though it can not be surely claimed that prohibition is the sole
factor, it is unquestionably important. The observable differ-
ences in the morals of wet and dry towns are impressive.
In view of these considerations, bearing upon the intimate
relationship between alcohol and prostitution, the person who
hopes to see the morality and health of the community in which
he lives advanced, must desire the partnership of drink and
vice to be broken. Many cities have tried to accomplish this
by issuing police orders, forbidding solicitation in drinking resorts
and dance halls5 and forbidding liquor to be sold or distributed in
houses of prostitution. But the separation of the liquor traffic
from prostitution involves extremely difficult police problems.
It would be necessary to distinguish between the disorderly and
5 Practically every Vice Commission has recommended the prohibition of
soliciting in cafe's, saloons, dance halls, etc.
88 SOCIAL HYGIENE
the law abiding saloon, cafe, dance hall, wine room, or cabaret.
It would involve careful supervision of borderland resorts, which
fluctuate between decency and disorder from week to week and
from day to day.
On the other hand, though liquor were abolished from all
houses of prostitution, some would still be able to continue
their business. This has been proved to be the case in several
cities, for example, in Cincinnati, where, according to the state-
ment of the Chief of Police, liquor is not sold or distributed in
houses of prostitution and yet houses exist under regulation.
To issue an order forbidding the sale or distribution of alcoholic
beverages in houses of prostitution is tacitly to recognize and
attempt to regulate an evil forbidden by law and inimical to
health and morals. This is a form of regulation, a policy which
is now generally in disfavor in America, and which has been
abolished as a method of dealing with vice in nearly all our
cities.
Meanwhile, even supposing the successful separation of liquor
and commercialized vice, the other disastrous accomplices of
liquor remain. Alcohol has other partners than prostitution.
They are poverty, crime, and disease.6 To exclude drink from
houses of ill-fame and disorderly resorts would be an improve-
ment, but the economic, health, and criminal problems asso-
ciated with alcohol, partly as cause, partly as effect, would not
be simplified.
Is not the simpler method one which has no compromises, no
complicated distinctions, but which is in line with the policy
of vigorous, consistent, continuous vice repression — the com-
plete abolition of the liquor traffic? The gains which are to be
had by putting a stop to soliciting where drink is dispensed, and
by excluding liquor from all classes of disorderly resorts would
be ours, and in addition thereto, the simplification of problems
of crime and poverty, and the substantial improvement of the
public health.
8 Rosenthal states that 73.3 per cent, of crimes against morals are enacted
while the perpetrator is under the influence of alcohol.
PROSTITUTION AND ALCOHOL 89
BIBLIOGRAPHY
Alcohol and Crime. Dr. J. Gonser. Westerville, O.: Amer. Issue Publishing Co.
Alcohol and Criminality. Olaf Kinberg. Jour, of Criminal Law and Crimi-
nology, November, 1914, p. 512.
Alcohol and Mental Work. Dr. A. Smith. Westerville, O. : Amer. Issue Publish-
ing Co., 1898, p. 12.
Alcohol and War from the Psychological Standpoint. G. T. W. Patrick, M.D.
British Jour, of Inebriety, July, 1916.
The Alcoholic as Seen in Court. Dr. V. V. Anderson. Jour, of Criminal Law
and Criminology, May, 1916, pp. 89-95.
Alcoholism. Dr. Edith Spaulding. Amer. Acad. of Medicine. Bull., February,
1914, p. 13.
Alkoholismus und Prostitution. O. Rosenthal. Berlin: A. Hirschwald, 1905,
pp. 12, 19, 31.
Boyhood and Lawlessness. West Side Studies. Survey Associates, 1914, p. 146.
Commercialized Prostitution and the Liquor Traffic. George J. Kneeland. SOCIAL
HYGIENE, January, 1916, pp. 69-90.
Commercialized Prostitution in New York City. George J. Kneeland. New York:
Century Co., 1913, pp. 15-16.
History of Prostitution. Dr. W. W. Sanger. New York: Medical Publishing Co.,
1910, pp. 541-542.
License in Place of Licensing. Robert A. Woods. The Survey, September 30,
1916, pp. 635-637.
Mobilizing Against Alcohol. Boston: Unitarian Temperance Soc.
The Neglected Girl. Ruth True. New York: Survey Associates, Inc., 1914, pp.
85, 87, 88, 129.
Never Again for Russia. Literary Digest. April 22, 1916, p. 1182.
On the Witness Stand. Hugo Muensterberg. New York: McClure, 1908, pp.
254-255.
Prostitution and Mental Deficiency. Walter Clarke. SOCIAL HYGIENE, June,
1915.
Psychological Effects of Alcohol. Raymond Dodge and Francis G. Benedict.
Washington: Carnegie Institution, 1915, chapter IX.
Psychology of Alcoholism. George R. Cutten, M.D. New York: Scribners, 1907,
p. 149.
Recommendations of Laboratory of Social Hygiene. New York: Bureau of Social
Hygiene, 1915.
Russian Prohibition. Ernest Barron Gordon. Westerville, O. : Amer. Issue
Publishing Co., 1915.
Sex in Relation to Society. Havelock Ellis. Philadelphia: F. A. Davis Co., 1913,
pp. 207-208.
The Social Evil. E. R. A. Seligman. New York: G. P. Putnam's Sons, 1912,
pp. 37, 125-126, 136.
The Social Evil in Chicago. New York: Amer. Vigilance Association, 1911, pp.
119, 175, 544.
World's Social Evil. Wm. Burgess. Chicago: Saul, 1914, pp. 71-72, 176, 291-293.
Young Working Girls. Robert A. Woods and Albert J. Kennedy. Boston:
Houghton, Mifflin Co., 1913, p. 89.
90 SOCIAL HYGIENE
REPORTS ON VICE CONDITIONS
Baltimore, Maryland. Annual Report of the Society for the Suppression of Vice,
February 27, 1912, pp. 8, 9.
Bay City, Michigan. The Social Evil in Bay City, 1914, pp. 29, 35.
Bridgeport, Connecticut. Report of Vice Commission, 1916, pp. 23, 39-40, 83.
Chicago, Illinois. Chicago Civil Service Commission, Police investigation, 1911,
pp. 15, 19, 25.
Report of City Council Committee on Crime, March 22, 1915, pp. 97, 162,
172.
Report of the Chicago Vice Commission, 1911, pp. 34, 77, 82, 108-113, 119,
155, 172, 319, 320-21.
Denver, Colorado. Report of the Denver Morals Commission, 1913, pp. 5, 6.
Elmira, New York. Report on Vice Conditions, 1913, pp. 29-34, 55, 68.
Grand Rapids, Michigan. Report of Vice Committee of Forty-one, 1913, pp.
9, 11.
Lafayette, Indiana. Report on Vice Conditions, October, 1913, p. 29.
Lancaster, Pennsylvania. Report on Vice Conditions, 1913, pp. 19, 31.
Lexington, Kentucky. Report of Vice Commission, 1915, p. 16.
Little Rock, Arkansas. Report of Little Rock Vice Commission, May 20, 1913,
pp. 9, 11.
Louisville, Kentucky. Report of Vice Commission of Louisville, 1915, pp. 14,
68, 91.
Minneapolis, Minnesota. Report of Minneapolis Vice Commission, 1911, pp. 25,
75.
Newark, New Jersey. Report on Social Evil Conditions, 1913-14, pp. 21, 24, 56,
60, 62, 155.
New York, New York. Commercialized Prostitution in New York City, Knee-
land, 1913, pp. 15, 53.
Paducah, Kentucky. Report of the Paducah Vice Commission, 1916, p. 32.
Philadelphia, Pennsylvania. Report of the Vice Commission of Philadelphia,
1913, pp. 8, 21.
Rockland County, New York. Report of Survey Made in Rockland County,
1914-15, p. 16.
Springfield, Illinois. The Springfield Survey, June, 1915, pp. 1, 23, 53, 162.
Syracuse, New York. Report of Moral Survey Committee, 1913, pp. 33, 38, 88.
Toronto, Ontario. Report of the Social Survey Committee of Toronto, 1915,
p. 10.
Massachusetts. Report of the Commission for the Investigation of the White
Slave Traffic, So-Called, February, 1914, pp. 14, 18, 63, 77.
Michigan. Report of Commission to Investigate Extent of Feeble-Mindedness
in Michigan, 1915, p. 55.
Wisconsin. Report and Recommendations of Wisconsin Vice Committee, 1914,
pp. 54, 60, 70, 98, 152, 153, 154, 155, 156, 175, 206, 227, 235.
SOCIAL HYGIENE ACTIVITIES OF THE MAINE
MEDICAL ASSOCIATION
F. N. WHITTIER, M.D.
Chairman of the Committee on Venereal Diseases, the Maine Medical Association
The Committee of the Maine Medical Association on Venereal
Diseases and their Prevention was appointed June 28, 1910, at
the annual meeting in Bar Harbor, for the purpose of investi-
gating and formulating a plan for the prevention of venereal
disease in Maine.
In its first year, the committee worked along three lines : (1)
Collection of statistics regarding the frequency and disastrous
effects of these diseases. (2) Investigation of what has been
done along these lines abroad and in this country. (3) Con-
sideration of various plans for the prevention of venereal disease.
At the meeting in 1911 the committee reported to the Associa-
tion as follows —
As a result of a study of statistics, your committee is convinced that there is
good reason for believing —
That venereal disease destroys more lives than does tuberculosis.
That venereal disease is more prevalent than all other severe contagious
diseases combined.
That, taking into consideration the sterility, the wrecked homes, and the
ruined lives caused by venereal disease, it is one of the worst evils in the world
today.
As regards what has been accomplished, your committee believes that the
greatest advance has been along the lines of awakening the world to a higher
ideal of sexual morality. Education has been the most potent force thus far.
The licensing of houses of prostitution does not seem to work out well.
The committee suggested in its report that the Association
recommend to the State Board of Health the sending out of
circulars of information on sex hygiene to school superintendents
with the request that such circulars be distributed among teachers
and also among pupils when deemed advisable; and that syphilis,
gonorrhea, and chancroid be added to the list of diseases which
91
92 SOCIAL HYGIENE
physicians are required to report to the State Board of Health,
provided that these diseases be reported by number and not by
name. The committee also recommended the appointment of
a committee of the Association to cooperate with the State
Board of Health in carrying on a campaign of education of the
public as regards the importance of the prevention of venereal
disease.
This first report of the committee was approved by the Asso-
ciation and the committee was continued to carry out its recom-
mendations as far as possible.
The report of the committee and the action of the Associa-
tion were immediately brought to the attention of the members
of the State Board of Health. These officers expressed them-
selves as being in sympathy with the work, but pointed out that
the State Board of Health had no funds available for the pur-
poses recommended and consequently could not cooperate ac-
tively with the committee.
At a special joint session of the committee with the State
Board of Health in 1912, resolutions were passed by the Board
approving the dissemination of information upon the dangers of
venereal infection; expressing the readiness of the Board toco-
operate with the committee in the protection of the community
and the education of children; and stating as the sentiment of
the Board that syphilis, gonorrhea, and chancroid should prop-
erly be included in the list of infective diseases made reportable
by law, provided such diseases be reported by number and not
by name.
In the campaign of education of the public undertaken by the
committee, the plan advocated by Dr. Marshall H. Bailey,
Medical Director of Harvard University, seemed best to meet
the needs of the work in Maine and was chosen. By this plan
educational pamphlets dealing with sex hygiene are sent to
parents with personal letters asking the parents to read the
pamphlets carefully and if they find nothing objectionable in
them, to give them to their children to read, or to read such
extracts from them to their children as their own judgment dic-
tates. Parents are further requested, in case they do not agree
SOCIAL HYGIENE ACTIVITIES 93
with the views expressed, to help the committee by writing
frankly their criticisms to the chairman. After the considera-
tion of a number of educational pamphlets, the committee
selected the sex hygiene pamphlet The Boy's Venereal Peril,
issued by the Council on Health and Public Instruction of the
American Medical Association, for distribution to parents of
boys. Not so much has yet been done with pamphlets for girls,
but a few copies of Dr. Winfield S. Efall's pamphlets, also issued
by the American Medical Association, have been used. Nearly
two 'thousand individual letters have been written to parents
and forty-five hundred educational pamphlets distributed under
this plan.
It is a point of gratification to the committee that while
many other methods of teaching sex hygiene have been severely
criticized, the plan of teaching the importance of prevention
through parents has not been attacked.
Since 1911, the committee has been continued each year with
but three changes in membership. The reports of the com-
mittee, issued annually, have been widely distributed. Indi-
vidual letters explaining the work have been written to many
teachers, superintendents of schools, physicians, clergymen, law-
yers, business men, and others interested in the welfare of the
youth of Maine. These have included the members of the Maine
Medical Association, three hundred clergymen of the state, and
the members of the faculties of the four Maine colleges. The
general interest shown in the work and the numerous letters of
endorsement received have been very encouraging. It has been
mainly through the cooperation of the state superintendent of
public schools, the local superintendents, and clergymen that the
names of parents to whom educational pamphlets are sent have
been secured. The combined number of letters, reports, and
educational pamphlets sent out since the committee began its
work is in excess of eighteen thousand.
In order to become familiar with the work for the control of
venereal diseases in other parts of the country and to be able
to work to best advantage, the committee has twice sent ques-
tionnaires to the boards of health of all of the states of the
94 SOCIAL HYGIENE
country. In 1912, an opinion was asked in regard to the advisa-
bility of required reporting of venereal diseases to the state
boards of health. At that time only two states, California and
Utah, had such laws. A majority of all the replies received
were in favor of making venereal diseases reportable, provided
that they be reported by number. During the past year, the
committee has made a rather extensive study of the work for
the prevention of venereal disease in all of the states and terri-
tories and in a number of cities. The statistics gathered indicate
that the dangers of venereal infection and the importance of
the prevention of venereal disease is being recognized more and
more in all parts of the country. The number of states taking
active measures for the control of these diseases by education,
required reports, free laboratory diagnosis, and segregation of
persons suffering from venereal disease, is increasing every year.
Twelve states and one territory now have laws or regulations
which require the reporting of venereal diseases to the state
boards of health and twenty-seven states and two territories pro-
vide free laboratory diagnosis of venereal diseases in some form.
The health officers of a number of cities where the licensing and
segregation of prostitutes have been attempted bear out the
opinion of the committee expressed in its first report that such
efforts do not accomplish the desired results.
The committee also collected statistics of expenditures by cer-
tain states in fighting tuberculosis and venereal diseases and
found that in fifteen states in which statistics were available,
$5,849,000 was spent in the prevention of tuberculosis; $11,000
in the prevention of venereal diseases.
Funds for the work have been contributed by the Maine
Medical Association and by individuals, a number of the amounts
having come unsolicited from outside of Maine. The first five
hundred dollars was secured without direct solicitation by a
statement of conditions and the work the committee hoped to
do. In the six years since the committee was appointed to
June 7, 1916, there was received in individual subscriptions to
aid the work $1263; from the Maine Medical Association $150;
and in interest on bank deposits $34.99. In addition, the chair-
SOCIAL HYGIENE ACTIVITIES 95
man last year received in trust twelve shares of stock, the income
from which at the present time is $72 a year. In accordance
with the wish of the donor, this stock is ultimately to be turned
over to the Maine Medical Association to establish a fund, to
be known as the Prince A. Morrow Memorial Fund, the annual
income to be used for the promotion of social hygiene work in
Maine along ethical and scientific lines. Since the last report
was presented in June, subscriptions in aid of the work have
been received to the amount of $179. The committee is regis-
tered and licensed to secure funds for its work by the State Board
of Charities and Correction.
The committee is working this year along the lines set forth
in its reports of 1915 and 1916 as offering the most at the pres-
ent time in this state, as follows: —
1. Assisting in awakening the people of Maine to the dangers of venereal
disease.
2. Assisting in some degree in establishing higher ideals of sexual morality.
3. Arousing parents to a sense of responsibility in regard to the sexual morals
of their children.
4. Calling the attention of parents to the need of developing in their children
a feeling of responsibility in regard to the health and welfare of their future
families.
5. Assisting in awakening public opinion to support officers of sanitation in
applying modern hygienic methods to the control of venereal disease.
The committee is considering the advisability of asking of the
next legislature of Maine the passage of bills to provide for free
Wassermann reactions to be done in the State Laboratory of
Hygiene; the required reporting of venereal diseases by number
to the State Board of Health; and the segregation of persons
suffering from syphilis in a communicable form.
Correspondence and exchange of literature with societies and
committees of similar scope will be cheerfully undertaken. The
membership of the committee for the present year is F. N.
Whittier, M.D., Chairman, Brunswick; A. L. Stanwood, M.D.,
Rumford; R. A. Holland, M.D., Calais; W. F. Hart, M.D.,
Camden.
THE MUNICIPALITY AND VENEREAL DISEASE1
The hospitals must not only change their present attitude
toward venereal diseases, but if they are to be modern hospitals,
they must provide the very best men and the very best means
for the diagnosis and treatment of patients suffering with ve-
nereal diseases, irrespective of the facts as to whether these people
are innocent or guilty under the social law. Such patients are
a menace to the public health, and it is folly to talk about iso-
lating whooping cough and scarlet fever when we permit gonor-
rhea and syphilis to run at large. In every case, private or
public, sources of infection must be carefully traced, and, where
necessary, free diagnosis and treatment furnished by the city.
If the patient is unwilling to accept such treatment, arrest and
confinement to the hospital must follow. Visiting and follow-
up work must be instituted, and frequent or occasional visits
made after patients have been discharged in order that carriers
of infection may be prevented.
This problem of venereal disease in the municipality is both
a medical and social problem, having vast possibilities for harm,
not only in the transmission of infection to others, but in the
late remote consequences of these infections, such as circulatory
changes and disorders of the nervous system, which may take
place as a result of these infections. This problem is not to be
solved until the care and treatment of genito-urinary diseases
cease to be a matter for jest and until the services of medical
workers become both medical and social and are firmly, more
intelligently, and thoughtfully brought to bear upon the con-
quest of the problem. Then, and not until then, when the sex-
ual appetites of men are brought under the restraint of educa-
tion and training, when the feeble-minded are segregated, when
alcoholism, the drug habit, and the patent medicine habit be-
come no more, will the venereal disease problem be in process
of conquest; for then, they who lust after irregular sexual pleas-
ures will be bound, to make us free.
1 The Municipality and the Venereal Disease Problem. By George W. Goler,
M.D. SOCIAL HYGIENE, Vol. II, No. 1, Jan. 1916:
96
THE TREATMENT OF VENEREAL DISEASES IN GEN-
ERAL HOSPITALS OF NEW YORK STATE
OUTSIDE OF NEW YORK CITY
JOSEPH J. WEBER
Executive Secretary of the Committee on Hospitals, New York State Charities Aid
Association
Scientific progress in recent years has had a two-fold influ-
ence on the problem of venereal diseases. It has caused the
problem to assume vastly greater importance than was formerly
realized, and it has produced extraordinarily efficient means of
identification and treatment. In the light of the new significance
given these diseases and the more efficient means of diagnosis
and treatment now available, what part are general hospitals
playing in combating them?
The Committee on Mental Hygiene of the New York State
Charities Aid Association was especially interested in securing
this information, as far as the general hospitals in the state are
concerned, particularly with regard to syphilis, as this is the
most frequent cause of insanity among the patients admitted to
the state hospitals for the insane. The Committee on Hospitals
of the State Charities Aid Association, therefore, undertook a
study of the present facilities for the treatment of these diseases,
as a basis of a proposed program looking to their improvement.
A letter and questionnaire were carefully prepared, with the
assistance of Dr. W. F. Snow, General Secretary of the American
Social Hygiene Association, and Dr. Thomas W. Salmon, Medical
Director of the National Committee for Mental Hygiene, and
sent to 107 general hospitals throughout New York State. Of
these, 42 filled out the questionnaire more or less fully.
The first question was: "Are cases, diagnosed as syphilis before
or on admission to the hospital and found to be in need of medical
treatment in a hospital, admitted and treated as such on your wards f"
97
98 SOCIAL HYGIENE
All of the 42 hospitals answered this question; 19 hospitals
replied that they take free patients of both sexes; 21 admit
male pay patients; 22 admit female pay patients; 1 of the
hospitals requires special permission from its executive board
as a condition for admission. While two hospitals do not
admit patients of this type to their wards, they do treat them
in private rooms. One hospital admitting syphilitic patients
does so only for salvarsan treatment.
"// patients," ran the second question, "are admitted with
other diseases but later show evidences of syphilis needing treatment,
is treatment given for syphilis on your wards?" Forty-one hos-
pitals answered this question; 35 give treatment to free pa-
tients of both sexes; 37 to pay patients of both sexes; 1 hos-
pital which does not give treatment on its wards does, how-
ever, give it in private rooms.
The presence of syphilis as a known complication of other
conditions justifying medical treatment would prevent free pa-
tients of both sexes from being admitted to 13 hospitals, and
pay patients from 15 hospitals. Twenty-five hospitals said that
syphilis as a known complication would not debar pay patients
of either sex from their wards. While the presence of syphilis
would prevent patients from being admitted to the wards of
one hospital, this hospital does, however, admit such cases in
emergencies. Another hospital, while not admitting cases of this
type to its wards, does treat them in private rooms.
Nineteen hospitals admit to their wards both free and pay
surgical and medical male cases needing hospital treatment for
gonorrheal infection, while 20 admit female pay patients. The
permission of its executive board is a condition of admission in
one of the hospitals.
"Would the presence of gonorrheal infection as a known compli-
cation of other conditions justifying medical treatment prevent the
patient from being admitted to your wards?" was another question.
Eleven hospitals responded " Yes" in the case of free patients of
both sexes; 13 responded "Yes" in the case of pay patients of
both sexes; 3 hospitals ignored the question.
VENEREAL DISEASES IN GENERAL HOSPITALS 99
Twenty hospitals treat both free and pay children for gonor-
rheal vulvo-vaginitis. Among these is one which admits if the
disease is complicated with other conditions, while another re-
quires special permission from its executive board. Two hos-
pitals stated they had had no applications for the admission of
this type of case.
Of the 20 hospitals which stated that they do not admit to
their wards children with gonorrheal vulvo-vaginitis, 4 dispose
of these cases by referring them to other hospitals; 7 by referring
them to private physicians for treatment at home; 1 by refer-
ring them to the board of health; and 1 by referring them to
the district nurse; 1 of the hospitals evidently takes care of
these cases in its isolation ward.
Twenty hospitals approve the plan of receiving syphilitic and
gonorrheal patients in special available wards where their general
wards are not open. Two do not approve this plan. Nineteen
hospitals refrained from expressing themselves either way.
Of the hospitals which do not admit cases of syphilis and
gonorrhea, 9 refer such cases to dispensaries or other hospitals,
8 to private physicians, and 1 to the board of health; 5 hos-
pitals stated specifically that they do not refer these cases to
other agencies; 19 ignored the question.
Twenty-one of the hospitals answered the question: "// cases
of gonorrhea and syphilis are treated in your hospital, are they,
when discharged, referred to your social service department, or, in
the absence of such a department, to some other department or to
an individual, to see that treatment is continued?" Three hospi-
tals refer patients, upon discharge, to their own social service
department; 1 to the health officer; 1 to another hospital; 12
to a physician; 3 to a physician or dispensary; and 1 to a vis-
iting nurse. Apparently only 4 out of the 42 hospitals that
replied to the questionnaire take any steps through their social
service or other departments to see that the treatment prescribed
is continued; 2 by sending a social service worker .or nurse to
the home of the patient; 1 by having the patient visit the dis^-
pensary; and 1 by placing the case under the supervision of the
district nurse in the community.
100 SOCIAL HYGIENE
Seventeen hospitals give syphilitic and gonorrheal patients
literature as to how to avoid spreading infection; 12 hospitals
stated that they do not give any literature or instructions; 13
ignored the question.
The question relating to laboratory equipment brought out
these points: —
Eight out of 38 hospitals are equipped for Wassermann test
and complement fixation test; 9 are equipped for dark field
illumination work. Of the hospitals, however, not equipped
with laboratories, 11 have the use of, or send specimens to, other
laboratories.
Returning to the matter of hospital records, 16 hospitals re-
ported a total of 228 cases of syphilis cared for last year. It is
impossible to present a classification of these cases into male and
female free and pay patients, as several of the hospitals reported
total figures only. Ten stated they had not cared for any cases ;
16 omitted an answer to the question, one because its venereal
disease department was not yet one year old.
Twelve hospitals reported a total of 182 cases of gonorrheal
infection cared for last year. Here again, it is impossible to pre-
sent a classification of these cases into male and female free and
pay patients, as several hospitals reported total figures only.
Eleven stated that they had had no cases; 19 ignored the ques-
tion.
Only 9 hospitals stated that they furnish salvarsan or equiva-
lent treatment free. In 4 instances the county or city furnishes
it free for its own cases.
Before a syphilitic patient is discharged, 5 hospitals require
healed contagious lesion; 2 insist only on the disappearance of
symptoms, while only 1 requires negative Wassermann tests.
Eight stated that they have no specific regulations covering the
discharge of syphilitic patients, and 7 that they leave the matter
to the physician. Before a gonorrheal patient is discharged, 1
hospital requires a negative prostatic massage, 1 a negative
complement fixation test sometimes, and 3 a negative cervical
smear. Fourteen stated they have no specific regulations regard-
VENEREAL DISEASES IN GENERAL HOSPITALS 101
ing the discharge of gonorrheal patients, and 3 that they leave
the matter to the physician.
On the whole the answers indicate that the facilities at the
command of the 42 hospitals that returned the questionnaire
are inadequate and ineffective. Is it not safe to assume, more-
over, that the facilities of a large number of the 65 hospitals
that refrained from filling out the questionnaire are also inade-
quate and ineffective?
The hospitals, generally speaking (though, of course, there are
exceptions), fail in these respects: —
a. They apparently do not appreciate the significance of the
venereal disease problem.
6. Many of them provide no facilities.
c. The treatment which is prescribed is not thorough-going
and as effective as it might be.
d. Follow-up work is neglected. .
e. Records are inadequate.
In support of these criticisms, the following points stand out
clearly: —
Only 19 out of 42 hospitals take free syphilitic patients of
both sexes; only 21 or 22 take pay patients.
Only 4 out of 42 hospitals take any steps through their social
service or other departments to see that treatment and follow-
up service are continued after the patient leaves the hospital.
Only 17 hospitals give literature and instructions to patients
regarding the danger of contagion.
Only 8 are equipped for Wassermann tests.
Only 16 reported on the number of patients treated for syphilis
last year. The volume of their work was small — a total of 228
cases.
Only 9 hospitals furnish salvarsan treatment free, though this
is the generally recognized specific.
Only one hospital requires a negative Wassermann as a con-
dition of discharging a patient.
Is it not evident, in view of these facts, that a systematic
effort should be undertaken to secure, so far as feasible, a more
102 SOCIAL HYGIENE
extensive and a more thorough-going treatment of these diseases
by general hospitals, especially in instances and localities where
dispensaries do not or can not meet the needs?
THE VENEREAL PERIL1
ISAAC W. BREWER, M.D.
First Lieutenant Medical Reserve Corps, U. S. A.; Sanitary Supervisor New York
State Department of Health
You men who have been called to the Mexican border are to
be congratulated for having the opportunity to be so closely
associated with so large a body of young men. The lessons in
good citizenship which you are learning here are invaluable to
you. You are however confronted by many problems; some
are entirely new and others are old ones clothed in a new sig-
nificance.
One of the greatest problems before you at this time is the
"venereal peril." It is a real live peril and upon the way you
meet it depends your future health and happiness and probably
the health and happiness of your wives and children.
*******
The venereal diseases are seldom contracted except from a
prostitute. You will often hear that the women in a certain
house are very particular, that they are regularly inspected by
a physician, and that there is no danger from having inter-
course with them. My friends, there is nothing in inspection.
These women are out for the money and are not fools and they
regularly fool the doctors.
Official regulation and inspection of prostitutes has been prac-
tised in certain European cities and it is a strange coincidence
1 Address delivered to the troops of the 13th Provisional Division, United
States Army, at Llano Grande, Texas, during August, 1916. The portions of
Lieutenant Brewer's address which described the venereal diseases, their results,
and treatment, are omitted, as readers of SOCIAL HYGIENE are familiar with
such facts. The address is of especial interest in showing the new viewpoint
which many army and navy officers are now emphasizing and the kind of appeal
which has been found effective with men under such conditions as are found
among the troops along the Mexican border. It is significant that the same
appeal has been found most influential among the British troops in training
camps and assembled for service along the European battle lines.
103
104 SOCIAL HYGIENE
that it is to those same cities that the doctors who wish to
make a specialty of venereal disease go to study. If the regula-
tion were effective, the diseases would have disappeared from
such cities.
I knew a boy of eighteen, who was assigned to a company
that was doing guard duty in the Sampoloc District of Manila,
the red light district. The older men in the company teased
him and said he would not be a man until he had intercourse
with a woman. One day just after dinner he went to a Japanese
house of prostitution. The woman had been inspected that day
and showed her certificate; however, he became infected and
finally came to the hospital where he was operated upon and
was very sick for several months, finally being sent home broken
in health with a disease contracted "not hi the line of duty."
Inspection did him no good.
I was once on a transport that moved some troops from one
port in the Moro provinces to another. At the port of embark-
ation the prostitutes were all inspected and certified. How-
ever 10 per cent, of the men were transferred as having venereal
disease and about as many more were found to be infected.
These men told me that their disease was contracted from
women who were inspected and certified. Do not be deceived;
inspection is no guarantee that the woman is free from disease.
There are persons who will tell you that a man must exercise
his sexual organs or he will lose his manhood. There is no
more pernicious teaching. These organs do not need exercise,
in fact a man is able to refrain from using them for years with-
out suffering in the slightest. It is true that the sexual passion
is the strongest of the animal passions, but, it is also true that
one of the greatest differences between the human being and
other animals, is that the human being has his passions under
control and the animal does not. He whose passions are uncon-
trolled approaches the state of one of the lower animals.
I have told you about some of the results of venereal diseases,
not with the idea of scaring you into avoiding them but that
you may know the risks you run and the far reaching after
effects and be able intelligently to shape your own course in this
THE VENEREAL PERIL 105
respect. However, I want to try and help you avoid as far as
possible the pain, sorrow, and degradation that come from con-
sorting with prostitutes.
The easiest way to get out of trouble is to keep away from
trouble. If you avoid the house of prostitution you will avoid
temptation. This camp (Llano Grande, Texas) is ideally situ-
ated for avoiding prostitutes. There are none nearer than
Donna, seven miles off, and a man must be very anxious to get
into trouble if he will walk fourteen miles to find it, or if he will
expend one-fifteenth of his pay to get where trouble is. My
friends, stay away from the red light districts and you will
keep out of trouble.
If, however, your comrades (I do not call them friends), should
persuade you to go out to see the sights, let me ask you to
pause before you enter a house of prostitution, and, for just
one moment frame up in the doorway the face of your mother,
your sister, or the girl you love, and see if you are willing for her
to see you enter that house. If you are not, you are losing
your self-respect. Now there are two things a man must have
if he expects to amount to anything in this world : health and
self-respect. You cannot smirch the clear mirror of your self-
respect for months and years and have it still retain its luster.
If your strength of will is not sufficient to protect you and
you have intercourse with a prostitute, you still have a slight
measure of protection through the use of the venereal prophy-
lactic that can be had at each infirmary in the camp. It is not
absolutely certain for there are a few men who contract the
disease even though the prophylactic be used. This is recog-
nized by the War Department, for if a man has used the pro-
phylactic and later develops the disease he will not be punished.
If you have failed in self control, do not delay. Get back to the
camp at once and take the treatment immediately. This may
keep you from disease but it will not restore your self-respect.
You are young men and the road of life looks bright to you
and I hope each one of you will prosper in the work you under-
take. There will come a time in your life when you will want
a home. A marble palace does not make a home; a house
106 SOCIAL HYGIENE
furnished with rare and beautiful things is not a home; a dinner
of the most expensive foods served on golden dishes will not
make a home for you. It takes a woman to make a home.
Without her there can be no home, and whenever the right
woman comes she will make a home no matter how humble the
building may be or how poorly it is furnished.
Somewhere in this land there is a woman who will make a
home for you. She is keeping herself clean and pure until the
day she gives herself to you. She will bring to your home
100 per cent, of health, purity, and virtue. What will be your
contribution? Only " damaged goods?" Damaged beyond re-
pair in some house of prostitution?
I hope every one of you will have a real home and that you
will contribute to that home 100 per cent, of purity, honor, and
good health.
A GOOD EDITORIAL AND AN INTERESTING LETTER
The editorial from the Houston, Texas, Chronicle for October
21, 1916, and an open letter addressed to the Mayor of Houston
by Principal Wesley Peacock of the Peacock Military Academy,
San Antonio, are presented to readers of SOCIAL HYGIENE as
illustrations of the change in public sentiment which is already
widely extended over the United States. Many of the cities
in the South seem to have been slower to attack the problems of
commercialized prostitution than those of the North, but these
documents are indications that when the repression of prostitu-
tion has once been undertaken in the South, it may be followed
up more vigorously than has been the case in some of our northern
cities.
ELIMINATE THE VICE DISTRICT
The Houston, Texas, Chronicle, October 16, 1916
It is with reluctance that The Chronicle is forced to the con-
clusion that segregation is an unwise and unpractical method by
which to handle the social evil.
For many years we have tried to believe that restriction,
limitation and regulation were the best means by which to over-
come this defect in our community life.
Possibly this view is correct with regard to a city just emerging
from pioneer times, and in which society has yet acquired little
definiteness of character. But for a community which aspires
to leadership of a great section, and which wishes to be looked
upon as an example to be emulated, it is impossible.
Cities, we suppose, must expect to assume moral as well as
economic obligations. Their preponderating influence in educa-
tional and financial affairs makes it incumbent upon them to do
more for the moral elevation of society, for the suppression of
crime, for the checkmating of vice, than smaller centers.
The fact that congestion afflicts them with much of the drift-
wood and refuse makes such a course, not only more difficult,
but also more imperative.
107
108 SOCIAL HYGIENE
If society can not look to the city for its most substantial lead-
ership in the never-ending conflict with criminality and vicious-
ness, the general outlook is gloomy indeed, for it is in the city
that these dangerous elements find their strongest foothold.
No one expects that abandonment of the segregated district
would eliminate the social evil.
Indeed, no one who has given the subject serious thought
expects that the application of human remedies will eliminate any
evil.
So far as can be determined mankind is subject to the same
degenerate instincts and guilty of the same faults as in the
beginning.
The struggle against these instincts and these faults is appar-
ently unending, its hopeful aspect lying in the belief that we do
lessen their scope, influence and destructiveness as the years
drift slowly by.
In this struggle society has availed itself of two processes —
first, regulated tolerance; second, an uncompromising idealism
as expressed in prohibitive law.
At one time or another about every crime and vice has been
dealt with by the former method.
Even murder has been licensed under certain conditions, and
many an ancient town had a particular place in which duelling
was permitted.
It would seem that society has been obliged to depend on reg-
ulated tolerance until such time as sentiment was sufficiently
crystallized against any particular crime or vice to express itself
in prohibitive law.
With respect to the social evil it would seem justifiable to
assert that society, in the United States at least, has reached a
conviction that prohibitive law, not regulated tolerance, is
desirable.
This is indicated by the fact that practically every state in the
country has enacted prohibitive statutes, and that most segre-
gated districts are illegally maintained.
The Chronicle would not go so far as to contend that abolition
of the segregated district would result in an immediate diminution
A GOOD EDITORIAL AND AN INTERESTING LETTER 109
of the social evil in Houston, but it would remove that power
of concentration and cooperative effort which the evil now
enjoys, and would in this way give better prospects of its gradual
suppression.
We are too familiar with what concentration and cooperation
have done in business, in education and in politics, not to under-
stand the tremendous potentiality they develop with respect to
vice.
The grouping together of a hundred or so disorderly houses,
with their numerous inmates and hangers-on, can not help
developing a power which similar numbers could not exercise
were they scattered about and out of touch with each other.
A segregated district enables the keepers of houses to act in
concert, not only in recruiting the constantly depleted ranks of
girls, but in bringing pressure to bear on men about whom one
or another of them knows something of a compromising nature.
Moreover it is not apparent that the segregated district has
stopped the establishment of disorderly places in other parts of
the city, or in eliminating the use and sale of intoxicating liquors.
The fact that quite a few United States liquor licenses are held
by proprietors in the district casts grave doubts on the police
chief's assertion that no liquor is sold and consumed there.
It is our candid opinion that the people of Houston have been
deceived not a little regarding the good accomplished by regulated
vice, and have permitted themselves to be presumed upon by
smooth and optimistic explanations.
The Chronicle hopes that the situation can be corrected with-
out any quasi-religious spasm, or the holding forth of hired
purity squads. At the same time it recognizes the fact that
just such indifference as Houston is exhibiting toward a matter
of this character and importance is largely accountable for much
of the sensational evangelizing which seems to be popular in
our cities now and then.
110 SOCIAL HYGIENE
AN OPEN LETTER
SAN ANTONIO, TEXAS,
April, 1916.
Honorable Ben Campbell,
Mayor of Houston, Houston, Texas.
DEAR SIR:—
I have just returned to his home a sick young student who says
he contracted a disease in your red-light district as he passed
through Houston two weeks ago. This is not the first time I
have sent home students from Houston infected with venereal
diseases, as well as students from East Texas who had entered
our school after having been exposed and infected in your
protected district. The number of these young men dismissed
from our school in recent years on account of venereal diseases,
representatives of the best families of your city and East Texas,
claiming to have been tempted and ruined by an institution
officially recognized, advertised, and protected by your city
and county authorities, may not be counted on the fingers of
both hands.
I have a right to speak to you plainly both in censure and in
sorrow. I respect you highly because of your honorable position,
and because of the good you have done. By reputation I con-
sider you the most popular mayor of Houston for many years,
for my school boys from your city have told me so. They look
upon you as a leader of old men and of young men, and they
believe that your vice district is conducted in accordance with
the laws of the city of Houston and the state of Texas, and more-
over, they believe that your city ordinances require inmates of
disorderly houses to be regularly inspected by physicians for the
protection of boys and young men against venereal infection.
The Peacock school does not live in San Antonio, but in Texas.
For the last twenty-five years I have lived in Houston as well
as in San Antonio. I visit your city every year in the interest
of my school, where I receive a large and valuable patronage,
of the best and noblest boys in Texas. My information comes
from these boys and young men, who know as much about your
city as you and your police commissioner.
A GOOD EDITORIAL AND AN INTERESTING LETTER 111
If for no higher interest, for the sake of these boys and young
men, their sweethearts and their wives, whose health and happi-
ness depend upon your administration, I have a right to appeal
to you to do your duty in accordance with the law and your
oath of office. Every boy of the age of sixteen in your city knows
that in one hour you can close every disorderly house in your
protected district, and that in one day you can destroy this
district as an institution for political vice and graft. There
is not a policeman or a detective in your commissioner's depart-
ment who can not do the same thing under the law and under
your authority. There is not a citizen of your c'ty who can not
do the same thing within a period of a month if he could find an
attorney bold enough to file suits of injunction against the
owners, lessees, and tenants of disorderly houses, provided he
could find the money to pay the expenses of his salary and the
cost of the court. The law is sufficient, even drastic, and in-
junctions are easily and quickly obtained before your district
courts; but your best people are afraid, fearing both social and
commercial ostracism.
Some of your ministers of the gospel hesitate to declare for
law enforcement in this red-light district for fear of removal
at the hands of their official boards. Some of your best citizens,
some of them members of your churches, own property used for
immoral purposes, for which they may be fined and imprisoned
under the law.
If you retort that I should first clean up my own city, I
reply that a few of us a year ago closed the entire red-light dis-
trict of our city by the injunction process, and that in spite of
the positive opposition of every city and county officer, without
a single exception, and that afterwards our newly elected police
commissioner enforced the law and abolished the district for a
time, but he afterwards revoked his order, broke faith with the
people, and allowed at least a part of the district to be reopened
and reestablished under his protection and with his authority,
all in defiance of the law, in defiance of the sentiment of moral
and religious people of this city, but in compliance with expressed
and repeated demands of the liquor interests, and the politicians.
112 SOCIAL HYGIENE
This led to his resignation. Yet our work of cleaning up has
only begun.
It is not a question of vice, but of law. It is not a question of
expediency, but of duty.
I have let your red-light district alone, but it has not let me
alone, it has not let my students and friends alone, and it has
not let my business alone. It has caused me the loss of boys
and business. This morning's paper asserts that 61 patients are
undergoing treatment in the Pasteur Institute in Austin, be-
cause they had been bitten by dogs afflicted with hydrophobia.
These 61 patients will not perpetuate the disease because of
confinement and inoculation. Today in your city of Houston,
according to the estimate of doctors and scientists, there are at
least ten thousand men, women, boys, and girls afflicted with
venereal diseases, many of whom will perpetuate the disease and
infect many of both sexes with practically incurable diseases,
causing untold sorrow and unhappiness for years to come.
The young man I have just dismissed from school says that
this exposure to disease was his first sexual lapse, and his father
and mother believe that he tells the truth. He says that last
Christmas some of the cadets of the Agricultural and Mechanical
College chartered three coaches for the home going, and spent
a night in Houston, numbering two hundred fifty students,
nearly all of whom spent the night in your protected vice dis-
trict hi drunkenness and debauchery, many of whom he saw
taken to the train the next morning hi an intoxicated condition.
At that time he had refused to go with the crowd. Like nearly
all men, he labored under the impression that your city ordinances
provided for a regular and systematic inspection of the women.
He also said that neither his father, his mother, nor anyone had
ever instructed him in personal and moral cleanliness. He was
ignorant, but the mayor, the police commissioner, and your
officers of the law are not ignorant.
I contemplate sending my own son to your Rice Institute,
and I should like to recommend the institute to the graduates
of our school, but I cannot consistently do so because of the
laxity of your laws and your officers. There is no education.
A GOOD EDITORIAL AND AN INTERESTING LETTER 113
without character, and there is no character without morals.
The moral status of Houston will never surpass that of its mayor
and its police commissioner. The law does not impose upon you
an obligation to suppress vice, or sin, but it does impose upon
you an obligation to enforce the law whatever that may be, and
to suppress legalized, commercialized, advertised and protected
vice, which not only prostitutes your men and women, but your
officers as well. To say that you can not enforce the law, is to
admit your election and control by your lawless elements. The
majority of your citizens are good, but they are afraid.
Assuring you that I write in the kindliest spirit in the hope of
doing good in the interest of the health, happiness and morals
of the people of Houston and of Texas, and assuring you that
if you do not suppress your district, the State Anti-Vice League,
recently organized in Texas, will certainly do so in the next few
years, and hoping for a reply to this letter in the same spirit
in which it is written, I beg to remain
Very respectfully,
WESLEY PEACOCK.
BOOK REVIEWS
YOUR BOY AND His TRAINING. By Edwin Puller. New York: Ap-
pleton, 1916. 282 pp. $1.50.
A large amount of literature has been written on the boy problem
and each point of view as to the "cause and cure" is so radically dif-
ferent from the other that one feels the real problem is as far from
being settled as the treatment of hay fever by the physician. That the
average parent does not understand the boy is sadly too true. The
biologist notes with interest the wonderful instinctiveness with which
the animals, lower down in the scale, care for and rear their young;
but in the human scale he finds a surprising lack of instinct in this
direction. The mother must be taught how to care for her child, and
even then, sooner or later, there arises a wide gap — an unbridgeable
chasm — between the parent and child. Mr. Puller in his book Your
Boy and His Training has furnished the much-needed explanation for
this barrier. He has brought together the results of his wide experi-
ence of work among boys and presented them in a most delightful way
to his readers.
The book throughout is characterized by a wholesomeness, sanity,
and breadth of vision which is so essential in treating this most impor-
tant problem of life. It is written for parents and can be read without
a dictionary. It will no doubt render a great service to adults, and
lead to a better understanding and appreciation of the red-blooded,
harum-scarum, pirate-hunting boy who is breaking their hearts, and
everything else about the house.
The author has stressed parental responsibility and the need of
parental training as a "basic preliminary to solving the boy problem.
The far-flung necessity for parental instruction is made imperative by
a racial habit — of Americans especially — of drifting out of touch with
their children during adolescence."
The unwillingness of parents to unbend their mature dignity, even
in the privacy of the home, is indeed a mark of the provincial mind.
The unwillingness to understand and get the point of view of the boy
is the chief cause of the boy's gravitation to the "society of the drunken
hostler who is ever ready to regale him with a collection of stories
replete with profanity and obscenity."
114
BOOK REVIEWS 115
During the pre-adolescent age and especially during adolescence, the
boy craves the companionship of men. It is then that the average
parent is too absorbed in other matters, feeling satisfied with giving
the child food, clothing, money, and an education. "Happy indeed is
the man/' the author continues, "for whom time has not rung down
the curtain of oblivion on the scenes of youth; for only in this state. of
mental attunement is he able to retain the boy's point of view which
is an indispensable requisite to chumship and comradeship with his
son."
Child psychology is not difficult of understanding if parents will but
allow themselves to find their way to the child's heart; and the easiest
way to do this is to scare up a few pirates and show the boy how to
hunt them. The author relegates dune novels to their well-earned
scrap heap and substitutes "heroes who exemplify in the achievement
of enterprises of adventure and daring the virtues which all boys
should seek to emulate." Chumming with virtue inspires virtue. By
way of helpful suggestion a long list of good books is supplied; books
which every boy should read — then re-read. Even the parent might
read them and profit thereby.
Then by way of suggestion, without any attempt at exhaustive-
ness, Mr. Puller outlines sex instruction, leaving that duty to the par-
ent whose intimacy and love furnish a better ground of common under-
standing. He would begin when the child first begins to catechize
about the phenomena of nature. The awakening child's mind must
be satisfied and this can be done in no better way than to have the
mother explain truthfully, without arousing the child's curiosity, and
simply answer the child's interrogations. The information given in
reply to sex questions must be inevasive and sufficiently satiating to
allow no opportunity for the mind to ponder too much over and grow
curious about.
Just as there would be no excuse for social settlements were it not
for parental neglect of children, just so there would be no excuse for
social hygiene societies if parents were not always proving alibis when
charged with responsibility in the court of conscience. There is a
lamentable lethargy in our parents in America which is the cause of
much immorality. At present some parents instruct their children in
matters of sex. It is given to them unconsciously in their home train-
ing. The larger number of the parents leave that part of the education
to social hygiene societies and the church, schools, and settlements.
Many parents refuse to give this knowledge themselves either through
116 SOCIAL HYGIENE
prudery or ignorance and at the same time refuse to allow the schools
to do so: so the boy goes to the worst sources for his information on the
real phenomena of life.
Mr. Puller's idea of private instruction is the ideal way, where
children can not obtain this knowledge from parents; but it is thus far
not feasible owing to the scarcity of competent teachers and the great
expense of this method. A man thoroughly acquainted with his sub-
ject and also with boys should have no trouble with "Psychology of
the Mob." It is the teacher's timidity which provokes mirth when
sex knowledge is given.
"Sex instruction must differ in one important respect from scien-
tific instruction in that it must not seek to create interest and awaken
curiosity in the subject with which it deals, but merely to satisfy the
interest which spontaneously arises in the child's mind, truthfully but
only so completely as may be necessary to give proper guidance to his
conduct, both hygienic and ethical. Premature development of sex
consciousness and sex feelings is harmful." This quotation is from
The Matter and Methods of Sex Education, of the American Federation
for Sex Hygiene. It quite typically expresses Mr. Puller's ideas, how-
ever; it is the idea to which all are turning the more they have experi-
ence in sex education.
The book is to be recommended to all mothers and fathers and other
adults, especially church and social workers and educators. It is a
splendid testimonial of the great work the Boy Scout Organization is
doing. A very helpful feature is the classified bibliography of sex
educative literature and reading books for boys.
"Happy indeed is the man who has a son; and thrice happy he who
has three!" J. A. S.
CHILD TRAINING. By V. M. Hillyer. New York: Century Company,
1915. 287 pp. $1.60.
The first seven years of life have long been looked upon as the most
important period for the formation of character. Ignorance both of
principles and methods, however, has prevented the majority of par-
ents from achieving more than a minimum part of what would, with
well directed effort, be found easily possible. Of great value to them,
therefore, will be this volume, which presents detailed plans for direct-
ing the child's activities toward positive character-building. Through
drills and games, resulting in the formation of right habits, is to be
BOOK REVIEWS 117
brought about the physical, mental, and moral development of the
child in this pre-scholastic period.
It is a species of preparedness which should appeal to parents, for
it will enable them to avoid many of the unpleasant crises of their life
with their children. For instance, instead of waiting for a critical
situation of threatening disobedience to arise, the child is accustomed
through various drills and games to instant response to the word of
command. As a result, his first impulse becomes one of obedience,
instead of disobedience. All such positive training in self-control is
definite sex education of the most needed kind, and is of the greatest
value because planned to meet the needs of the period before the child
attends school.
The book seems eminently fitted to realize the author's ami, which,
in his own words, is "to produce children who will be more observant
and attentive, with more originality, more initiative and sharper wits,
who will think and act more quickly, be better informed and more
accomplished, more skilful with their hands, more courteous and con-
siderate of others, and above all, healthier animals."
On the practical side the book presents drills for establishing the
habits of obedience, order and neatness, observation, association, atten-
tion, and concentration; little plays which will inculcate the common
courtesies of life; exercises, songs, and games for building up the body
in strength and grace; work in manual training and suggestions for
occupations; and a syllabus for information lessons, together with
directions for teaching reading and writing. Altogether, a book too
valuable for the parents of young children to miss from their book-
shelves. R. W. C.
COMMUNITY ACTION THROUGH SURVEYS. By Shelby M. Harrison.
New York: Russell Sage Foundation, 1916. 29 pp. $.10
Since the days of "muck-raking" the social surveyor has pointed
the way to a saner and better method of measuring and improving
conditions of life in city and country. Just what a social survey is,
how it is brought about, and what ought to follow — and what does fol-
low— are outlined in this pamphlet. It presents a list of the specific
developments following the publication of the findings and recommen-
dations of surveys made in Pittsburgh, Newburgh, Topeka, and Spring-
field, 111. From Springfield, alone, comes a list of forty-one items of
civic and social advance following the survey although the pamphlet
118 SOCIAL HYGIENE
points out that credit for the actual achievements should at least be
divided with many local organizations.
The social or community survey is described as an important
"means to a better democracy" through "informing the community
upon community matters, and thereby providing a basis for intelligent
public opinion. It is a school whose teaching is not confined to children
and youth, but which aims to get its facts and message, expressed
in the simple terms of household experience, before the whole people."
"To sum up the survey in a few sentences .... it is an im-
plement for more intelligent democracy, its chief features or charac-
teristics being: the careful investigation, analysis, and interpretation
of the facts of social problems, the recommendation and outlining of
action based on the facts, and the acquainting and educating of the
community not only to conditions found but to the corrective and pre-
ventive measures to be adopted .... It deals with the whole dis-
trict and endeavors to lead individuals to think in terms of the whole.
It is the application of scientific method to the study and solution of
social problems, which have specific geographical limits and bearings,
plus such a spreading of its facts and recommendations as will make
them, as far as possible, the common knowledge of the community
and a force for intelligent co-ordinated action." The author pins his
faith upon the "correcting power of facts" and the belief that American
experience shows "that communities will act upon facts when they
have them."
THE GREAT UNMARRIED. By Walter M. Gallichan. New York:
Frederick A. Stokes Company, 1916. 224 pp. $2.25
In The Great Unmarried, Mr. Gallichan discusses what may be
termed the cause and cure of involuntary celibacy. He first out-
lines carefully the social and economic factors that make for the
deferment of marriage, notably poverty which is "one of the most
palpable and wide-spread," false and unworthy standards of living,
and lack of idealism in sex relationships due largely to our faulty
understanding of the meaning of the sex impulse.
He then advances specific remedies through economic and social
reforms. Higher wages, improved housing, the endowment of
daughters for marriage, and a bonus to parents who are willing to
raise good-sized families, are among the economic measures sug-
gested. Ease of divorce must be provided to eliminate the mis-
BOOK REVIEWS 119
giving incident to the "perilous embarkation" of matrimony. Health-
ier views must be dispersed on the value and purpose of conjugal
relations. In making these proposals, Mr. Gallichan opens up in a
fearless way a wide field of controversy.
His position rests throughout on the premise that monogamous
marriage is "the most equitable and moral form of sex relationship,"
and "the community that cannot devise means for a normal, moral
sex life for its members is in an unwholesome and dangerous con-
dition." From this standpoint, the reader will probably wonder
what Mr. Gallichan would suggest for the problem of the excess of
women, already acute in England before the war, and greatly inten-
sified now in all the European countries. What modification of
monogamy may be forced by this situation? For lack of the con-
sideration of this question the present study is unfortunately incom-
plete. Otherwise, the reader will find an admirable review of the
obstacles to marriage and the way to remove them.
E. J. H.
MORAL SANITATION. By Ernest R. Groves. New York: Association
Press, 1916. 128 pp. $.50.
The popularity of the Freudian theory at the present time is the
reason for the issuance of this little volume. The author accepts the
teachings of Freud as the essential method for determining human
motives. While he acknowledges that morality is a social matter, he
sees in the repressions of childhood, particularly those of the sex in-
stinct, the groundwork of future conduct which determines individual
morality.
The cravings of youth represent to him the basis of morality. To
uncover these unfulfilled desires is to suffice in gaining a higher stand-
ard of moral principles for the community.
Proper emphasis is placed upon the importance of the home and a
plea for better homes and more intelligent parenthood is included,
though these are taken to represent attempts at centering all moral
activities in the home. The failure of the home as a moral agent is
deemed to be due to parental self-deception and selfishness.
The moral significance of labor, proper industrial adjustments, and
vocational guidance are advocated as important steps in the solu-
tion of moral problems.
While there are many practical suggestions scattered through the
120 SOCIAL HYGIENE
book, the satisfaction of the thought of the author demands the uni-
versal acceptance of Freudian doctrine. At the present time further
study is required before such a point of view may be urged as a moral
panacea. I. S.
FATHER, MOTHER AND BABE. By Anna Jenness-Miller. New York:
Physical Culture, 1916. 288 p. $1.00.
"The danger from much which passes for plain teaching of plain
truth lies in the sudden arousing of sex consciousness, without at the
same time furnishing any adequate stimulus to sex control." This
quotation, while indicating the clearness with which the author of
this volume sees one of the problems of sex education must also serve
as the standard by which her own work will be judged. Measured by
this standard it can not be given entire commendation, even though
much that it contains is of value both from the practical and the ideal-
istic viewpoint.
Simple as seems the work of presenting to the unprejudiced mind of
the child the facts of life's origin and his own physical structure, its
real difficulty lies in the intricacies of child psychology. If we could
be sure that the child would think only what we bid him to think, our
task would indeed be an easy one.
It is not alone prohibitions which contain suggestions to the acts they
are expected to prevent. Words or phrases which present vivid mental
pictures to the child act also as strong suggestions. If, then, differ-
ences of sex are pointed out to children in definite terms which connect
form with function, the child's impulse to test the information received
by personal experience will become almost too strong to be resisted.
This is the fatal mistake made by the author in her first chapter;
so serious a mistake that it hardly seems worth while to call additional
attention to the biological error of attributing to the father alone the
life-giving germ, allotting to the mother simply the work of receiving
and nourishing the vital spark to which she is apparently supposed
to have made no contribution.
Aside from these considerations, there is much in the book to com-
mend. In the first place it brings out the fact that the father is, in
the title itself, placed where he belongs, with the mother and babe;
in the second place, a sane and sensible tone pervades it due in part to
the mingling of sex knowledge with other information needed to insure a
well-regulated life in the home; and in the third place, it presents rea-
BOOK REVIEWS 121
sonably both sides of that most difficult of all questions, the relation of
husband and wife.
From the instruction of the children in sex matters, the author goes
on to discuss the sufferings and dangers of childbirth, the care of the
prospective mother, preparing the wardrobe for the little newcomer,
and its first care, making altogether a fairly comprehensive and prac-
tical volume.
W. C.
THE PSYCHOLOGY OF RELAXATION. By George F. W. Patrick. Bos-
ton: Houghton, Mifflin, 1916. 280 p. $1.25.
This is a volume of five essays respectively on the Psychology of Play,
the Psychology of Laughter, the Psychology of Profanity, the Psy-
chology of Alcohol, and the Psychology of War, with an introduction
and a final chapter, headed "Conclusion."
As explained in the preface, these essays, all but one, are revisions
and elaborations of essays published in scientific and popular magazines.
Apparently on quite disconnected subjects, they have as their common
element the idea of relaxation from the strain and stress of modern
life. Each essay has this idea, not as an incidental feature but as its
objective point.
The essay on Play has little in it that is new except the emphasis it
places on play as relaxation, and on the close relation of the play of
children and the play of adults. The essay on Laughter discusses the
various theories that have been held and finds its central significance
in "slips and lapses" of thought, speech, and action which bring about
a sudden drop from a conventional to an unconventional level. Like
play, it is a release from strain and the stress which convention places
upon us. Profanity is similarly discussed from the point of view of
emotional stress and of mental hygiene. This is perhaps the most
original of all the essays. In the essay on Alcohol the author briefly
reviews comparatively recent scientific investigations, and argues that
by paralyzing the higher and later developed brain tracts which underlie
the higher thought processes and voluntary attention, it throws the
mental life upon the lower, older, and better organized brain tracts,
and in this way produces relaxation. Men get drunk to drive dull
care away. War, the author argues, is likewise a recoil of the mind
from the high tension of modern life. In war society sinks back to
the primitive type, and men give expression to the lower instincts and
122 SOCIAL HYGIENE
elemental passions. Modern life requires high efficiency, severe self
control, inhibition, concentration, and sustained effort. War is the
reaction from this.
These essays are scientific in character, and are written in a clear,
readable style. Each subject is treated in a fresh way; and the stu-
dent of applied psychology will find them interesting reading.
T. M. B.
INDIVIDUALITY IN ORGANISMS. By Charles Manning Child. Chicago:
University of Chicago Press, 1915. 213 p. $1.25.
Dr. Child in Individuality in Organisms contributes a new view of
the nature of life processes in the simpler organisms. The book "deals
primarily with the problem of the nature, of the unity, and order in
the organism; the constancy of character and the course of develop-
ment; the maintenance of individuality in a changing environment."
The organism is, in Dr. Child's opinion, a dynamic entity, a moving
equilibrium in a world of constant change. In the presence of this
fact the old static distinction implied in the isolation of the germ plasm,
and therefore, the impossibility of inheriting acquired characters or
habits, have less and less significance. Likewise the classic distinction
between morphological and physiological science loses importance.
The key to the understanding of life processes in the simpler forms,
those processes which express themselves in individuality, in repro-
duction, and in other activities is found in this intimate relation of the
simple animal or plant to its environment. The same law holds with
regard to higher forms, but it is obscured by the existence of more
highly complicated mechanisms.
FIFTY YEARS OF ASSOCIATION WORK AMONG YOUNG WOMEN. By
Elisabeth Wilson. New York: Young Women's Christian Asso-
ciation, 1916. 402 p. $1.35.
This interesting history of the work done in the United States by
the Young Women's Christian Association gives an account in Part I,
of the prayer unions and other religious associations and organizations
in Great Britain and America before 1866 and of the status of women
at that time as the author sees it. Part II shows the development
of the local, national, and international organizations in America from
1866 to 1906. In Part III, Miss Wilson outlines the present national
activities of the Young Women's Christian Association from 1906 to
1916.
BOOK REVIEWS 123
The many fields into which its work has spread is surprising to one
unfamiliar with the Association's activities. There are chapters on
work with women students in state universities, through clubs, in-
cluding those for negroes and Indians, for girls of the city and country,
and for girls at work in the various industries. There are classes in
English for foreigners, and an International Institute whereby girls
released in New York City by the port officials are called upon by an
Association visitor speaking the language of the stranger, through
whom the ways of the new world are explained, and every effort is
made to relate the new Americans to the best institutions and forces
in our country.
With all this historic and present accomplishment, the Association's
forward look is especially important and the author's feeling is that
it is but entering upon its great work, — a work which aims to cover
all of woman's interests and activities.
Of particular interest to SOCIAL HYGIENE readers is the work of the
"Commission on Social Morality from the Christian Standpoint, seek-
ing and holding the place of the Association in the present day crusade
against the social evil." This commission is still carrying on its
investigations and will soon, it is hoped, be ready to make a report
upon its work.
An appendix includes a chronology, a list of the Young Women's
Christian Associations of the United States, and a directory of the
present officers of the National Board.
GENETICS. An Introduction to the Study of Heredity. By Herbert
Eugene Walter. New York: Macmillan, 1914. 272 p. $1.50.
This is a most readable scientific book, careful in its analysis of the
fundamentals of heredity as experimentally determined and sane in
its handling of the agitating theories which are to date unverified, if
not undeterminable. It is marked by a simplicity characteristic only
of a scholar, who, in the words of a recent writer "after using the
scaffolding of the technical knows how to abandon it." The inquiry
accepts the mechanistic assumptions of material science and the author-
ities cited are general and extensive rather than specific and detailed.
Professor Walter believes that the Darwinian and Lamarckian expla-
nations of variation are untenable and that by far the greater number
of observations recorded substantiate the Weismann theory that the
causes of variation are intrinsic or inborn in the germ plasm. Upon
124 SOCIAL HYGIENE
these variations evolution depends, for without them there would be
uniformity of generations and no possibility of progressive change.
The treatment of the question of acquired characters is worth especial
consideration; it is a splendid example of condensed exposition upon
the arguments for and against this historic controversy.
Another noteworthy chapter is that dealing with the determination
of sex. Sex is a Mendelian character, the determiners of which are
carried in the germ plasm and unalterably fixed at the time the egg is
fertilized. The desire to predetermine the sex of offspring seems
destined to continued lack of gratification, inasmuch as all evidence
from the study of sex control is as yet negative.
In conclusion the author discusses the effects of inbreeding upon
man and urges cultivation of the eugenic conscience. The means he
proposes for the restriction of undesirable germ plasm are : control of
immigration; abandonment of forcing sexual offenders to marry in
order to legalize the offense, thus causing subsequently two defective
streams of germ plasm to combine repeatedly; complete sexual segre-
gation of the most serious defectives, and sterilization as a still more
drastic safety measure. In approaching the eugenic ideal positively,
he advocates subsidizing the fit, enlarging individual opportunity, and
preventing the germinal waste of war.
M. C. G.
THE MEANING OF EVOLUTION. By Samuel Christian Schmucker.
New York: Macmillan, 1916. 292 p. $1.25.
This book is not intended for biologists, but is addressed to the large
audience of persons to whom the much misunderstood term "Evolu-
tion" is unpalatable. There is so prevalent a repugnance to facing the
possibility of being descended from creatures not unlike the ape, that
the masses stubbornly refuse to inquire into the present status of the
distasteful idea. For such, if they can be persuaded to read, Dr.
Schmucker's work should be stimulating and fairly convincing. The
author has avoided technicality and presented the subject in a manner
intelligible to those unfamiliar with biological phenomena, theories,
and terminology.
The historical sketch of the pre- and post-Darwinian points of view
as well as the analysis of Darwin's own study and conclusions are
fascinating in their sympathetic insight.
BOOK REVIEWS 125
The exposition of adaptation for the individual and for the species
is illumined by a wealth of vivid illustrations.
The chapter on "Life in the Past" is merely a cursory survey of
animal development during geologic periods.
By no means the least useful chapter is entitled " How the Mammals
Developed." It can be recommended heartily for the perusal of adoles-'
cents because it presents in a simple way a description of the asexual
and sexual methods of reproduction from the lowest organisms up.
through the animal kingdom. The growing complexity as seen in the
higher species and their methods of nourishing their young are ex-
plained in such a way as to be splendidly useful in the sex education of'
the boy and girl.
Since the weight of evidence is against the transmission of acquired
characters Dr. Schmucker is of the opinion that improved environ-
ment can only slowly, if at all, improve the race. He believes man-
kind is growing gradually cleaner-lived, but that the struggle out of
bestiality is so far from attainment that heroic effort is needed on the
part of eugenists. He criticises adversely the requirement of health
certificates for marriage on the ground that such restriction would result
in increased illegitimate parentage. Society has the right, however,
and the duty, he declares, of protecting itself against the multiplication
of feeble-minded by legally adopting surgical means. Thus there may
be removed the possibility of generations of criminals, but the author
holds the position that a "distinct majority are criminals more through
environment than heredity." Therefore, in cutting off the possibility
of posterity we must carefully determine whether we are dealing with
an hereditary or an acquired case of criminality.
The most effective course now open to the eugenist is an active
attempt to foster in our youth such an admiration for vigor of body '
and mind that the thought of mating with the mentally and physically
defective will become repulsive and unmeditated. The eugenic aspect
is handled at the end of the book in conjunction with an earnest plea
for tolerance on the part of those who still disbelieve in the application
of the principle of evolution to man. The author urges open-minded
consideration of the disclosures made by specialists in the field of science '
and a greater willingness to reconstruct our former conceptions of
truth in accordance with the most careful investigations of present day
thinkers.
M. C. G.
126 SOCIAL HYGIENE
INTRODUCTION TO THE STUDY OF SOCIOLOGY. By Edward C. Hayes.
New York: Appleton, 1915. 718 p. $2.50
The bulk of the material in Part I is grouped under four heads which
are subdivisions of the topic "The Causes which Affect the Life of
Society." These four are: I, Geographic; II, Technic; III, Psy-
chophysical; IV, Social. Under the first head are treated such sub-
jects as the influence of the physical world on man's habits, occupa-
tions, migrations, his moods, and temperaments. In the second we
have a study of rural conditions, of city life, of groups and crowds,
the influence of wealth, the organization of our poor relief. In the
third are considered the biological backgrounds, heredity, immigra-
tion, disease, hygiene, and eugenics. In the fourth is a study of the
inner life of society, the thought of the individual in reference to the
group, the power of suggestion and imitation.
In Part II we find an analysis of the life of society, the classifica-
tion of social activities, the characteristics of society, the relations of
the group and individual.
In Part III is given a sketch of social evolution, and such institutions
as the family and religion are discussed.
Part IV deals with social control, the efforts of the group to get the
individual to follow its standards, the treatment of crime, education.
In barest skeleton I have suggested the contents of the book. The
various chapters are carefully worked out and are fall both of fact
and suggestion. The volume should be of chief value to mature men
and women rather than to young students. For one who has a gen-
eral knowledge of the world and who appreciates careful and logical
(I do not mean "dry") treatment of important subjects this book is
to be highly commended.
Readers of this journal will be chiefly interested perhaps in the au-
thor's discussion of eugenics and education, and I have saved this
topic for more detailed mention.
Under the general heading " Psychophysical Causes which Affect the
Life of Society" (pages 209 to 301) will be found a very interesting
survey of the things we inherit and the things we must acquire. Thus
the author — a preacher as well as a teacher — does not hesitate to say
that "No man is born with a conscience any more than one is born with
a language. But just as we are born with the predisposition to com-
municate and so to learn a language if one is spoken by our associates;
otherwise to begin to make one, so also we are born with the predispo-
BOOK REVIEWS 127
sition to acquire from society a conscience or to begin the making of
one."
The social differences between the different races are greater than
the physical differences of their bodies. "The prizes of life are not
offered to the negro in the same degree and on the same terms as to
the white man." Caste differences do not predicate differences in
ability. We are all conscious of the presence of defectives as well as
geniuses. Biology teaches us that it is possible to eliminate many of
the defects. "The aim of eugenics does not imply the evolution of a
new type of humanity higher than has ever existed before, but more
general conformity to the existing standard of human excellence.
. But more is biologically possible than may prove to
be socially possible The chief social agency for the
promotion of eugenics is education and the development of a eugenic
morality Not, however, that we want an increase in
the number of children born, but rather that we want an increase of
the number of children born in families where they are both well born
and properly nourished."
"Whatever else is desirable, age-long social experience has demon-
strated that four traits are essential as elements in the character of
individuals who are fitted to maintain a high and advancing social
order, namely: (1) reliability; (2) temperance or the due subordination
of each particular appetite, natural or acquired, to the requirements of
the whole of life; (3) industry or steadiness in endeavor; and (4) the
social spirit, or justice." The training of the young in these virtues
comes largely from the school, the church and the family, as well as
from the chance associations of every-day lif e. " Even if science should
succeed in providing successfully for the physical care of babies in
batches, there would remain the more exacting task of motherhood in
the development of personality. It is a task in which many mothers
fail, but one in which no other agency can succeed as mothers can."
Throughout the volume the author is fair and just, restrained but
not timid. It is not a book for hurried reading but one which demands
time for thought and will repay the reader for the time spent.
C. K.
NOTE AND COMMENT
Prostitution in the Dutch East Indies. Mr. van Walsem, the In-
spector of the Government Office for the Suppression of the Traffic
in Women in the Dutch East Indies, writes from Batavia, Java, in-
August, 1916, as follows: —
By a resolution of the Governor-General of the Dutch East Indies, dated the
29th of November, 1910, it was determined that from the 1st of March, 1911,
the medical examination of prostitutes by the government should not take place
any more. Moreover, different new regulations were made on the 1st of Sep-
tember, 1913, and came into force against brothels, procuring, and the white
slave traffic. Of these regulations the following is the most important for our
purpose :—
He who makes a profession or practice of provoking or encouraging lewdness of
others with third persons shall be imprisoned for a period of three months to one
year or pay a fine of one thousand guilders.
Although in this clause the word "brothel" is not mentioned, it is clear that
by it the trade of the brothel-keeper is made liable to punishment. It must be
understood that no one has ever supposed that these penalties would have the
result of causing prostitution to disappear from the Netherlands Indies. The
legislator has perfectly understood that this could never be the result of such
a measure. It was no less a person, than the advocate of this new article — the
late Mr. Regout, LL.D., at that time minister of justice, who on the discussion
of this bill spoke as follows in Parliament: —
"Prostitution is such a general phenomenon, peculiar to every time, that it
would be folly to suppose that such a simple penalty will cause it to disappear.
. . . . This article, is not directed against prostitution as such, but only
against those who make money through the lewdness of others or who make a
profession or a practice of it."
The parasitical life of the brothel-keeper is attacked by that article, for he
exploits the women living in his house for immoral purposes; he is also a white
slave trader, as the regular importation of new forces is necessary for his busi-
ness and therefore the Dutch legislator prohibited this anti-social profession as
well as that of the souteneur and white slave trader.
The prostitute as such is free, however. The article does not touch her; her
personal liberty to do what she likes is not hindered. The legislator does not
interfere with her mode of living.
The state has not to be a moralist. It is only in the case that prostitution
coincides with the exploitation of women or in other words, that third persons
make money by the act of a prostitute, that the legislator interferes.
It need hardly be said that this article was not agreed to unanimously, such
was also the case with the abolition of medical examination of prostitutes.
128
NOTE AND COMMENT 129
There were and there still are people, who maintain that the abolition of ill-
famed houses is the cause of the increase of clandestine prostitution. In my
opinion, this argument does not hold good for the following reasons: —
1. In order to prove the truth of this assertion, it would be necessary to know
exactly, how much clandestine prostitution took place in a city or country before
the abolition of the brothels.
It is only when such knowledge is obtained that a comparison can be made
between the situation before and after the abolition and that it can be proved
that clandestine prostitution had been increased by the abolition of brothels and
of public prostitution.
Now we have no reliable statistics about this question. The assertion there-
fore that clandestine prostitution has been increased by the above-mentioned
reason is only a supposition, which cannot be corroborated by scientific means.
In a Dutch town (Arnheim) where by an accidental state of affairs the number
of clandestine prostitutes could be controlled before and after the abolition, it
was ascertained that secret prostitution had decreased after abolition, a proof
that the assertion of our adversaries is incorrect in its general sense.
2. The increase of clandestine prostitution does not coincide by any means
with the abolition of brothels. In countries and cities, where such a legal pro-
hibition does not exist and where brothels are allowed, we see an increase of
clandestine prostitution.
That is the case at Paris and at Singapore, in the West and in the East.
I made an inquiry last year at Singapore about the number of Javanese prosti-
tutes in that town. Only thirty-eight lived there, ten of whom lived together
in three brothels, the others lived separately and preferred doing so independ-
ently to living in an ill-famed house. You know perhaps that at Singapore no
obstacles are placed in the way of brothels.
This remarkable phenomenon, viz., the increase of secret prostitution through-
out the whole world, also in countries where the legal prohibition of brothels
does not exist, can — in my opinion — be explained as follows: —
1. Women are becoming more and more independent. Their desire of inde-
pendence is becoming greater and greater. That is also the reason why they wish
to have the free disposal of the money they gain as prostitutes.
In contrast with what one can observe everywhere in the whole world, viz.,
increase of trade on a large scale, here the preference is given to trade on a small
scale.
2. The love of luxury and pleasure, which increases in proportion to the
facility with which they can be procured and the increasing intercourse of our
days with the world at large, cause women and girls to look about them in order
to find the means of satisfying this craving for luxury and pleasure. Many
girls find those means by giving themselves up to prostitution.
3. The church, the religions are losing their influence on the people more and
more. Moral notions and ideas are becoming lower and lower.
The argument that the disease will increase by the abolition of medical exami-
nation, to which women living in an ill-famed house are subjected, is the next
we have to consider.
I shall cite the words of medical doctors. They have more authority on this
subject than moralists.
130 SOCIAL HYGIENE
1. The late Prof, van Haren Noman, a celebrated Dutch medical man, col-
lected in the years 1889-1896 information about this question, from which I
derive this assertion : —
"From my practice of many years my opinion is that the infection, got in
brothels, is more manifold than that got by secret prostitution."
2. The section "Rotterdam" of the Dutch Society for the Progress of Medical
Science unanimously advised in 1901 the council of that town to abolish the
brothels, because the medical examination did not give sufficient security.
3. Messrs. B. van Dugteren, M.D., and F. Rietema, M.D., treating the ques-
tion of medical examination in their report about prostitution, made in 1897
for the Dutch Society of Dermatologs, said: "Next to the impossibility of dis-
tinguishing the sick women from the sound women, next to the confidence
unjustly awakened, we find also a cause for the increase of the disease in the
resistance of the women themselves."
4. Finally I will make a comparison between England and France in connec-
tion with our subject.
In England there are no regulations, in France there is an elaborate system
of regulation with its "police des moeurs, maisons tole>6es, etc." What is the
result? (see English Parliament Blue Book, c. 7148, of 1893, page xxv).
In England there are statistics published by the Registrar-General, showing: —
a. Deaths at all ages as caused by venereal diseases per 1,000,000 living.
6. Deaths from (hereditary) venereal disease of children under one year old
per 100,000 living at that age.
c. Candidates for recruitment refused on account of syphilis per 10,000 offer-
ing for enlistment.
Taking a period of twenty years after the Contagious Diseases Act was abol-
ished, that is between 1886 and 1907, the fall in each case was as follows: —
a. From 92 to 58, i.e., 37 per cent.
b. From 116 to 71, i.e., 39 per cent.
c. From 82 to 18, i.e., 78 per cent.
In other words the disease has steadily diminished without regulation.
On the other hand in France with its elaborate system the disease had appar-
ently increased. At the International Congress of Medicine held in London
in 1913, a paper was presented by Professor Ernest Gaucher and Professor
Gougerot, both of Paris, on "The Dangers of Syphilis and the Question of State
Control."
Professor Gaucher's words are important for he holds the principal chair of
syphilography in Paris. The following sentences are worth noting: —
"1. The greatness and the difficulty of the question is obvious. Hardly any
of the problems have been solved, at least in France."
"2. Regulation is theoretically the most seductive system. All prostitutes shall
be brought under judicial authority, thus all can be subjected to inspection
and only those who are free from contagion shall be authorized to continue their
'profession.' "
"3. Regulation which exists in France and other states aims at fulfilling this
program. Unfortunately the practical difficulty is far from the theoretical ideal.
The majority of syphilographers and philanthropists oppose it
esolutely.
NOTE AND COMMENT 131
The French Extra Parliamentary Commission and the International Con-
gress at Brussels arrived at conclusions unfavorable to administrative regula-
tions and to the "police des moeurs."
"4. I do not hesitate to declare publicly," one of us (Gaucher) has said, "that
regulation is iniquitous, illegal, inefficacious and positively harmful."
"5. I refuse to admit the argument from common sense, as stated by my
eminent master Professor Fournier."
Could any words show more clearly the bad effects of regulation?
The contrast between the state which Professor Gaucher describes in France
and that shown by the statistics of the Registrar-General in England is most
remarkable.
Reports on Vice Conditions in Bridgeport, Connecticut; Paducah,
Kentucky; and St. Louis, Missouri. Previous to the investigation of
vice conditions in Bridgeport,1 the city had the reputation of being an
"open town." This reputation was not entirely deserved, but the
older- segregated district, closed four years ago, was one of defiant
flagrancy, and for years had been accepted as an inevitable, even if
distressing, public institution.
When the investigation began, Bridgeport had a well-defined segre-
gated district. In December, 1915, while the work was in progress
this district was closed by order of the mayor and superintendent of
police. After the houses were closed, some of the hotels, cafe's, cabarets,
saloons, and oriental restaurants became the rendezvous of prostitutes
and their patrons, and became subject to investigation. The revelation
of conditions in these resorts was of a serious nature, and such dis-
closures form a large part of the report.
One chapter deals with investigations of certain public dance halls.
The scenes in these dance halls were obscene and indecent in the
extreme. The dancing was sensual and immoral with no attempt at
control or restriction. Drunken boys and girls reeled about the floors,
knocking over tables laden with half-empty beer glasses. Prostitutes
solicited men openly for immoral purposes.
To quote from the report: —
No more serious problem can confront usHhan the control of the dance halls.
At the present time in Bridgeport there are multitudes of working girls who
seek through them an outlet for their social and fun-loving instincts. Private
homes are closed to them; the rooming houses have no place for recreation. It
is natural, then, that these young women should accept any chance that offers
for having a good time. As the element of choice of companions is reduced to a
1 The Report and Recommendations of The Bridgeport Vice Commission,
John R. Brown, Chairman. Bridgeport. Connecticut, 1916.
132 SOCIAL HYGIENE
minimum by the public character of a dance hall, and undesirable persons can
go on the floor at any time by paying the price of admission, many an innocent
girl may find herself in a party with one or more prostitutes, and follow their
lead.
An important chapter is the one on venereal disease in Bridgeport,
followed by tables of statistics supplied by the Department of Public
Charities. Another interesting chapter reviews one hundred and ten
.cases in which there was a relation between poverty and vice.
Among the constructive recommendations appear the following: —
We recommend that such persons be treated as abnormal and antisocial mem-
-bers of society, and their cases disposed of by the courts in accordance with law
after diagnosis and recommendation of the psychopathic board which we here-
after recommend.
We recommend that the patronage of all saloons be carefully watched by the
police, that the law prohibiting loitering of women be strictly enforced.
• We recommend that the board of health examine all saloons frequently, and
that they compel the saloons to observe all sanitary laws to the letter.
We recommend that all private booths and side rooms in restaurants, cafe's
and saloons be forbidden, and that where now existing they be ordered taken
down by the authorities.
That there should be an amendment to the present law regarding the reporting
of venereal infection to the board of health. The suggestions made by the
Hartford Commission would, we believe, be quite satisfactory. "The report
could be made sufficiently descriptive to establish the individuality in each case
(without disclosing the identity of the person) to prevent duplication of the
same case even if reported by several physicians. Such case should be re-
ported on blanks substantially as follows: — (1) Date, (2) Exact age, (3) Sex of
patient, (4) Name of physician reporting, (5) Names of previous physicians con-
sulted, (6) Disease, (7) Is diagnosis positive? (8) Date of infection, (9) Place of
infection, (10) Source of infection, (11) Complications thus far present, (12) To
what extent is the patient a menace to society? The report should be made
obligatory on the part of the attending physician on penalty of fine."
A venereal diseases clinic should at once be established in which such diseases
are diagnosed and if, necessary treated free.
In view of the fact that much vice comes from the lack of normal and healthful
recreation, and as the opportunities for such recreation in Bridgeport are small
and totally inadequate in the present rapid growth of the city, we advise that
the Mayor and Common Council appoint a recreation commission who shall see
that a recreational survey of the city is made and that they bring in a plan for
the extension of recreational facilities to cover a large group of years. This
commission ought to deal with the dance halls, the cabarets, the school recrea-
tions, school centers, playgrounds, theaters, moving picture shows, park amuse-
ments and all athletics.
In our judgment, there are four normal and satisfactory ways in which the
facts of the sex function can be taught in the education of a child. They should
NOTE AND COMMENT 133
all be used — the biological, the physical training, the ethical and the religious
methods; they show in turn the facts, the personal apprehensions, the moral
implications and the sacredness of the sex relation.
We recommend that the co-called Iowa Injunction and Abatement Law, which
has been adopted in many states, be enacted at the earliest possible date.
We recommend that the state establish a farm and reformatory for prostitutes,
similar to those successfully and scientifically run in other states, to which women
might' be committed for treatment and preparation for a return to normal and
respectable life.
We recommend a morals commission, chosen by the Mayor, to hold office
without pay, and who shall use an appropriation as need may arise for investi-
gation and oversight into any conditions which affect the morals and public
order of the community.
One of the most interesting features of the report of the Paducah,
Kentucky, Vice Commission2 is a chart showing sixty-four houses
of prostitution scattered throughout the city. For many years the
officials of Paducah had tolerated such houses, backed by public opin-
ion, until at last this vice expressed itself at the very doors of respect-
able families. Hundreds of children were found playing in and around
the houses and some actually lived in these resorts/
In summing up the facts in the report, the following statements are
especially significant : —
Paducah has one public prostitute to every thirty-five of her adult woman
population.
Houses are located in every part of town save in the extreme west end.
Fifty per cent, of the inmates have been infected with syphilis.
Ninety-five per cent, are at present or have been infected with gonorrhea.
More than six hundred cases of beer are sold in these houses each month.
Fifty to seventy-five per cent, of the profits from prostitution go to the
madames.
Ninety per cent, of the profits from beer go to the madames.
The property owner makes from 125 to 100 per cent, more on his property
leased for this purpose, than for any legitimate use.
Hundreds of children loiter and play about the houses, and are necessarily
absorbing the atmosphere to say nothing of possible infection.
Boys under twenty-one years of age are frequent and regular customers.
The average life of a public prostitute in Paducah is four and one-half to five
years.
Three thousand cases of gonorrhea and syphilis are treated by Paducah
physicians a year.
Seventeen madames do a business of $11,000 per month.
8 Report of the Paducah Vice Commission, Reverend Clinton S. Quin, Chair-
man. Paducah, Kentucky, 1916.
134 SOCIAL HYGIENE
A conservative estimate of money spent in houses of prostitution in Paducah
is $400,000 per year.
"We lay at the feet of no man," writes the Reverend Clinton S.
Quin, Chairman of the Vice Commission, "no one administration, the
responsibility for vice conditions in our city. What is here is a growth
of years, and we believe what we recommend, if carried out, will make
our city a much cleaner and better place in which to live."
Among the recommendations are the following: —
Elimination of public prostitution through the rigid enforcement of the law.
Notice to be given June 15, 1916, that ninety (90) days after date, September
15, 1916, all keepers and inmates of houses of prostitution, all keepers of houses
of assignation, and the owners of such property, shall be prosecuted to the full
extent of the law, and prosecution to continue every day until such traffic is
abolished.
That from this date, June 15, 1916, the Commissioner of Public Safety shall
enforce the law relative to the sale of liquor in houses of prostitution, and also
that law relative to minors visiting such houses for any purpose. That all
player pianos in houses of prostitution be ordered stopped.
That no prostitutes be allowed to come into any public house of prostitution
after this date, June 15, 1916, and that none shall be allowed to move into any
other location.
That after due notice, say thirty (30) days from this date, the license of any
saloon keeper be revoked who permits a prostitute to frequent his saloon, or who
permits prostitutes to live or to ply their trade, on his premises.
The appointment of a morals commission, to include the Commissioner of
Public Safety, to continue the work as instituted by this Commission, part of
whose duty it shall be to see that the law is enforced. That the Mayor shall
have the appointment of this Morals Commission, and that it shall consist of
not less than five, nor more than ten members, and that the term of office of
this Commission shall continue one year from date of appointment.
That a woman probation officer be appointed in the Juvenile Court.
That a woman be appointed, with the proper power, to meet all trains, for the
protection of incoming girls and women.
That steps be taken to bring about such legislation as will create an institution
for the feeble-minded, said institution to be along the lines of the one at Vineland,
New Jersey.
A report of the Committee of One hundred of St. Louis,3 places
special emphasis on the work of the City Courts and of Division Num-
ber 2 of the Court of Criminal Correction in handling cases of this
class in the calendar year 1915. Under such headings as "The Trial,"
"The Parole," tables show the disposition of different degrees of prosti-
1 Commercialized Prostitution in St. Louis, by J. G. Fertig, published by the
Committee of One Hundred for the Suppression of Commercialized Vice, St.
Louis, Missouri, 1916.
NOTE AND COMMENT 135
tution cases. A special statement is made under "Syphilis andGono-
coccus Infection" giving the number of cases treated in the City Hos-
pital and the city dispensaries.
Certain remedies are suggested. These include the amending
of present city ordinances, so as to provide: —
1. That women convicted of prostitution be sent to the Work House for an
indeterminate period not exceeding one year, and that no fine be imposed.
2. That prostitutes sent to the Work House be given an industrial training.
3. That a physician of the Hospital Division examine all women arrested for
prostitution.
4. That syphilis and gonococcus infection be made reportable to the Health
Commission; and
Finally that an injunction and abatement law be enacted by the state legis-
lature at its next session.
G. J. K.
Continued Agitation against Segregation in Japan. The letter
printed below, sent out by a committee of foreign residents of Osaka,
continues the story in SOCIAL HYGIENE for October, 1916, of opposition
to the establishment of a new segregated district in that city. A
hopeful feature of this opposition, whether or not the immediate point
at issue is won, is in the fact that it is not confined to foreign residents
to whom the Japanese system of segregation might well be expected
to be abhorrent, but that it first sprang up among the Japanese and
was later given Christian and foreign support.
To the Foreign Christian Public:
The undersigned have been requested to present to you a statement con-
cerning the progress of the anti-vice campaign in the proposed new segregated
district, Tobita, Osaka, and to solicit your continued sympathy and help in the
fight that is to be waged during the fall and winter.
We are glad to report that the representative committee appointed last spring
are not relaxing their efforts one whit, and now with the changes in the Cabinet,
and with the meeting of the Osaka Prefectural Assembly to open in November,
they are taking up the fight with redoubled vigor and energy.
You will remember that the government order permitting "Tobita" was
issued on April 15th. During these six months a temporary bamboo fence has
been built around the plot, a land company has been formed and the different
lots have been bought up by the prospective operators. On September 22d the
land company called in a Shinto priest, the head of the great Osaka Tenjin shrine,
and held the "Jichinsai," or ceremony for propitiating the guardian deities of
the ground. This is as far as the scheme has developed during the half year.
Not a street has been laid out, not a foot of land has been filled in, nor has a
single house been built. The farmers are as usual raising their crops on the land,
and have paid their rent up to the end of December. Although the outcome of
136 SOCIAL HYGIENE
the opposition campaign is still uncertain, it has already stirred the police of
Osaka and Tokyo to make repeated raids against private houses of prostitution,
and has led to stringent measures in Osaka against the public exhibition of girls
behind the bars in the entrance ways of the licensed houses.
The committee plans to keep up a hot campaign during the remainder of thia
year. Three thousand volumes of a special 140-page book on the license problem
in general, and the Tobita question in particular, have been printed and are
now being sent out all over Japan to members of the privy council, the cabinet,
the two houses of parliament, governors, university professors, prefectural
assemblymen, and other leading men. The influential citizens of Osaka will
each receive a copy. The printing and mailing of this is costing 490 yen. New
petitions from hundreds of Osaka Christians and other well wishers are being
sent to the Diet, and a new petition from mothers is being sent to Governor
Okubo and the Home Minister.
At the opening of the Osaka Prefectural Assembly in November it is planned
to negotiate with the leading newspapers for a whole page of propaganda material
in each paper. At the same time special letters will be sent to each member of
the Assembly, and some public lectures will be given. This is to strengthen the
hands of the Anti-Tobita party in the Assembly, who are as determined as ever
to make an issue of this problem in the deliberations of that body.
It is evident that the crucial moment of the battle is now approaching. The
activities of the next few weeks will determine the happiness or misery of thou-
sands of Japanese young women, as well as the prospect for purity in this, the
second city of the Empire. Furthermore this fight concerns the whole country,
and the whole cause of anti-prostitution everywhere. In the providence of God
the conflict has been raised in Osaka, and the warriors here must bear the brunt
of the fighting. This they are willing to do, and with the exp3rience gained thus
far, and the spirit of unity and enthusiasm prevailing, perhaps no other place is
so well fitted to answer the call of God with reference to this movement. But
the issue of the battle here is bound to affect tremendously the solution of the
social evil problem throughout Japan, and even outside of Japan, so that we feel
justified in responding to the request of the General Committee to present this
wide appeal.
The prosecution of this movement costs money. Up to date 1428 yen has
been raised, of which 104 yen remain. Perhaps six-sevenths of the above amount
has come from Japanese sources. It is estimated that the fall and winter cam-
paign will require at least 1500 yen more, and we beg to urge that foreign Christ-
ians generally will make use of this opportunity to show their sympathy in a
practical way. Contributions, large or small, will be gratefully received and
wisely used. The Rev. W. R. Weakley, 14 Kawaguchi Cho, Osaka, will act as
Treasurer in collecting this foreign fund, and later pass it over to the General
Committee. Please use the Furikae Chokin blank enclosed, Osaka 12122.
"The King's business requireth haste."
"Pray without ceasing."
G. ALLCHIN,
W. H. ERSKINE,
Signed, ( G. W. FULTON,
G. GLEASON,
Osaka, October 16, 1916, \ W. R. WEAKLEY.
NOTE AND COMMENT 137
London1 s Campaign Against Vice. Men "more mischievous than
German spies" are loose in the British capital, says the Bishop of
London. They are the "male hawks" who "walk up and down this
very Piccadilly night by night with an army of helpless and trembling
girls under their surveillance, and who take from them the very money
the girls earn by their shame." Side by side with the male hawk
"as a traitor to his country" the Bishop placed "the writer of lecher-
ous and slimy plays. " He went on to charge this type of playwright
with "the insolence to try and make money out of the weaknesses of
our boys." "God knows, in the heyday of their youth they do not
always find it easy to keep straight," he exclaims; "these devils de-
liberately try to make it harder." In an interview in Reynolds's News-
paper (London), Bishop Ingram returned to the subject of the pro-
tection of boys under arms from the purveyors of vice. The inter-
view runs: ". . . . I repeat the assertion I made on Wednesday
from the pulpit of St. James's, Piccadilly. 'It is the business of us
middle-aged men who are not allowed to fight and the women of Lon-
don to purge the heart of the Empire before the boys come back.
If it is to be still the old London, those who have died will have died
in vain.'
"I spoke those words in Piccadilly, the center of organized vice of
the entire universe. It is a time for plain speaking; why should we
shut our eyes to obvious facts? The male hawks of Piccadilly, and
the unfortunate women upon whom they prey, constitute such a dan-
ger to the nation that, if only the nation realized it properly, the evil
would not be allowed to continue one minute longer.
"There is unfortunately in England a tendency to regard vice and
licentiousness as a necessary evil. I have heard men who lead per-
fectly moral lives say they suppose these things are inevitable. In
other words, public opinion has countenanced prostitution. Men
with so-called advanced views declared that morality and health did
not go hand-in-hand. What utter nonsense ! No man ever has suffered
or ever will suffer, from living cleanly; all arguments to the contrary
are merely a pretext to cover immorality."
The question of punishing the wrongdoers is regarded of minor
importance by comparison with "the necessity of a change of mind
and spirit in the country." — Literary Digest, November 4, 1916.
The Injunction and Abatement Law in Indianapolis. The Indiana
Injunction and Abatement Law has been utilized to great advantage
138 SOCIAL HYGIENE
during the fifteen months since its enactment in reducing commercial-
ized vice in Indianapolis. During that time twenty-four suits have
been brought against the keepers of houses of prostitution, all of which
resulted successfully. These women were put under an injunction
which is binding on them as long as they live in the state of Indiana;
they include practically all of the notorious women who have long and
successfully, from the financial standpoint, conducted their business
of prostitution in Indianapolis.
In addition to these twenty-four cases, more than sixty houses of
prostitution have been vacated, after notice and threat of enforcing
the law, and without the need of bringing suit. Scarcely a week passes
that some such houses are not thus vacated.
But the influence of the law has extended to many more houses and
people than are included in the above eighty cases of houses of prosti-
tution that have been stopped doing business during the past year.
Many have abandoned the business or refused to enter it or continue
it through fear of this law. Therefore it is impossible to estimate
exactly how extensive has been the influence of this law in Indianapolis.
The feature of the law which makes it effective is that it reached
the property owner and in most of the twenty-four suits instituted
the property owner was a party to the suit. Property owners and real
estate agents are extremely sensitive about publicity of the bad reputa-
tion of their houses. For that reason mere notice to the owner ia
most cases has been sufficient.
The enforcement of this law in Indianapolis has been at the instance
chiefly of the Church Federation. When its officials are satisfied of
the location of a house of prostitution, either by its own investigations
or by reports from reliable people, the secretary of the Church Feder-
ation notifies the owner of the real estate of this report and requests
him immediately to investigate and turn the people out if the report
be true. In nearly all instances the people have been turned out within
two days. The real estate agents of the city have cooperated with the
Church Federation in an endeavor to protect their real estate from such
use and reputation. No real estate owner has refused in a single
instance to act promptly and effectively, excepting where the houses
were owned by the women who ran them.
The prosecuting attorney has also cooperated with the Church
Federation in enforcing the law and the public endorsed him in a remark-
able manner in his renomination and reelection.
At first the defendants in the suits brought employed counsel and
NOTE AND COMMENT 139
showed considerable fight, but in most instances the lawyers employed
by them respected the law, settled the cases, and refused to advise
appeals. Likewise the courts have treated the law with great respect
and have sustained and enforced it effectively, in spite of claims for a
time that the law was unconstitutional.
The result has been to enhance greatly the respect of the public
and officials for this law and the improvement in social conditions at
which it aims. This sentiment became so strong that this law was
employed against a burlesque house where vulgar or immoral theatri-
cal performances were given. This theatre persisted in its degrading
shows in spite of every other effort to correct the evil. Finally, suit
was brought against the manager and lessor under this law, for "lewd-
ness," the theory being that the shows given were lewd and covered
by this statute which includes the word "lewdness." As soon as the
lessor saw the hand of the law reaching out on the lease and property,
the theatre was closed and it has not been operated since. The suit
was successful. This is, so far as known, the only instance in which the
Injunction and Abatement Law has been employed against a theatre
or other evil than prostitution.
Many of the houses formerly used for purposes of prostitution have
been changed into legitimate business establishments; many of the
women have apparently abandoned commercialized vice; some have
left the state; and others have scattered through the city. The latter
are followed and the crusade against their business constantly pushed.
The constructive side of the problem has not been neglected and
consideration is being given to a bill in the next legislature to establish
a self-supporting penal farm and industrial institution for the pro-
tection of society against women of this class and particularly for
their own rebuilding and regeneration, and to which the courts can
send such people, instead of turning them loose, as heretofore, with
the fine of one dollar and costs. V. H. L.
Indianapolis, Ind., November, 1916.
The Injunction and Abatement Law in Erie, Pennsylvania. The
Public Morals Committee of Erie, Pennsylvania, representing the
members of the Men's Inter-Church Federation and the Erie County
Branch of the American Federation of Catholic Societies, was organized
early in 1916 when it became apparent that the city administration
had adopted the policy of an open town and was making no effective
effort to check prostitution, gambling, and violation of the liquor law.
140 SOCIAL HYGIENE
A newspaper account says that matters were brought to a head, when
an afternoon paper reproduced a card bearing the name of a police
department investigator which the madam of a house of prostitution
said he had left with her; he had told her "if she got into any trouble
to call him and he would see that everything was all right."
The Public Morals Committee began an investigation early last
spring, and as soon as sufficient information was gathered a sub-com-
mittee called upon the Mayor at his office, presented a list of thirty-
seven brothels, and asked that he take action to abate them. He re-
plied that he was doing what he could to keep the town clean but made
no promise of definite action. The Morals Committee, after waiting
forty-eight hours to give the Mayor opportunity to do something, served
upon the madams and owners of property occupied for purposes of
prostitution notices as required by the Injunction and Abatement
Law, calling upon them to discontinue their unlawful business within
ten days. These preliminary notices proved effective in one case
only. Considerable delay between the serving of the first notices
and the application to the court for temporary injunctions was caused
by the difficulty encountered in identifying the owners of some of the
propei ty in question. It is reported that one woman who owned and
operated five houses of prostitution in Erie was doing business under
six different names. Finally, however, petitions for temporary in-
junctions against the owners and operators of the houses in question
were presented to the court which granted the injunctions without
question. This action proved to be a judicial error as the law permits
the issuance of such preliminary injunctions only after hearing evi-
dence. When the Morals Committee petitioned the court to make the
temporary injunctions permanent, the point was raised that they had
been illegally granted. The court admitted the error, but immediately
gave the complainants opportunity to present evidence, issued pre-
liminary injunctions in due form on the same day, and made them
permanent the day following.
A French View of Social Hygiene was recently presented by M.
Jules Bois before a group of interested persons in the library of the
American Social Hygiene Association. M. Bois was sent to the
United States by the government of France to strengthen the bond
of friendship between the two countries by making known the true
spirit of the French people and by developing an interest in the
study of the French language and literature in this country.
NOTE ANH COMMENT 141
The French people, he said, have always been devoted to their
homes. The depth of this attachment to home life has not been
understood by visitors from other lands, who have, for the most
part, seen only the superficial side of French life. Nor did the
nation itself realize the strength of its devotion to its highest ideals
until it was tested by the exigencies and horrors of the present war.
The presentation of the various phases of social hygiene to a people
who had not yet reached the point of modern emancipation has been
a most difficult problem, which is, however, finding a solution through
an appeal to the love of beauty so characteristic of the French nation.
It is the idealistic presentation of the beauty oi chastity which reached
the soul of the Frenchman of today.
The first result of this movement was a strengthening of the ideal
side of man's character, accompanied by a growing emancipation
of the present generation of women. The French woman of today
has progressed in the direction of independence of thought and free-
dom of action, a thing practically unknown before, and this has
compelled a respect and consideration from men which has been a
potent factor in stimulating the finer elements of man's nature.
The sense of equality between men and women has developed
to the point of recognizing the justice of a single standard of morals:
but whether the accepted code of a man's life shall be established as
this standard, or whether man shall rise to woman's level remains
as one of the most vital questions of the present time.
R. W. C.
The University of Wisconsin Advises Freshmen. In a booklet of
information for freshmen, Dr. S. H. Goodnight, Dean of Men at the
University of Wisconsin asks the question "How are you going to
start?" and says: —
Well begun is half won. If you can pass through the first semester at the
university without being dropped for poor work or placed on probation, it is
proof positive that you are not lacking in ability to finish a four-year course in
a creditable manner and the probabilities are that you will. But, unfortunately,
fellows with plenty of ability often fail because they don't get started right.
Directions and suggestions follow for such practical matters as the
choice of rooming and boarding places, "Getting on with the Land-
lady," care of money and means of earning it, sharing in university
activities, and the like. The paragraphs on "Temptations" are quoted
for their social hygiene content: —
142 SOCIAL HYGIENE
Temptations, (a) Loafing — an easily acquired and very pernicious habit.
Beware of a crowd of "good fellows" who have it, it is alarmingly prevalent
and frightfully contagious, (b) Depending on someone else to help you do
your work — nobody can "show you how" to be an athlete, you must train and
practice in order to excel; nobody can "show you how" to be a student, you must
do your own studying, (c) Cribbing — a = b = c. The disease sets in after the
moral tissue has been sapped away and the backbone has been replaced by a
shoe-string. The Faculty Committee on Discipline has a drastic remedy which
rarely needs to be applied more than once, (d) Smoking — a treacherous and
insidious habit that soon develops to the point of dulling both physical and
mental alertness in growing youths. Let it alone, (e) Profanity — a useless,
inane habit which stamps the habituee as of low ideals and vulgar mind. Shun
it. (f) Drinking — a fatal vice which is happily on the decline. Student drink-
ing has decreased enormously in recent years. Practically all student organiza-
tions have taken a stand against it. The student drinker can't maintain him-
self, and he either stops drinking or leaves college, (g) Lewdness — nothing
more speedily stamps a student in a co-educational institution as an undesirable
academic citizen than lack of high regard for womanhood as evidenced by ques-
tionable female associations. On this point, too, public sentiment, so long
indifferent, is being rapidly moulded. Clean living and respect for women are
now being recognized as essentials, not as mere embellishments, of "college
spirit."
These temptations are not indigenous to any one locality. They are not new
to you. You have met them all in high school. But you had the safeguards of
home to aid you in overcoming them. Alone in a strange town they will present
themselves to you more persistently than before. There is no talisman which
can protect you from them; you cannot hide from them. Meet them you must,
and it is only by meeting them squarely and in overcoming them directly that
you can gain that measure of self-mastery which is the end and aim of true edu-
cation. And no weapons for overcoming temptation have as yet been invented
which are half as effective as a whole-souled interest in the work of the class-
room, intensive application to one's studies during study hours, and as recrea-
tions, wholesome reading, out-door exercise, and the cultivation of one of the
student activities.
Disturbing Conventions. Miss Jane Addams writes, in The Survey for
October 7, under the above title, of the changing attitude among women
toward the illegitimate child and its mother, as a "contemporary
modification of an age-old tradition" containing "evidences of that new
chivalry of women for each other, expressing protection for those at
the bottom of society."
For years fierce maternal affection for their children and a desire
to protect the home have led mothers all over the world to ostracize
the "bad woman" and her children. Gradually, however, pity for
these little children who are brought into the world handicapped by
NOTE AND COMMENT 143
the stigma of illegitimacy and who must be fed and reared, is bringing
about a new order which is seeking to right the former wrongs.
Miss Addams tells of a few instances that have come to her notice
where women, breaking through the conventions that have bound them,
are caring for the illegitimate children of their own sons and daughters
and are thus making real progress in the solution of this great problem.
Wherever the "woman's movement" has gone with its revolt against
injustice we find the strong, noble women rising to help their weaker
sisters, returning to that "idealized version of -chivalry which was the
consecration of strength to the defense of weakness."
The Shield — A Review of Moral and Social Hygiene. The Shield,
published by the British Association for Moral and Social Hygiene, is
being issued, beginning with April, 1916, as a quarterly review of con-
venient size and pleasing appearance. The scope and variety of its
contents are enlarged and the two numbers already issued are filled
with valuable and interesting material. For example, in the April
number, the Report of the Royal Commission on Venereal Diseases is
discussed; Dr. Helen Wilson presents -a paper on Hospital Accommoda-
tions for Venereal Diseases; John Cowen, well known for his work for
the repression of prostitution in the Far East, writes of the moral and
medical problems of military camps; among other topics are "The
Problem of the 'Undesirables/ " "A Training Colony for Women,"
and "Women Police." The July number has studies of sex education
by Miss Norah March and C. C. Osborne, of alcohol as a cause of
venereal diseases by Dr. J. T. Dodd, and other valuable papers on
social hygiene topics.
The Shield was first issued as a weekly in 1870, and has been issued
as a monthly, a fortnightly, and a quarterly. Since 1909 it has been
under the editorship of Dr. Helen Wilson. Founded to oppose the
"infamous Contagious Diseases Acts and to proclaim their futility,
injustice, and immorality," it has consistently labored against all forms
of official regulation of vice and for the eradication of prostitution. In
its new form it gives promise of increased usefulness and influence. It
is published at 19 Tothill Street, London, S.W.
The American Journal of Syphilis. The publication of the first
number of a new quarterly journal under the above title is announced
for January, 1917, to be devoted to the study of syphilis in all its phases.
Original articles dealing with the work of investigators will be featured,
144 SOCIAL HYGIENE
and it will be the purpose of the editors to make the magazine cover
the field of syphilology in a thorough and timely manner. Social
hygiene workers will be especially interested in the department "The
Social Aspect of Syphilis," of which Wm. A. Pusey, M.D., of Chicago,
is editor and A. Ravogli, M.D., of Cincinnati, W. F. Snow, M.D., of
New York, and W. C. Rucker, M.D., U.S.P.H.S., are collaborators.
The journal is to be published by the C. V. Mosby Company, St.
Louis, Mo. Loyd Thompson, M.D., Hot Springs, Ark., is managing
editor.
The Morals Court of Chicago. The Institution Quarterly, an official
publication of the state of Illinois, contains in the issue for September
30, 1916, a report by Dr. Anna Dwyer of the Chicago Morals Court.
Dr. Dwyer is the physician of the Court and her statement, there-
fore, concerning the medical phases of the Court's work is authoritative.
Her recommendation that girls be taught useful trades in the public
schools is clearly in line with the attempt to prevent the continual
recruiting for the purposes of prostitution of young girls whose lack
of training and discipline makes them particularly susceptible to moral
failure. Dr. Dwyer says: —
The Morals Court of the city of Chicago, dealing primarily with statutory of-
fenses against society, has in the past year heard cases against several thousand
women offenders. Of these offenders nearly three thousand have been given
physical examination by the physician of the Morals Court, whose work has been
established for the double purpose of giving aid to the diseased and of securing
a medical history of each patient with a view toward determining some method
that might ameliorate present conditions of society
The examinations conducted in the Court went far toward determining the
causes of prostitution. Principal among these are the lack of parental control,
and alcoholism. The average age of the prostitute examined has been 26. One-
half of the number examined have been among the Court "repeaters." The oc-
cupation of these women seems to be allied with their condition in some way,
for the greater number were waitresses, followed by laundresses, chambermaids,
houseworkers, scrubwomen, seamstresses, manicurists, nurses, clerks, house-
wives. The higher the requirement demanded of women in trade, the less like-
lihood there seems to be of their becoming prostitutes. Most of the offenders
have no occupation. After them come, in ratio, the women of the unskilled
trades.
Of examinations made this year by the physician to the Morals Court, 2873
were for venereal disease. Of these, 1080 had suffered from gonorrhea; 670 from
syphilis; 703 were drug users.
NOTE AND COMMENT 145
Contributing causes of prostitution: Loss of one or both parents; lack of pa-
rental control; love of fine dress; lure of vicious men; influence of bad women;
alcoholism.
Occupations: Waitress, 454; laundress, 264; housework, 201; cooking, 36;
chambermaid, 34; seamstress, 54; prostitution, 193; manicure, 24; nurse, 12;
clerk, 16: housewives, 286.
The necessity for food, shelter, and clothing for these women demands that
some provision be made for their care. The establishment of some business
that would yield them employment is one of the needs of the social problem.
Even with their limited training they would be able to do laundry work, garment
making, or garment cleaning. This business might be made not only self-sup-
porting, but even profitable.
So noticeable is the fact that practically none of the women who are brought
into the Morals Court have had any training in self-supporting trades that the
lack appears to be closely associated with the problem of morality. It would
therefore seem advisable that every girl in the public school should be taught
some useful work. Books are not the only intellectual force in mind training.
Tools are quite effective and in many cases children who seem unable to grasp
book knowledge become not only manually but mentally efficient through the
use of these tools.
For the girls of the city a useful trade, although not a preventative of vice,
might readily become a means of regeneration. The experience of arrest and
imprisonment would deter many women from repaating the offense for which
they were punished, if they had the means of supporting themselves other than
by moral offenses. In connection with this problem, it must be remembered
that among habitual offenders vice is a business, a means of livelihood.
An Australian Report on Venereal Disease. The Committee of the
Australian Parliament appointed to consider a report on causes of
death and invalidity presented in May, 1916, a report on venereal
diseases which seems to have been influenced strongly by the report
of the British Royal Commission on Venereal Diseases. It presents
the essential facts in regard to syphilis and gonorrhea, with especial
reference to results, prevalence, and treatment, and makes recommen-
dations including educational work, the provision of free diagnosis
and treatment, repression of prostitution, legislation making the report-
ing and treatment of venereal disease compulsory, and continued re-
search regarding these diseases.
The report says: —
Educational. An educational movement is of the highest importance. Every
boy at a certain stage should be taught the lesson of clean-living and continence,
that the continent life is the right life, the healthy life, the safe life, while the
incontinent life is degrading and full of danger. The continent life is not with-
out its troubles, but they are of little account. Nature has provided for the
146 SOCIAL HYGIENE
escape of any accumulating secretion, and the simple acts of involuntary emission
are perfectly harmless. They become harmful only when dwelt upon as some-
thing evil. No feeling of shame should attach to them. This statement must
not be taken as applying to masturbation, which is a great evil.
The necessary teaching for boys should be given at about the age of fifteen
(15). The teaching is best given individually by the father or schoolmaster.
Class teaching on the subject is not advisable. School medical officers and
chaplains may be of great assistance, but the question should be dealt with as
a matter of health and of danger to health.
The widespread notion that incontinence is essential to manliness is untrue.
The most manly boys are clean-living boys.
Mature men need instruction which may be given by lecture. Technical and
trade schools, for instance, may be reached in this way. All soldiers on enlist-
ing should receive a warning which should be repeated every year. The regi-
mental medical officer is the best instructor. The universities do not fulfil their
duties to their undergraduates. A warning should be given at matriculation to
every male student. Girls should be dealt with according to their characters
by mothers and school-mistresses. In most cases the ordinary moral lessons
suffice, but in some cases more explicit warning is necessary.
The continued education of the medical profession and the students entering
into it is a prime essential in all questions relating to venereal disease. All for-
ward movement in this matter depends on an instructed medical profession,
seized of all the dangers and competent to deal with them. We believe that
during the last ten years much progress has been made in this respect in the
Commonwealth, and that recommendations that would have been futile ten
years ago may now be made with good prospect of success.
Provision of Means of Diagnosis and Treatment. It is essential that full pro-
vision should be made for the accurate diagnosis of venereal disease by labora-
tory methods Such tests and laboratory assistance should be avail-
able for every case without charge. We do not object to the payment of a fee
by those who can afford it, but we believe that it would be a national economy
to make such tests free
Those sick with venereal disease should be able to obtain thoroughly compe-
tent treatment, including indoor hospital treatment for all who require it. As
far as possible this provision should be made in connection with existing general
and special hospitals, and should be as free as possible from any stigma, being
merely a branch of hospital work
Venereal diseases are town diseases. Great towns suffer more than small
towns, and small towns more than country districts. The provision that is made
should be adjusted accordingly. In the great towns special cliniques should be
provided at the hospitals for patients in the infectious stage, under special staffs
with large experience in new methods; and medical practitioners and medical
students should be encouraged to familiarize themselves with the practice of
such cliniques. In smaller towns, the work should be more closely associated
with the general administration of the local hospital, and the provision should
be less specialized. All such provision should be absolutely free to patients
with limited means.
Regulation of Prostitution. We are opposed to any form of Contagious Diseases
NOTE AND COMMENT 147
Act. Such Acts have not proved effective. The improvement in the British
Army came after the abolition of the Contagious Diseases Acts. At least half
of the spread of syphilis is due to clandestine prostitution. The danger lies
where it is not suspected. Any control of brothels should be under the ordinary
police regulations. Any system of harrying scatters the women widely, with
increase of the mischief. The Inspector-General of Police in New South Wales
states that now in Sydney instead of going to a brothel with a man, a woman
will take him to a lodging house, or what is coming to be called "residential
chambers." He holds that prostitution is just as bad as it used to be in Sydney,
but carried on under a different system.
Solicitation in the streets by men or women should be severely dealt with.
At the present time solicitation by women is openly practiced. Men, often well
dressed, and evidently not of the poor, persistently accost decent girls quietly
going about their business in the streets. Girls attending night classes arc fre-
quently molested. If this evil is not repressed, citizens will be compelled to form
vigilance committees and to act for themselves.
In addition to legislation for the compulsory reporting and treatment
of venereal disease: —
We believe that the following legislation would also be wise: —
1. To provide that if an infectious patient persists in the intention to marry,
despite the warning already alluded to, a communication made bona fide by the
medical practitioner in attendance to the person to be married or to the parent
or guardian of such person shall be privileged. The existence of such privilege
would probably make such disclosure unnecessary. We are not in favour of
requiring a clean medical certificate from both parties before every marriage.
2. To provide that if a person marries while in the infective stage of a venereal
disease without giving information before marriage to the other party, and with-
out the knowledge of the other party, such act should be ground for decree of
nullity of marriage if action is taken within twelve (12) months after marriage,
and without resumption of marital intercourse after discovery. The children
of the marriage, if any, should not be illegitimate. This legislation is recom-
mended unanimously by the British Royal Commission.
3. To provide that all still-births should be registered when three months
of pregnancy have been completed or when there is a definite afterbirth.
4. To provide for further detention of prisoners found to be suffering from
venereal disease, in an infectious stage, on the lines of the New South Wales Act.
5. To strengthen the police laws when and where necessary — especially in
order that any solicitation in the streets by men or women may be sternly put
down. We believe that such action would do more than anything else to clean
the life of the cities and great towns. In this connection the Police Offences
Act of New South Wales deserves careful study; but we have already expressed
our belief that any general policy of harrying brothels is unwise, and we have
drawn attention to the evidence of the Inspector-General of the Police Force of
New South Wales before the Parliamentary Committee in 1915.
148 SOCIAL HYGIENE
The Western Australia Act for the Control of Venereal Disease, recently
passed, provides for free diagnosis and treatment and contains com-
pulsory and penal provisions. No person other than a physician, or
person acting under the direct instructions of a physician, shall attend
on or prescribe for any person for the purpose of curing, alleviating,
or treating any venereal disease. Every person suffering from any
venereal disease shall, within three days of his becoming aware or
suspecting that he is suffering, consult a physician and place himself
under treatment by such physician. He must keep under treatment
until he receives a certificate of cure. If he changes his physician he
must declare the name and address of his last previous adviser, and the
new physician shall notify such previous adviser. Every physician
must report all cases of venereal disease in prescribed form to the com-
missioner of public health, stating age and sex of patient, but not name
and address. If a patient fails to attend his physician for six weeks
the physician must notify the commissioner, giving name and address
of patient. The physician shall give the patient written notice of the
danger of the disease, particularly warning against marriage until
cured. In case of a person under the age of 16 years being infected,
the parents or guardians are to exercise their authority to secure observ-
ance of the act. They must report to the commissioner failure of the
person to carry out the law. Penalties of from $25 to $250 are provided.
The most drastic provision of the act relates to compulsory exami-
nation and treatment. When the commissioner has received a signed
statement stating that any person is suffering from venereal disease,
and whenever the commissioner has reason to believe that such person
is suffering from such disease, he may give notice, in writing, to such
person requiring him to consult a physician or produce a certificate
that such person is or is not suffering from the disease. If the com-
missioner is not satisfied with such certificate, he may authorize any
health officer or any two physicians to examine such person and report
the result to the commissioner in writing. If the report states that the
person is suffering from the disease, and the commissioner judges there
is risk of infecting others, he may issue a warrant for arrest and
detention in a hospital for two weeks. If further detention is deemed
necessary, the governor of the hospital on the recommendation of the
commissioner, may issue a warrant for the arrest and detention of the
person for such time as he thinks fit and for treatment and examination.
The detained person may apply for an independent examination by
two physicians. The section applies to persons already in prison, and
NOTE AND COMMENT 149
the hospital detention is to count as part of their term of imprison-
ment. The warrants issued authorize the use of force to carry them
into effect, and the police "shall on sight of the warrant" render all
necessary aid, under a penalty of $100. No person shall knowingly
infect any other person with venereal disease or knowingly do or suffer
any act likely to lead to the infection of any other person with such a
disease, under a penalty of $250 or six months' hard labor. The com-
missioner is to provide, free of charge, all laboratory investigation
necessary to accurate scientific diagnosis to all physicians. Powers
are given to subsidize hospitals for the treatment of the infected, and
at such hospitals the treatment shall be free. Every physician in
receipt of any salary from the state shall examine and treat free of
charge any infected person who applies to him, and the commissioner
shall reimburse him under a penalty of $25. All proceedings under
these sections of the act in any court shall be in camera, and it shall
be unlawful to publish in any newspaper a report of any such proceed-
ings. The penalty for the first offense is $500 or six months' imprison-
ment, and for the second offense $2500 or twelve months' imprison-
ment.
Advertisements of medicines or appliances for venereal diseases,
impotence, or female irregularities are prohibited. No circulars,
books or printed notices may be circulated by hand, exhibition, news-
paper, or by the post. Finally, the government has issued a booklet
on venereal diseases, so that ignorance cannot be pleaded as an excuse.
The manner in which they are contracted, the symptoms, and the
precautions to be taken by infected persons are described. — Journal of
the American Medical Association, September 2, 1916.
A Wassermann Survey on 500 Apprentice Seamen. This study by
C. B. Munger, Passed Assistant Surgeon, U.S.N., and published in the
Naval Medical Bulletin for October, 1916, was prompted by the study
of the Prevalence and Prevention of Syphilis by Captain Edward B.
Vedder, Medical Corps, U.S. A.1 and is based on 500 Wassermann blood
tests on accepted recruits stationed at the Naval Training School, San
Francisco, Cal. At this station men accepted by the recruiting officers
in the western part of the United States are reexamined and those
found not to be physically qualified are discharged. No known syphi-
litics are retained. The examinations in question were made on ac-
cepted recruits with less than one week's service.
1 SOCIAL HYGIENE, Vol. II, No. 3, July, 1916.
150
SOCIAL HYGIENE
Surgeon Hunger compares his results with those of a similar study
made at Fort Slocum upon Army recruits, as follows: — •
TOTAL
+
+
•4
+
-
INED
Num-
ber
Per
cent
Num-
ber
Per
cent
Num-
ber
Per
cent
Num-
ber
Per
cent
Naval Training
Station
500
5
1
3
0.6
0
0
492
98.4
Fort Slocum
500
35
7
48
9 6
54
10.8
363
72 6
The difference in the results of these two stations, that is, 15 per
1000 for the Navy recruits and 16 per 100 for the Army, is regarded
as "almost unbelievable, but is probably accounted for by the age of
the recruit," which is, for the Navy study, 19 years.
Three hundred and sixty-five or 73 per cent., were under 21. Among those
giving the double-plus reaction all were over 21. Two were 21, one was 22, one
was 23, and one was 29 years of age. Among the 365 men under 21 only two gave
a positive reaction, while from the 135 over 21 six gave at least a plus-one reaction.
Vedder states that ''609.67 per thousand of all the recruits accepted during
the fiscal year 1913 were 24 years of age or under and the ages 21 and 22 furnished
the largest number." From a study of the tables I should say fully 75 per cent,
of Army recruits are over 21 years of age, while nearly 75 per cent, of .Navy re-
cruits are under that age.
Of course it is expected that there will be more cases of syphilis among men
of 22 years of age than those of 17, but one hardly looks for the four years between
the two ages to account for the great majority of syphilis.
Another factor which may influence the result is leaving home for the first
time. A great number of our recruits are brought to the recruiting office by
parents or guardian, handed over to the recruiting officer, and transferred to the
training station. These boys are under age and have had few opportunities for
staying out nights and drinking intoxicating liquors. Men between the ages
of 21 and 23 have probably been away from home for a year or two and have
already passed through the wonderful experiences to which apprentice seamen
take so kindly.
It appears from a study of the official reports of admissions for syphilis for
several years past that the relative number of admissions in the Navy during
the five years is about the same as that of the Army. From a survey made at the
Army laboratory, it is estimated that 16 is the percentage of probable syphilitics
in the Army in the United States. Now if the percentage of admissions is the
same, we may assume that the number of syphilitics is the same. Therefore,
while the percentage upon admission to the Navy is only 1.6 it soon reaches 16.
If these figures are all true, the majority of cases in the Navy are primary
while those in the Army are probably readmissions of the disease contracted
prior to enlistment.
NOTE AND COMMENT 151
It must be remembered that the recruits examined by each laboratory were
to all purposes civilians — that is, they had been in the service only one week,
or less than the incubation period for syphilis. Also that among those of the
average age for entering the Navy we find 16 per 1000 are probably syphilitics,
while among those of the average age for entering the Army we find ten times
that number, or 16 per 100.
Boys entering the Navy soon contract enough syphilis to bring the percentage
up to 16 and boys in civilian life do the same thing. In other words one out of
six boys will contract syphilis before he is 23 whether he is in the service or out.
A few conclusions drawn from this report are as follows: —
The majority of accepted recruits, especially those under 21 years of age,
are free from syphilis.
About 15 per cent, contract syphilis soon after entering the service.
The percentage of syphilis is about the same, at least not less, among civilians
as it is among military men.
The majority of men who contract syphilis become infected some time between
the seventeenth and twenty-third years of life and service conditions have little
if any influence.
The Navy is much more responsible for the health of the personnel than the
Army for two reasons: First, because the men are much younger when enlisted;
and, second, because the majority have no syphilis prior to entry into the service.
The prevention of syphilis in the Navy is directly dependent upon some form
of prophylaxis and not upon the selection of the recruits, as seems possible for
the Army.
Prophylaxis. We now can see the difficulties to be encountered if we would
decrease the amount of syphilis in the Navy.
Apparently different forms of prophylaxis have given good results, but if we
stop to think, it has been most efficient among older men who have perhaps
experienced some form of venereal disease and have had the necessary mental
impression to make them careful. A boy of 17 or 18 takes a sex lecture as a joke
and by the time he has learned his lesson it is too late.
Prophylaxis to be efficient must be applied before the boy leaves home and
must be in effect during the dangerous stage from the seventeenth to the twenty-
third years of his life or until he has reached the age of discretion. Instructions
and lectures may teach him to be more careful and may lessen the number of
exposures, but his judgment is poor.
In 1914 we had 53,016 sick days charged to syphilis, with a daily average of
145, almost enough to run the entire Navy for one day and quite enough to keep
the gunboat Annapolis in commission for the entire year. It would appear then
that prophylaxis should not be neglected and that the responsibility can not
.be shirked by calling it misconduct. Bluejackets are not different from other
men and as there is bound to be a certain number of exposures, it would seem
to be our duty to those of the next generation to at least give them a healthy
body to start with, no matter how radical a measure may be necessary.
The British National Council for Combating Venereal Diseases
in its first annual report, June, 1916, defines its aims and objects
as follows: —
152 SOCIAL HYGIENE
1. To provide accurate and enlightened information as to the prevalence of
these diseases, and as to the necessity for early treatment.
2. To promote the provision of greater facilities for their treatment.
3. To increase the opportunities of medical students and practitioners for
the study of these diseases.
4. To encourage and assist the dissemination of a sound knowledge of the
physiological laws of life in order to raise the standard both of health and con-
duct.
5. To cooperate with existing associations, to seek their approval and sup-
port, and to give advice when desired.
6. To arrange, in connection with such organizations, for courses of lectures,
and to supervise the preparation of suitable literature.
7. To promote such legislative, social and administrative reforms as are
relevant to the foregoing aims and objects.
Lord Sydenham, in his address as President of the Council, re-
viewed the work of the Royal Commission on Venereal Diseases,
of which he was Chairman, and said: —
The forces that can be brought to bear against these diseases are many, and
all are needed. The promotion of purity of life by religious and moral teaching,
and by inculcating the sense of duty and of chivalry, can give powerful aid to
the cause. Temperance, healthy exercise, and wholesome literature are invalu-
able allies. Social and economic conditions, and decent housing, perhaps,
especially, are all factors of great importance which must never be forgotten:
but complete victory can be attained only by stamping out existing disease and
preventing, so far as possible, its transmission. The State can play its part in
various ways, and to provide early, free, and easily accessible treatment is now
the plain duty of the Government.
The Council is providing lecture courses for women social workers
and teachers which include not only various phases of the venereal
disease problem, but also such subjects as the eugenic ideal, biology
and parenthood, parenthood and the coming generation.
Syphilis and Annulment of Marriage. The New Jersey Court of
Chancery held, on April 1, 1916, in the case of K. vs. K., 97 Atlantic
Reporter, 490, that the mere fact that one party to a marriage had
contracted syphilis at the time of the marriage is not ground in itself
for annulment. There must be convincing evidence not only that the
defendant had syphilis at the time but also that he knew he was suf-
fering from the disease and that he fraudulently concealed that fact.
While the case involved no new legal proposition it is significant because
the Court held that although the defendant was informed by the
physician that he had syphilis, his denial, coupled with an apparent
NOTE AND COMMENT 153
doubt on the physician's part of his diagnosis, was sufficient to over-
come the charge of fraudulent concealment. The opinion reads in
part as follows : —
Foster, V. C. This bill is filed to have the marriage between complainant
and defendant annulled upon the ground that at the time of the marriage defend-
ant fradulently suppressed the fact that he was then afflicted by the disease
called syphilis. A few days before the wedding defendant consulted a physician.
From his examination the physician found a sore which he says might have been
a usual sore or syphilitic, and he suspected it to be a syphilitic sore. He told
defendant of his suspicion and he denied that he had been exposed to syphilis.
From the evidence of the two physicians who testified for complainant it appears
this disease can be contracted in many ways by a person innocent of wrongdoing,
and that it was possible at the time Dr. Feldman examined defendant for him
to have had syphilis and be honest in his belief and denial that he did not have
it.
It further appears from the progress of the disease in defendant's case that
he was undoubtedly syphilitic when he consulted Dr. Feldman, and it also ap-
pears that some years after this consultation a blood test was made and defend-
ant was pronounced by a specialist as positively afflicted with the disease,
although he strongly denied it.
The parties lived together until September, 1914, when complainant, con-
vinced, notwithstanding defendant's repeated denials, that he was suffering
from this disease, left him.
The jurisdiction of this court to annul a marriage for fraud was determined
by the Court of Errors and Appeals in Carris vs. Carris, 24 N. J. Eq., 516, and on
this authority Chancellor Magie, in Crane vs. Crane, 62 N. J. Eq., 21, 49 Atl.,
734, granted a decree of annulment because of the husband's concealment of
his syphilitic condition at the time of his marriage and of his knowingly false
denial of his condition prior to the marriage when asked about it.
As stated, the evidence is convincing that defendant was affected with syphilis
at and before the time of the marriage, but it was held by the learned chancellor,
at page 27 of 62 N. J. Eq., at page 736 of 49 Atl., in the Crane case, that: —
The mere existence of that foul disease (syf hili ) in one of the parties to a marriage contract,
although it tended to rpnder, and upon discovery would render, Impracti'able the purpose of
marriage, wo. Id not, in my judgment, justify a decree ai. nulling the marriage.
And he added: —
It must therefore, in my Judgment, appear by appropriate and sufficient proof that the defendant
either represented to complainant that he WPS free from syphilis or that he concealed the fact that
he had syi hills when he was in duty bound to ilia 1 so it.
Complainant's case rests upon the assumption, as it afterwards developed
by the progress of the disease, that defendant was syphilitic, and that the
disease in 1914 had reached a stage that clearly indicated that it had been con-
tracted prior to the marriage, defendant must have known, when he consulted
Dr. Feldman, the nature and cause of the sore upon his lip, and that having such
knowledge he fraudulently concealed the fact from the complainant when it was
his duty to disclose it.
154 SOCIAL HYGIENE
The evidence does not support this assumption. On the contrary, defend-
ant denied to the physician that he had the disease, or that he had been exposed
to it. The physician from his examination was suspicious that the sore was
syphilitic, but was not certain about it and did not feel he had sufficient facts
on which to base an opinion or to justify him in communicating his suspicion to
complainant or her family. It is established that the disease can be contracted
innocently of wrongdoing, and one not a physician might be affected with syphilis
in its earlier stages, at least, and not know it. Because of the possibility that
defendant may have contracted the disease innocently, and the further possi-
bility that he could have the disease in its initial stage and not know it, I am
unable to find anything to warrant me in determining that the only and the
correct assumption arising from the evidence is that at the time of the marriage
and prior thereto defendant knew, or must have known, that he had syphilis,
and that having such knowledge he concealed the fact from complainant.
With the United States Troops on the Mexican Border. When our
National Guard organizations were mobilized on the Mexican Border,
the American Social Hygiene Association and other welfare agencies
recognized the social and moral problems likely to arise and took
immediate steps, with the cooperation of the military authorities, to
combat sexual immorality and prevent the spread of venereal disease.
It appears from the reports of observers that these efforts were well
worth while, though in some towns in or near which camps were situ-
ated the record as regards prostitution has been undeniably bad.
Most of the actual work in and about the army camps was done under
the direction of the International Committee of the Y. M. C. A. which
provided lectures on the venereal diseases in their relation to the
individual and the community, presented the photo play "Damaged
Goods," distributed nearly 100,000 copies, supplied by the American
Social Hygiene Association, of Dr. Exner's pamphlet Friend or Enemy,
written especially for the purpose, and Dr. Belfield's Sexual Hygiene
for Young Men, and did effective preventive work by supplying means
for decent recreation for the soldiers' hours of leisure. The military
authorities gave to this work their hearty cooperation and also provided
social hygiene talks by members of the medical staff.
It is reported that the men of the several military organizations
received such talks both by military surgeons and civilians with marked
interest and that to these efforts is to be traced much of the satisfac-
tory medical record. The use of medical prophylactics was insisted
upon by the military authorities, and has been the subject of com-
ment both favorable and unfavorable. How far it has been a factor in
reducing venereal disease can not now be determined.
NOTE AND COMMENT . 155
Two incidents are of especial significance as illustrating the trend
of feeling among progressive military officers. In answer to the charge
that he had refused to station troops in Austin, Texas, unless a segre-
gated district were established there, General Frederick Funston
wrote as follows: —
I am very glad indeed .... to deny absolutely and unequivocally certain
views that are said to have been held by me on that subject. I understand that
it has been claimed that I viewed with tolerance the existence of these places
because I thought them necessary for the contentment and well-being of the
soldiers. I assure you that my opinion is exactly the opposite and that here-
after, so far as I can have any influence over the stationing of troops along the
border, I am going to give the preference to those cities and towns where the
best moral conditions prevail. I have never in all my life held or expressed any
views that conflict with these.
Major General L. Ryan, in command of the New York State troops*
issued orders forbidding all use of intoxicating liquor and all patroniz-
ing of immoral resorts. Commenting on these orders and their results
The Rio Grande Rattler, printed weekly by the New York division, says : —
This is a real record. It is what the General refers to when he says we have
been making history in greater measure than any of us appreciate at this time.
We have demonstrated that United States soldiers can live three months in camp
without losing more men than they would lose in three months of fighting.
Group Study Courses. The University of Texas, Department of
Extension, Group Study Courses provide material, including detailed
program of work, selected reference libraries, and lectures by the direc-
tor of the course for groups of persons who wish to undertake a year's
work along definite lines. The primary object of these courses is to
encourage clubs or other groups to center upon some definite course
instead of scattering their energies over several more or less discon-
nected topics during the year. Two courses under the direction of
Dr. Wolfe, of the Department of Economics and Sociology, are of
special interest for their social hygiene features: "Social Problems.
A survey of some of the deep-seated social problems of our time" and
"The Sociology of the Woman's Movement" including the biology and
psychology of sex; the traditional ideas, and the present state of
opinion on this subject; the family and marriage ideas; women and
ethics — the influence of sex upon the development of morals; the
double standard; the social etiquette of sex.
156 SOCIAL HYGIENE
A Correction. In the article on " Prostitution and Mental Deficiency"
by Walter Clarke which appeared in the June, 1915, number of SOCIAL
HYGIENE, the author says: —
An investigation, which was made under the auspices of the Virginia State
Board of Charities and Correction, presents a very high percentage of aments
among the prostitute residents of the Richmond red-light district. Of one
hundred and twenty persons tested, the examiner found forty-two or 35 per cent,
to be imbeciles, and fifty-eight or 48.3 per cent, to be morons. That is, one
hundred or 83.3 per cent, were mentally defective and only twenty or 16.7 per
cent, were declared normal.
The report from which these figures were taken was provided by the
Virginia State Board of Charities and Correction, but the investiga-
tion referred to was not made under the auspices of the Board, but was
taken over by the Board and utilized later in preparing an article for
a special bulletin entitled Mental Defectives in Virginia. The percent-
ages given in the revised edition used by the State Board are: Feeble-
minded, 71.6 per cent; normal, 28.4 per cent.
Social Hygiene
VOL. Ill APRIL, 1917 NO. 2
IN DEFENSE OF RADICALISM*
DONALD R. HOOKER, M.D.
Associate Professor of Physiology, Johns Hopkins University
When I assert that social hygiene was radical at its inception
and is destined to continue radical so long as it serves a useful
purpose, some of you may experience a sense of distrust because
radicalism is in disrepute. But I purpose to show that radical-
ism as such serves certain fundamental purposes in the evolu-
tion of society, and that it is linked closely with the questions
which we are to discuss this afternoon. There are many, it is
true, who deplore radicalism in the movement today. These,
it would seem, think that a decade has raised us to the crest of
the great divide and that we have but to roll quietly into the
promised valley. But our efforts concern a profound change in
the most intimate and personal aspect of individual conduct as
this relates one individual to another; we are at grips with a
problem which reaches down into and ramifies so completely
through human life that no man can yet tell surely how far its
roots may have grown. We are dealing with age-old prejudices
which have become fixed opinions. Even to shake such opinions
will require a courageous and continuous radicalism.
Radicalism of thought is sorely needed on questions pertain-
ing to the relationship of the sexes today. Are the current
Chairman's address at a public meeting on ways and means of public edu-
cation regarding social hygiene, Annual Conference of the American Social
Hygiene Association, St. Louis, November 21, 1916.
157
158 SOCIAL HYGIENE
opinions defensible under modern conditions? Education and
economic pressure are rapidly changing the status of women, and
this must be retroactive on marriage. We must redetermine
the function of marriage. Is it to safeguard children or to
protect individual morals? Or is it merely better to marry than
to burn? We must argue out a rational basis for our judgments
on the point of birth control. Why should birth control be en-
couraged, tolerated or repressed? These and other similar
issues rise from foundations common to social hygiene.
At any point in social evolution individuals pattern their
conduct according to various accepted codes; their reactions are
essentially involuntary. Now the abrupt assertion that an
accepted code of behavior is wrong, whether it be true or false,
stimulates thought and leads to a revision of ethical standards.
When people think, they talk, and discussion crystallizes ideas.
As individual ideas become defined the way is opened for a new
consensus of opinion, for a new code of behavior.
Discussion has gone forward on certain questions in this
field, and the outcome is encouraging. The toleration of segre-
gated vice is giving way to the conviction that the method is
without merit; the foreshadowed evils of scattered prostitu-
tion have not appeared where the police have acted in accord-
ance with the new conscience. Vicious practices on the part
of men, which used to be regarded as emanating from a sexual
necessity, are now no longer generally condoned because dis-
cussion has extended the belief that such conduct is but the
expression of a desire, the repression of which is without evil
consequences to health. The infectious venereal diseases, long
regarded as beyond the scope of public health authorities, are
now on the list of diseases which must be reported in many
places, and in some places treatment is compulsory.
In addition to stimulating thought, radicalism has the fur-
ther function of forcing people to definite opinions. It de-
velops new ideas and leads to public discussion. This in turn
drives people to take a stand. Even when the stand so taken
is antagonistic to the proposal, it is indicative of advance, be-
cause indifference is never associated with change. We can not
IN DEFENSE OF RADICALISM 159
have motion forward without friction, and friction comes, in
this case, from the mass of human particles, one part insisting
upon movement, while another part resists such movement.
Opposition to radicalism is thus an encouraging sign. It is
like the purring of the kettle, and indicates that we may shortly
have tea.
But, alas, no good comes unalloyed. Radicalism is so sharp
a stimulus that it sometimes provokes ill-considered action.
The maternal instinct for the relief of a sick child may well be
wrong in the application of a remedy. Nevertheless the will to
act in the emergency is an essential feature for the welfare of
the child. Similarly radicalism stimulates the will to act, and
in the social hygiene movement this is an essential prerequisite.
As an example of the error into which those who would stem the
ravages of venereal disease have fallen, continental regulation
may be cited. In this case the woman, offending because she
had contracted disease, was locked up. It was thought thereby
to isolate the focus. As with a lens there are two foci, so in the
spread of venereal disease there are always two foci. The re-
moval of one female focus only accomplishes the creation of
another through a new medium, for the spread of disease. The
consequences of this error accentuate the difficulties of the
problem by encouraging the play of masculine appetite.
Heretofore, social hygiene in this country has concerned itself
with an effort to make clear to the public the nature and conse-
quences of the venereal diseases, and in doing so has dissemi-
nated knowledge concerning diseases and social conditions which
previously had been confined strictly to medical and criminologi-
cal circles. The result of this policy ten years ago was a violent
social reaction. A considerable proportion of the medical pro-
fession was antagonistic. A complicated situation was involved.
The ethics of the profession, largely based upon the relationship
of the physician to his patient, appeared less ethical when the
consequences to the community were considered. Furthermore,
although the essential facts could not be denied, the deductions
therefrom and the attempts at numerical definition of the prev-
alence of venereal disease, were promptly questioned. This
160 SOCIAL HYGIENE
latter objection was largely technical. Nevertheless, in con-
junction with an established habit of mind, it was sufficient to
determine the attitude of many conscientious practitioners.
An additional factor influenced physicians and the general
public alike. To bring out for public discussion a subject so
intimate and personal, shocked human sensibilities. Porno-
graphic reference to the numerous phases of the question, under
restricted conditions, was tolerable, and sometimes entertain-
ing. But a cold and open discussion, it was stated, especially
before mixed audiences, would destroy that modesty which was
synonymous with virtue. Many conscientious parents, domi-
nated by tradition, believed that it would stimulate dormant
emotions in young people, which, if aroused, might lead to utter
ruin. In addition, they feared that the information, even if
correct, would deter young women from marriage, or arouse a
questioning attitude incompatible with matrimony. Indeed the
method was an irritant upon the social body so powerful that
many thought the normal functions of society would be forever
upset.
But, in spite of this somewhat painful reaction, a goodly
number of people, including physicians, foresaw the problem
with sufficient clarity to support whole-heartedly the germi-
nating movement. It may very properly be inferred that the
audience this afternoon represents this group. It is to the
credit of this radical element in society that much has already
been accomplished, and as regards certain aspects of the prob-
lem on which public opinion has not yet finally spoken, there is
evidence of a state of flux.
From the standpoint of radicalism, however, social hygiene
is now dormant because the public has become accustomed to
public discussion of the subject, and individuals composing the
public have either taken or rejected the facts presented. It
may be that a period of dormancy must intervene between
periods of activity. But this is not the concern of those who
would further the social hygiene movement. It is the task of
social hygiene to press forward the inquiry into social conditions,
and to keep the public mind aroused and vigilant as to the ways
IN DEFENSE OF RADICALISM 161
and means which may be proposed as restoratives of social
health.
The program of the afternoon has been designed to such an
end, and the discussion will lend itself to the creation of a con-
structive plan of work such that the radical stimulus to action,
so essential to progress, will be curbed, and prevent us from
falling into the errors which bestrew our forward path. In this
connection, it will not be amiss to stress a recent case in which
the radical spirit has been productive of very serious conse-
quences. You will at once appreciate that I refer to individual
prophylaxis.
The eagerness to meet the purely medical aspects of venereal
infection in the arms of our public service without due regard
for the broader issues involved, has resulted in the introduction
of medical prophylaxis for men. The purpose of this procedure
is, as you know, to protect men who expose themselves to infec-
tion. I need not detail the method. It is sufficient to state
that while effective, it is not always effective. You will note
in the first place that the principle defending this attack upon
venereal disease is essentially the same as that defending the
hygienic regulation of prostitution. It is an effort to treat the
individual without regard to the effect on society. In effect,
the proponents of both methods say that, while we can not guar-
antee protection, we may hope to reduce the sum total of dis-
ease by safeguarding individual exposure. The statistics of our
army appear to support such an assertion although the Surgeon-
General's Report is careful to point out that other factors may
probably have contributed to the improved conditions.
The significant fact is that venereal infection remains one of
the major causes of incapacity in army life. Between the
chance of injury in the application of this prophylactic measure,
thus facilitating the lodgment of the causal agents of disease,
and the chance of carelessness or neglect of its use, there is
abundant opportunity for failure. But granting success in
many individual cases of exposure, we should wish to know the
educational effect of the method. Statistics can not, or do not,
throw light on this point. There is no doubt in my mind, how-
162 SOCIAL HYGIENE
ever, that it results in a vastly increased amount of sexual
promiscuity. As, in the case of reglementation, the false sense
of security from disease contributed to the encouragement of the
gratification of sexual appetites, so, under individual prophy-
laxis, we may believe that the average young man, alive to practi-
cal and selfish rather than to ethical considerations, will find a
justification of habits which he would otherwise regard as
dangerous to himself.
The application of individual prophylaxis to civil life has
even more serious consequences. Whatever coercive deter-
rents may be in force under a military discipline can, with diffi-
culty, find place in our modern community life, and the medical
vultures who soar over the heads of untutored youth will find a
heaven of industry and profit. But the worst and most hide-
ous consequence of all is taking the abuse of women for granted.
The neglect of this last feature is associated with the discarded
view that the prostitute supply is unrelated to demand and is not
affected by every influence which activates the tendencies of
men, and goes to prove that the relics of past opinions may be
dangerous companions when we consider modern problems.
If the radical spirit sometimes leads us far astray and must be
guarded as a sharp blade of effectiveness, it must nevertheless
permeate the life blood of the social hygiene worker. He is a
leader guiding into new fields of endeavor. We can not move
forward by the process of reasoning alone. The experimental
method must play its part and the leader instituting new tests
of effectiveness requires a radical spirit, a willingness to deviate
from the mode of procedure adopted by others. Under such
conditions some mistakes are inevitable. In spite of this danger,
a sympathetic attitude in those about him is essential. Friction
may be withstood if it be not present in every council. We must
not let conservatism and discouragement repress our leaders, for
even in their mistakes they are at least doing something — which
is more than can be said of some of their critics.
On the other hand, since the public assumes the attitude of
criticism and condemns the radical, it is itself impervious to
criticism, and its progress can not be retarded by criticism. It
IN DEFENSE OF RADICALISM 163
therefore follows that the effect of radicalism on the public
mind must be wholly good, since it acts as a stimulus to thought,
discussion and action. The single exception to this is when
radicalism leads to ill-considered action. It is your concern
and mine to see to it that such ill-considered action does not
take place. The public is a sound sleeper and the alarm must
ring loud before it will contemplate the day which is dawning.
Publicity methods are radical methods, and although they may
seem distorted, they are without doubt cleverly adapted to the
psychology of the sleeper.
The happy contemplation of work well done may well give in-
spiration, but it would be fatal if it relaxed the tension essential
for further strife. The dragon slain by St. George had but one
cave of refuge ; our dragon is established over the fair face of the
land and his trenches intercommunicate by devious paths.
Some of these have been leveled, and we have trembled at his
havoc, but what we have seen is as nothing to what is yet hid in
the subterranean passages of his viciousness. Every step of our
advance will reveal new horrors to eyes wearied with the com-
bat. To push forward with these thoughts in mind demands a
courageous radicalism which the individual too easily loses in
such a contest. It may well be that we shall shift the load to
younger shoulders for, as Norman Angell has aptly said, "The
very young people are the only old people, after all, for their
idealism is fresh from the century-old casks. Their wisdom is
the wisdom of the masters, unaltered by the pettier curbs of
their own experience."
Be this, however, as it may, the papers which are to follow
will light for us a new hope. Under the general title of "Ways
and Means of Public Education Regarding Social Hygiene,"
the speakers will not only interject a new radicalism into our
deliberations, they will likewise clarify the issues abounding in
this difficult but fundamental phase of social hygiene. We shall
receive from them that radicalism which is the quick stimulant
of thought and of discussion and which activates conservatism
from a retarding into a directive force.
THE CALL TO FACE FACTS1
Knowledge with regard to the evils and the sores of our social
conditions is of the utmost value and use when it can lead to
action or can by producing sane and wise thinking influence
conduct and public opinion. But it would be foolish to deny
that there are dangers in the- indiscriminate distribution of
knowledge. For knowledge is dangerous when it leads to panic
and hence to rash and ill-considered action to avert the evils
disclosed; it is dangerous when it leads to morbid absorption in
horrors, to rash judgments, to a loss of the sense of proportion,
to want of charity.
We have awakened to the recognition of a great evil. Women
are beginning to understand what the double standard of morals
means. Men are being forced to face the fact that it leads not
only to the ruin and degradation of vast numbers of girls and
women, but to widespread and terrible disease. Ignorance,
blindness, and weak acceptance of sin as a necessity have long
prevented us from facing this evil, but it can be ignored no longer.
It affects society as a whole, it affects the position of women, it
affects the relationship between men and women, it affects the
very future of the race itself.
The facts must be faced, but they must be faced in a wise and
sober spirit which will enable us to understand their true bear-
ing. On the spirit in which we face an evil that we are deter-
mined to fight must largely depend the possibility of real suc-
cess in the fight. In this matter, just because it concerns both
men and women so intimately, men and women must fight to-
gether. It is not a question of one against the other; both
must fight for the common good against a state of things which,
because it is disastrous for society as a whole, is equally disas-
trous for men and women, and the responsibility for getting rid
of it must rest upon both.
1 The Social Disease and How to Fight It. By Louise Creighton. Longmans,
Green & Co., London and New York.
164
THE NEW MORAL VIEWPOINT OF THE FRENCH
YOUNG MAN1
JULES BO1S
It is to Carpenter, I believe, that we owe the aphorism " Asceti-
cism is not an end in itself; it is a spiritual exercise." In any
event it is not given to all to be ascetic. Indeed those who con-
form strictly adopt asceticism only at a mature age. Chastity,
on the other hand, may be practised at any age.
Chastity is a peculiar state of mind, a spiritual and corporal
hygiene, a pure, clean, elevated outlook upon men and things.
The licentious see the universe through a thick fog. They are
confused; they are baffled; they flounder in the mud of their own
creation. The clean-minded man sees clearly, and acts promptly.
He is both agile and strong. He is not encumbered by the
heavy weight of desire. He has concentrated the impulses of
his heart upon a single end which leaves him fresh and gay.
Thus chastity has its place in every life. It is the glory as
well of the lover as of the virgin. In both man and woman it
is the foundation of the beautiful duty called love. It clings
both to husband arid to wife. It is the most beautiful ideal
that can hover over the lonely traveler through life as he works
out his solitary destiny. In the book of Judith we read that her
chastity was her strength.
The sun has never yet shone upon the debauchee or libertine
who was of any use in the world. Chastity — the chastity of
the layman, imperfect though it is — is the daily refreshment of
our inner strength; licentiousness, its dissipation. Chastity
clears from the eye that veiled appeal whose animal magnetism
thrills the passerby. Chastity ennobles our destiny; it affords
our impatient souls that peace of plentitude to which they so
1 Translated from an address delivered in the Library of the American Social
Hygiene Association, New York, November 9, 1916.
165
166 SOCIAL HYGIENE
ardently aspire. The chaste soul is self-contained and prudent,
never hypocrite or prude. He knows how to question the mys-
teries of the origin of life; how to strengthen the bonds of love.
When mankind realizes that the human beings about us should
be the source of our inspiration, not the melting pot of our en-
thusiasm, it will be chaste in love, chaste with love, for more
love — less from duty and from obedience than by knowledge and
enduring joy.
How melancholy the thought that the native and consecrated
immorality of man, and the prescribed chastity of woman, have
engendered the harlot! Year by year procurers repopulate the
havens of masculine egotism. Who more vigilant than a brother
to protect the honor of his sister? Yet how little does she sus-
pect that the security of her reputation depends upon those other
poor girls, sacrificed for her safety to the needs of those whom
her virtue repels? Alas! that the slavery of the harlot should be
the guarantee of purity.
However numerous and specious the arguments to prove that
the harlot-slave is a necessary evil, they fill me with shame and
disgust. In what strange fashion do we, a people of the highest
civilization, calling ourselves Christians, honor woman! In what
strange fashion do we forget our own dignity as men! We, the
stronger sex, have laid down the principle that our sex instinct
can not be interfered with. We systematically profane the tri-
umphant function of love. Even in our youth we stifle the awak-
ening and discourage the practice of idealism. The energy which
should be consecrated to the great work of the race and the en-
noblement of love, we waste in vile dissipation.
To what intellectual ecstasy may not the young man about to
conclude his training aspire ! Nourished with the beauty of the
past, his imagination filled with the lives and examples of heroes,
he is indeed ready for whole-souled devotion. Every noble
cause attracts him; he feels in his own heart the heart throb of
the universe. Yet at this very moment he is dragged down by
custom, diverted from his ideals by his surroundings, forced, as
it were, into degradation by his friends, and the habit of the
times.
NEW MORAL VIEWPOINT OF THE FRENCH YOUNG MAN 167
Instead of dreaming only of his mate, of her who shall be the
companion of his joys and the comfort of his struggles and his
woes, he goes down to the tavern, he dallies with the most con-
temptible consolation — desolation should be the word. These
wretched women — yet we must pity them, for their abasement
is due only to their complicity, or rather their enslavement ifi
masculine sensuality — these debauched ones in whom so little of
anything truly feminine remains, become the educators of his
heart.
At last his degradation is complete. As he takes on manhood
the youth accepts as the type of the opposite sex a woman who
responds only to those instincts in him which are the least
delicate and the least sure. Such indeed is the foundation for
the belief in the inferiority of woman.
And when she appears, she who merits the sum of his respect
and his affection, this young man, satiated with dissipation, medi-
tative, or distrait, is able to grant her no warmer sentiment than
a love mingled with jealousy or indifference, an affection without
fragrance. Neither he nor she will reach the intimate exaltation
of true and normal joy. The recollection of the harlot will ever
stalk between the lovers.
This is the age at which, after the springtime crises, the most
generous sentiments burgeon within him. His physical strength
and the undefiled recesses of his soul blossom in noble emotion,
which impel him to self-sacrifice, to the love of humanity, to
enthusiasm for elevated causes, to the practice of devotion, or to
the cult of the beautiful. All this, as it were, explodes in him
with all the more energy because his physical paroxysms are rare.
But these sentiments are rendered powerless by his surroundings,
by his education, and by the vague, vulgar, and degrading ideal
of libertinage granted or even ordained him. His most precious
aspirations melt away in an enervating evening where time is
killed and health destroyed in encounters " amorous" only by a
profanation of this word. Little by little the young man grows
pitifully serene; the flame of triumph is already tempered in
those tired eyes which reflect the vulgarity and the promiscuity
in which his days and nights have slipped away.
168 SOCIAL HYGIENE
And I must not fail to insist upon the reaction produced by
the vulgar harlot. For him she is not only a physical danger,
but above all, a moral blot. These cynical creatures who in the
words of the poet, " gather up the sins of the world" multiply
his physical and psychic woes. They teach him to mistrust
woman and to forget his mother. That sex, which is the more
fragile as well as the more tender, the more readily betrayed as
well as the more idealistic, the repository of the joy as well as of
the mystery of life, will seem to him henceforth a pitfall of venal-
ity, of corruption, and of lassitude.
Thus does the mind of the average middle-class young man
become obsessed with the illusion of his own superiority and of
the inferiority of woman. Alcohol hastens the disaster. Once
the exalted places of thought and emotion are laid waste, life
becomes a dead level. His horizon is limited by the setting sun;
utility and pleasure are the criteria of his ideals; mediocrity is
his fate. • His pride is lost, and with it all intense aspiration.
True science has never preached nor even tolerated debauchery.
The physiologist Mantegazza discoursed plainly upon the joys
of chastity. That young people of both sexes must conquer
their passions is asserted by a great number of medical men and
hygienists, who see in this the foundation of character and the
maintenance of health.
Yet, up to the present tune, there has existed in popular mor-
als and customs quite an opposite influence, the disastrous con-
sequences of which we have already described.
What then is the source of this prejudice that chastity, even
moderate chastity, is a detriment to a man?
It is due to a preconception founded on a long habit and tra-
dition of unrepressed sensuality. "Young people," says M.
Foul, " acquire the notion that continence is an abnormality, if
not an impossibility." In many a circle a young man would in-
deed not be considered a man if he had moral habits. Implant
such a notion in an untrained mind and, quite apart from the
fact that it may be difficult to root out, it is sometimes even dan-
gerous to combat; for if chastity result, since it is not obtained
by voluntary discipline and self-rule, nor by an inward and firm
NEW MORAL VIEWPOINT OF THE FRENCH YOUNG MAN 169
conviction, it is little more than an unstable physiological state,
shaken by a thousand dreams, and often more impure than avowed
impurity.
True chastity, such as we have already denned, is quite an-
other thing. It exists in the soul and in the heart before it ex-
presses itself in action or, rather, in order to control action the
better.
We may well brave the ridicule so ineptly attached to this sub-
ject, fortified with the realization that the best and noblest of
men, those who have rendered the greatest services to society,
either were chaste or at least knew how to control themselves.
True chastity must not be confounded with insensibility or
indifference. It has nothing to do with that tepidity which
knows not love. Our passions are noble forces; our desires are
outbursts which may be harnessed to the most noble tasks. But
the "temperamentally chaste" man, not only fails to acquire any
merit himself, but also has small influence upon his associates.
The secret of personal magnetism is often a victory over impetu-
ous passion.
To return to the average man, let us not mitigate our feelings
by any false modesty, since they are in strict accord with truth.
The man who does not seduce women; the man who passes by
his "opportunities" (evil opportunities indeed); the man who
sincerely respects each woman whom he encounters in life; the
man who awaits the leadership of love before attempting con-
quest, who, as a lover, is true to his beloved, who, having won
her love, -remains forever faithful; such a one is indeed worthy
to be called a man, while the capricious ephemerid, the flitting
sparrow, and the poisonous mosquito are pitiful varieties of use-
less or noxious creatures.
How then shall we combat this misguided tradition among
young men?
First of all by the suppression of the false, vile ideal which has
become almost consecrated by its general acceptance. Let li-
cense no longer be countenanced; let love illumine the horizon
of life; let our guide be respect for ourselves and a constant de-
votion to woman.
170 SOCIAL HYGIENE
This reform must begin at the earliest possible moment, even
in infancy, with an intimate, but guarded co-education of little
boys and girls, such as permits and encourages the good fellow-
ship derived from profound and life-long intimacy.
Early marriages must be encouraged. Here we must be in-
trepid and face life with confidence, waiving aside those careful
calculations which delay happiness and wither our destiny, recol-
lecting the while that life smiles upon the strong.
Moreover both society and the wedded pair must profit by the
energy of love. This energy is usually dissipated fruitlessly or
sometimes even with the most disastrous consequences, as a re-
sult of that ancient lack of discipline of the passions which cus-
tom has attempted to legitimize.
But after all, is humanity ripe for the rejuvenation of love?
That is the crux of the discussion.
No conquest of the ecstasies of a purely physical heaven will
suffice. Our spiritual, as well as our physical lungs must breathe
the stimulating ether of transcendental heights, clear of all dust
and mud.
The ideal of a single standard of morals for the two sexes, of a
moral restraint, applied as rigidly to the young man as to the
young woman can surprise only those who have not considered
the subject seriously. In principle this ideal has been accepted
by the most distinguished and the most diverse types among
men of all ages and of every country.
This, above all: one can not be a Christian and deny this
doctrine.
We read in Ecclesiasticus : "He that joineth himself to har-
lots, will be wicked. Rottenness and worms shall inherit him,
and he shall be lifted up for a greater example, and his soul shall
be taken away out of the number."
George Sand — who knew whereof she spoke — in Elle et Lui
pities more than she condemns the man who has wasted the
dawn of his existence.
"Why this frightful chastisement inflicted upon those who
abuse the strength of youth, incapacitating them from realizing
the sweetness of a truly harmonious and logical life? Is he so
NEW MOKAL VIEWPOINT OF THE FRENCH YOUNG MAN 171
criminal, this young man, cast out without restraint upon the
world, with unbounded aspirations and a belief that he can mas-
ter every phantom that presents itself, every intoxication that
allures? Is his sin aught but ignorance? Did anyone whisper
to him in his cradle that the struggle of life is an eternal combat
against self?"
I have found many passages in Emile that rail at our vulgarity
of morals, and highly praise the graces of chastity. ''We scoff
at it only after having lost it," says Rousseau.
The young man often gives way to his evil impulses rather
against his own good judgment, and under the pressure of bad
example. " He becomes," says Jean-Jacques " dissolute without
desire, and a fop through bashfulness." Indeed this philosopher,
who combined the experience of vice with the love of virtue,
adds that " vanity rather than love creates the libertine."
Buff on approaches the question as a naturalist. He thunders
against excesses chiefly because of their debilitating effect upon
physique and morals. Tolstoi supports Buffon's thesis in the
name of Christianity, and confirms by religious laws "the warn-
ings of nature."
The point of view of Dumas, the younger, is that of a practical
and moral layman. He believes that the duty of man is to love
but a single woman, to be chaste before uniting himself to her,
and to remain faithful thereafter. "It is not by physical pos-
session," he writes, "that one learns to appreciate woman. The
first priest you meet, granting his intelligence and chastity and a
six months' experience in the confessional, knows woman far
better than Don Juan with his list of a thousand and three."
The French dramatist, though a Parisian, has shown more daring,
one might say, than even the terrible Bjornstjerne Bjornson,
despite his reputation for harshness. Un Gant of the Norwegian
author depicts a young philanderer of mediocre quality engaged
to be married. Thouvenin, in the Denise of Dumas, on the other
hand, admits flatly that he was chaste before marriage, has been
faithful to his wife, and has no regrets.
Those who agree upon this subject are a strange assortment.
On the subject of the double morality Bossuet, for instance,
172 SOCIAL HYGIENE
supports Jean-Jacques. "The worst of our enemies," he writes
in his marvelously simple and picturesque style, "are the flat-
terers, and the worst of all our flatterers are our pleasures.
What shame, what disgrace, what ruin of fortune and infirmity
of frame follow in the trail of uncurbed seeking after pleasure!"
Sainte-Beuve attributes to early dissipation the miscarriage of
many a genius, the downfall of brilliant destinies, the destruc-
tion of noble characters. As for Lacordaire, his discourses on
chastity are known to every Christian, and the last part of his
book contains a passage which is a vigorous diatribe on the sub-
ject of the licentious young man.
Free thinkers, social democrats, religious souls, and even those
who have been debauched, if they retain any lucidity of intelli-
gence, extol masculine restraint.
We must exhibit greatest moderation in attacking such fixed
prejudices. Our beliefs have already made some headway, for
our young people are moved as never before by a sense of ideal-
ism and personal dignity. Let us not forget that the true object
of the soul, the unique excuse for living, is to bestow one's self.
Among the Septentrionaux chastity becomes fanatical. Svava
in Un Gant defeats her sound reasoning and the basic justice of
her point of view by her irritating irreconcilability. She slaps
her betrothed because he is not entirely innocent. We must
admit that she moves us more when she complains and suffers.
She would win us altogether if she could forgive his faults for
love's sake.
As for Tolstoi, after having criticized the customs of his time
with the rapture of a great satirist and prophet, he exceeds all
bounds. His dream of absolute chastity, even within marriage,
takes no account of the necessary consequences, which would be
either the suicide of humanity or a blasphemy against nature
which sooner or later would revenge herself by a prodigious
wave of impurity.
Let us remain Frenchmen; let us love love; let us remain chaste
to love the better thereby.
THE SWORD OF DAMOCLES
WILLIAM COLBY RUCKER, M.D.
Assistant Surgeon, United States Public Health Service
It was hot and sultry in the rooms of the County Medical
Society and the general sleepiness of the atmosphere was not in
any way relieved by the droning voice of Dr. Erasmus P. Hicks
dilating on the superiority of goat's milk for artificial feeding.
A few of the older men who felt themselves above criticism
boldly stalked out to the cool of the ante-chamber and one by
one the youngsters trickled through the door, leaving behind
only the occupants of the first three rows and those who had
fallen asleep in their chairs.
In the outer room Marcus was holding forth, an alienist of
international reputation, noted for a taciturnity which some-
times broke its bonds with the rush of a spring freshet.
"I tell you it gets 'em every time — sooner or later a man
has to pay. You fellows see the beginnings of things — the
finding of the indictment, as it were — I see the endings — the
execution of the sentence. And, God, what punishments!
Not only does the man who breaks the law of nature suffer — if
that were all it wouldn't be so bad — but the mental and physical
agony of the family, yes, and of the generations yet unborn, is
something unbelievable. The cruelty of it all! You know how
it is; sometimes after a short bodily inconvenience, often not
enough to be called an illness, they go on for years in fancied
security, even forgetting, perhaps, the sin of long ago. And
then the concrete pavement begins to feel like a plush carpet
beneath the foot, the gait becomes uncertain in the dark, the
lightning pains begin to rend the victim — you know the symp-
toms. Maybe it's a constant headache; and a round of oculists
and internists and sanitariums begins. Then one day some-
thing breaks the fine fiber of self-restraint and 'Change wonders
173
174 SOCIAL HYGIENE
at his absence until the Court appoints a conservator and the
name of the asylum comes out.
"Let me illustrate. I can tell it now because he's long since
dead and the family all live in Europe on his money. About
two years before the fire, I was called into the case as a consult-
ajit. Clear case of paresis — in my own mind I didn't give him
a year. Asked usual questions about previous history — patient
claimed good record — denied any wrongdoing and was upheld
in this by the family physician who said they had been intimate
for twenty years. Still, it didn't look right to me. I knew the
doctor wouldn't lie about it and the patient acted like he was
telling the truth. But it piqued my curiosity and afterwards
I used to catch myself wondering about it and debating whether
I was unjust to the man.
"Well, he got so it wasn't safe to keep him at home so we sent
him to Boardman's. One day his wife came into the office to
talk about the case; you know how they do; and in some way it
came out that the patient had toured Europe about a year be-
fore his marriage. This was a new aspect of the case to me so I
let her gabble on. She told me what an extensive trip it had been
and that he had kept a most minute diary during the entire
tune, but that she had never been allowed to read it. I felt at
once that I must have that book. At my request she searched
the house for it — couldn't find the thing anywhere — had his
private papers at his office gone over — not a single trace of it.
I was considerably put out — made me sore to lose such a chance
of proving up and settling the worth of a deduction I believed
correct.
"Just as I had about given up and told my curiosity it was an
old meddler to start me on such a fool's errand, Boardman
writes me that he found a greasy old note book on the patient
when he was admitted and that any attempt to take it away from
him always made him violent. It was the diary — I knew it
instinctively — and I didn't lose any time in getting out to the
asylum. Well, after a lot of wheedling I got the book, a little,
dog-eared, dirty volume written full of the account of that
journey. It wasn't an easy job to read it though. The grease
THE SWORD OF DAMOCLES 175
had soaked through and the faded letters in that methodical
business hand didn't stand out very plain on the yellow paper.
But I knew I had a human document containing the answer
to the question which had perplexed me so long.
"The beginning was about like that of any diary. Resolves
to make journey before finally settling down — bon voyage din-
ners— journey to New York — sailing of ship — waving friends on
pier — all that sort of thing. Makes an acquaintance on board,
young man about his own age — decide they will make the tour
together. Cherbourg — Paris— rather gay time — a Mile. Louise
Louis joins party and the three travel through Norway, Sweden,
and Denmark together, finally winding up in Berlin about two
months after the diary begins. Here the first rift in the lute —
the apple has turned to ashes — he feels sick — consults a doctor —
is sent to Founder in Paris. You know what that means.
The diary reads, ' Saw Dr. Fournier to-day. I am to return in
ten days for my sentence.' Poor ignorant boy, little did he
realize the meaning of that sentence even after it had been de-
livered. From that time on the course of the disease was that of
a typical light form, apparently yielding perfectly to treatment—
a treacherous viper waiting until it can strike the most telling
blow, biding its time until success has crowned years of labor
and brought the pleasant anticipation of retirement from active
life into the calm and peace of the family home.
"In three or four months the young man thinks he is cured,
leaves Paris, completes his tour, and, after a year's absence,
returns to New York. That day he made this entry (how it
sticks in my mind) 'And thus to-day ends my wander jahr — a
period of great profit, much pleasure, and nothing to look back to
with regret.' How little impression this awful thing had made
on his ignorant young mind ! He had already forgotten the worst
thing which was to happen to him in all his life. And in the
after years nothing occurred to recall it, but always the sword
hung above his head. Only one of his sons reached manhood,
his only daughter was a chronic invalid, and he sometimes won-
dered at the puniness of his grandchildren. But he did not see
in this the punishment for the sin of his youth nor did he realize
176 SOCIAL HYGIENE
the price he was to pay for this season of apparent immunity.
All the time he remained well, pushing his way up the narrow
ladder of success, accumulating wealth, gaining civic honors,
respected, looked up to, no one apparently so much to be envied.
And then the blow fell; but God was kind— he scarcely lived out
the twelvemonth."
There was silence for a moment and then one of the young-
sters blurted out: "Wonder what happened to the chum?"
"Well, I did too. So I went carefully through the book
again and found his full name and address. I know him well.
He's been in a rolling chair with locomotor ataxia for the past
fifteen years, suffering the pains of hell."
THE ATLANTA CAMPAIGN AGAINST COMMER-
CIALIZED VICE
MARION M. JACKSON
Vice-Chairman, Men and Religion Forward Movement, Atlanta, Georgia '
Commercialized vice was a problem in Atlanta. The fight
against it began in the Executive Committee of the Men and
Religion Forward Movement, representing the Protestant
churches in that city, and appointed in the spring of 1911 by the
Evangelical Ministers' Association.
Its chairman, John J. Eagan, was opposed definitely to the
segregation of the social evil at the time of his appointment,
but the committee was not wholly of the same opinion, though
the majority were in accord with him. But all believed that no
step should be taken, nor policy adopted, until a thorough sur-
vey of the situation in the city had been made. The subject
was referred to the sub-committee on social service, whose
chairman was J. C. Logan, secretary of the Associated Charities.
This sub-committee was also divided in opinion in the beginning,
but their report, based upon their study of conditions, was
unanimous in the end.
Their investigation, which was conducted by trained social
workers with the assistance of the police department of the
city, disclosed that there were forty-four recognized houses of
prostitution, a number of assignation houses, and prostitutes
in the majority of the hotels of the city. There were only two of
the hotels frequented by transients in which meetings were not
personally arranged with women by investigators.
Only eleven of the acknowledged houses, it was found, were
in the so-called " segregated" or Mechanic Street district. The
occupants of four of these houses claimed to own them. The
other seven houses in the district paid to their reputed owners
annually in the guise of rent $43,589.50. One house in the
177
178 SOCIAL HYGIENE
segregated district paid to its reputed owner $10,000 a year
as rent. If located in the most fashionable residence section
and rented for legitimate purposes $1800 per annum would
have been an excessive rental for it. These figures explain the
secret of why some strongly favor segregation.
There were 265 inmates of the recognized houses in Atlanta.
Of these, 104 had never worked for wages. Of the others, 95
had been earning an average of $5.25 per week. Out of 134
women and girls examined, 20 had earned between $3 and $4
per week; 46 between $4 and $6 a week; 29 between $6 and
$8; 16 between $8 and $10 a week; 10 between $10 and $15; 16
between $15 and $20 a week. Between 36 and 37 per cent,
of the inmates of the recognized houses had been employed in
stores, mills, or factories prior to their fall.
One explained: "I couldn't take care of my baby working at
$3 a week."
The volume of trade in the recognized houses amounted, in
round numbers, to $700,000 per annum.
In the year 1911, 13 girls, under ten years of age, infected with
venereal disease were in Grady Hospital, the city's hospital.
The committee on social service reported these facts to-
gether with the results of their study of the Chicago and Min-
neapolis vice reports and of conditions in other cities. They
recommended that the Executive Committee request the city
officials to appoint a commission to investigate conditions and
recommend a policy for the city. The facts had convinced the
sub-committee that no policy excepting one of repression of
prostitution was possible for any community. The Executive
Committee adopted this report.
In accordance with the report, the committee requested the
mayor of the city to appoint a commission to investigate.
Mayor Courtland S. Winn declined to act without direction
from the City Council. The request was placed before the
Council, which body by resolution directed the appointment of a
commission composed of five aldermen, five councilmen, and five
other citizens, to investigate and make their recommendations.
The Mayor announced the appointment of the commission in
ATLANTA CAMPAIGN AGAINST COMMERCIALIZED VICE 179
May, 1912. The Executive Committee placed before the
commission the facts and figures disclosed by their investigators.
Rumors and newspaper stories, indicating that a report would
be forthcoming favoring segregation of the social evil, and a
seeming policy of delay, convinced the committee that a cam-
paign of education through the press was necessary, if progress
was to be made. A committee on publicity, composed of John
J. Eagan, chairman, John E. White, C. B. Wilmer, W. W.
Orr, and Marion M. Jackson, was appointed. Contracts for
space in the Atlanta Journal, Constitution, and Georgian were
made, and a series of articles under the head of "Men and
Religion Bulletins" was begun. These appeared regularly every
week, some tunes more often, giving the facts with reference to
the social evil in Atlanta and elsewhere.
The sixth bulletin, signed by fifty-five clergymen of the city,
read : —
"It has been brought to the light of public knowledge that
there are more than forty houses in Atlanta for gain by public
prostitution.
"They exist in the knowledge of the Mayor, the City Council,
the Police Commission, and the police force, and carry on their
traffic openly as commercial establishments.
"They are scattered around the heart of the city, and, while
defying the law and the courts in their traffic, they claim and
receive immunity from the sworn officers of the law not allowed
other lawless business enterprises.
"In our capacity as citizens and as ministers of the Gospel,
we protest against these 'houses in our midst' as in defiance of
the law, as corrupting to the public morals and private virtue,
and as intolerable to the enlightened social conscience.
"As ministers of God we can not and will not be silent as long
as this partnership between the city and vice continues."
Light which was thrown upon the charge that vice was only
scattered by the closing of the district would be amusing, if it
were not for the tragedy involved when a house opened next to
one of the leading churches during the agitation prior to the
closing. The church complained. Its pastor had just vacated
180 SOCIAL HYGIENE
the manse. It was for rent. The inmates of the house moved
and opened for business in the manse itself.
The day that the twentieth article appeared in the paper,
September, 1912, the chief of the Atlanta police force, James L.
Beavers, issued an order giving notice that within two weeks
from that day cases would be made against the inmates of all
of the houses and against property owners, if the houses had not
been closed. This order marked the end of the open toleration
of prostitution in the city of Atlanta.
There had been no suggestion of graft in the police force.
But for more than fifty years, officials, the public, and the
churches had, by their silence, permitted the breaking of city
and state laws against prostitution. In fifty years, the traffic
in women and liquor had reached the mark of $700,000 per
annum. By intelligent investigation, the expenditure of
$2,009.96 in advertising, and by cooperation along lines which
educated the public and convinced officials that the blaze of
publicity could not be stopped, the ministers of Atlanta had for
the time being put an end to the partnership which had endured
for a half century between commercialized vice and the capital
of Georgia.
The ministers did not stop with the demand for law enforce-
ment. The bulletins had repeatedly stated that assistance and
shelter would be given to every woman and girl willing to ac-
cept them. The day that the houses were ordered closed
$10,000 was in hand to be used for this purpose. Committees
consisting of a minister and a Christian woman visited each
house repeatedly and personally invited the inmates to leave
their lives of shame.
Many came. Ministers opened their houses to them. The
keeper of the largest house in the district accepted the invita-
tion, and subsequently gave $2500 as the nucleus for a fund to
start a home, or place of permanent refuge for fallen women.
She today is engaged in Christian work.
Two hundred and sixty-five cases were handled during the
crisis; 75 children dependent upon fallen women were given
help; 139 of the women came from recognized hotels or houses
ATLANTA CAMPAIGN AGAINST COMMERCIALIZED VICE 181
of ill-repute; 64 of these were women who had been married, but
separated from their husbands; 14 were widows; 52, unmarried;
42 cases were attributed to drink or similar causes; 112 were
sent to their homes or given employment.
Until the crisis had passed, a home was maintained known as
Martha's Home. The former madame, who made the gift of
$2500, gave it this name because, she said, the hope of the fallen
woman was to learn to serve. Evidently the thought with her
was inspired by memories, whether conscious or not, of Germany,
her native land. As there was no home for wayward girls in
Georgia, nor any fit place of detention for incorrigible women,
any and all types of girls and women were handled temporarily
through this house of refuge.
But Fulton County, where Atlanta is situated, soon provided
a suitable place of detention for incorrigibles, and a move was
begun to get the state to establish a school for wayward and
delinquent girls. Efforts had been previously made to secure
this school, but they had failed. At the 1913 session of the
legislature of Georgia, a bill was introduced and passed establish-
ing "The Georgia Training School for Girls." Wayward and
delinquent girls under the age of eighteen are committed to this
school. Its first board, consisting of W. L. Moore, of Atlanta,
as chairman, M. Ashby Jones, D.D., of Augusta, Mrs. W. H.
Felton, of Cartersville, Mrs. Z. I. Fitzpatrick, of Madison, and
W. D. Davis, of Waynesboro, have charge today of a splendidly
equipped plant, supported by the state, where seventy-five girls
are being trained for useful womanhood. Without the use of
paid publicity, backed by the organized demand of the churches,
this school could not have been established. Today, those who
were its bitterest opponents at the time of its establishment
are its staunchest supporters.
Soon after the closing of the segregated district, two of the
Atlanta papers, the Georgian and the Constitution, openly en-
dorsed the move. The commission appointed by the Mayor
reported commending the action of the chief of police. But the
committee was convinced that steps had already been begun to
remove the chief of police, who fortunately held office under
civil service.
182 SOCIAL HYGIENE
The Executive Committee, backed by the Ministers' Asso-
ciation, was convinced that the campaign of education through
the medium of paid advertisements must be continued for the
protection of the chief of police and the holding of the ground
gained. The members also felt that so long as the prohibition
law was being openly violated, it was only a question of tune,
if the violations were not checked, before the return of the
segregated district.
On the other hand, those favoring the unlawful sale of alco-
hol and the open town saw the situation in the same light. A
chief of police who would close a segregated district would
inevitably in time make an end of law-breaking clubs and blind
tigers. Either the chief or the blind tigers would have to be
eliminated. An examination of the files of the Atlanta papers
beginning with the closing of the district and continuing until
January, 1916, will disclose the fight for and against the chief of
police and law and order.
This situation made the continuation of the paid publicity on
the part of the committee imperative. Cartoons ridiculing the
police department and articles tending to prove the force in-
efficient because of the chief's so-called mania for prosecuting
women instead of looking after burglars and worse types of
crooks constantly appeared. The committee met them with
paid articles giving the facts and pointing to the law-breaking
in the locker clubs and near-beer saloons.
The fight continued through 1913, 1914, and 1915. In
1915, just prior to the meeting of the legislature in June, when
more drastic prohibition measures were expected to be intro-
duced, and when more violent attacks than ever before were
being made upon the chief of police, a committee of citizens ap-
pointed by a meeting of certain members of the Atlanta Chamber
of Commerce, invited the chairman of the Executive Committee
and his associates to a conference. At that conference the citi-
zens' committee requested that the publicity campaign be dis-
continued. They charged that the campaign was hurting
Atlanta. The chairman of the Executive Committee, replied
that the committee would gladly stop the publicity if the
ATLANTA CAMPAIGN AGAINST COMMERCIALIZED VICE 183
attacks upon the chief of police would cease and the locker
clubs and saloons would obey the law. He urged the committee
of citizens to cooperate in accomplishing this. They declined.
The chairman then informed them that the publicity would con-
tinue. Their reply was that other measures would be adopted
to put a stop to the campaign.
They were successful. The police board met one evening.
At that meeting charges were preferred against the chief, ac-
cusing him of incompetence, insubordination, and listening to
outside parties instead of consulting the board in the conduct
of his department. The next morning, the last bulletin ap-
peared picturing conditions in Atlanta and the forces working
to destroy the chief of police. Thereafter, the three Atlanta
papers refused to publish the advertisements prepared by the
Executive Committee of the Men and Religion Forward Move-
ment. The committee representing the selected members of
the Atlanta Chamber of Commerce had spoken to the press.
The press obeyed.
The trial of Chief of Police Beavers by the Board of Police
Commissioners followed. He was found guilty. An order de-
moting him to the rank of captain was passed. He appealed
his case to the Superior Court. At the same tune a move to
recall the members of the police board responsible for his de-
motion was begun.
The three daily papers took up the fight against the recall.
Before the election, the three published statements to the
effect that no moral issue was involved; that the segregated
district had been closed never to be reopened; that the chief of
police was not really involved for the reason that his case had
been appealed to a higher court which could be counted upon
to give him justice, and that the fight against the police commis-
sioners was merely a work of spleen on the part of a few dis-
gruntled politicians and the fanatics of the Men and Religion
Forward Movement.
The recall was overwhelmingly defeated at the polls, but the
police commissioners of Atlanta and the three papers were com-
mitted to the policy for which the Executive Committee had
184 SOCIAL HYGIENE
fought, while the case of the chief of police was still pending in
the higher court.
Subsequently, the court reversed the finding of the Board of
Police Commissioners and ordered a new trial in terms which in
the opinion of many lawyers amounted in substance to the di-
rection of an acquittal and reinstatement. Notwithstanding,
at the second trial, the chief was again condemned. His appeal
is now pending again before the higher court. His lawyers and
the committee are confident of another reversal of the finding
of the board.
But the most striking development of all has been the election
as mayor of Asa Candler, the most prominent of the leaders of
the fight to recall the commissioners for demoting the chief of
police. The election of Mr. Candler as mayor, though the
question of commercial vice was not involved; the passage of
laws putting an end to locker clubs and near-beer saloons, and
the pledge of the police commissioners and daily papers of
Atlanta to a policy of repression of prostitution would seem to
indicate a final victory against the segregated district and law-
lessness in the capital of Georgia.
Unquestionably great progress has been made, but the work
is far from being completed. The old cry of scattering vice in
apartment houses and hotels is being raised. And without
doubt conditions are far from being satisfactory. There is
much of prostitution in the city. The county has abandoned
the home for incorrigibles and prostitution is increasing be-
cause of lax police methods and the demoralization resulting
from the removal of Chief of Police Beavers. But fortunately
the committee, by reason of the thorough investigation made
prior to the closing of the district, is in possession of evidence to
prove that, in spite of these manifest defects and failures, con-
ditions with reference to the social evil are better in Atlanta
today than they were prior to the closing of the Mechanic
Street district, when a section of the city was openly advertised
as being set apart for commercialized vice.
THE PROPHYLAXIS OF VENEREAL DISEASES1
MAZYCK P. RAVENEL, M.D.
Professor of Preventive Medicine and Bacteriology, University of Missouri
We are in the habit of believing that once the cause and meth-
ods of transmission of any disease are known, such a disease is
under our control and can be prevented. Unquestionably the
proposition is correct in general, as witness our control of yellow
fever, bubonic plague, etc. Venereal diseases, however, are a
most discouraging exception to the rule. Few, if any, diseases
are better understood as regards cause, both immediate and pre-
disposing, and methods of transmission, while for all of them we
have laboratory methods for diagnosis of great nicety and exact-
ness.
Statistics. In seeking the explanation of our difficulties we
are met at once by the fact that we have up to the present no
accurate statistics of the prevalence of venereal diseases except
in certain groups of men such as the Army and Navy. Admit-
ting that many estimates are much exaggerated, we still know
that they are certainly widely prevalent in every stratum of so-
ciety. That our figures are so lacking and inaccurate arises from
the secrecy maintained in regard to these troubles. The phy-
sician feels in honor bound to guard the secrets which come to
him professionally, and in this is protected by the code of medi-
cal ethics and, to a great extent, by the law. He often carries
it to the point of giving the name of some symptom or lesion as
that of the disease, inevitably causing misleading confusion.
Correct data concerning cases and deaths are fundamental in
the control of communicable diseases, and in none, perhaps, quite
so important as in venereal diseases. Unfortunately the report-
presented at a public meeting on health aspects of social hygiene, Annual
Conference of the American Social Hygiene Association, St. Louis, November
20, 1916.
185
186 SOCIAL HYGIENE
ing of these diseases, so long regarded and called " private,"
carries unusual difficulties, which can be overcome only by in-
tensive and long continued education of the public and physi-
cian alike.
Registration of cases. Registration must be insisted on for
these diseases just as for smallpox, diphtheria, scarlet fever, and
the other contagious maladies which are at present accepted uni-
versally as properly reportable, though fraught with much less
danger to the community.
It must be remembered that even deaths from contagious dis-
eases which carry no opprobrium are reported in less than two-
thirds of our country, and that morbidity reports of every kind
are woefully deficient almost everywhere. It is therefore too
much to expect that the reporting of these secret diseases will
be accomplished quickly. The failures of the past should not
discourage but rather lead to further efforts, which must be edu-
cational in large part. In all cases the rights of the individual
must be guarded, and when this is efficiently done much of the
opposition will be overcome. Improvement is marked in those
places where registration has been carried out on a rational basis
for some time. On the other hand the rights of the public must
be remembered. They are more important than those of the
individual, but concealment and evasion of the law are so easy
that more good is accomplished by the moderate course.
Medical prophylaxis. In the prevention of all contagious dis-
eases the most important measure is the care of existing cases,
for each case is a focus of infection, — soil, so to speak, which has
been seeded and cultivated, and has yielded an abundant harvest,
now ready for distribution. Diagnosis is the first requisite.
Laboratories for diagnosis. Public health laboratories for diag-
nosis, as well as for determining cure, are of prime importance in
this work. Many states and cities provide for the simpler diag-
nostic methods, and an increasing number are making provision
for the more difficult procedures, such as the complement fixa-
tion tests. The increase in the use of such facilities shows that
physicians are recognizing the importance of the aid given. In
New York City, in 1914, 59,614 specimens were examined by
PROPHYLAXIS OF VENEREAL DISEASES 187
the Health Department, while for the first half of 1916, 39,694
such specimens were submitted, indicating a total of 79,388 for
the year.
Analysis of these figures reveals one disquieting fact, — that
the importance of laboratory control over gonorrhea is not yet
realized. Certainly gonorrhea is much more prevalent than
syphilis, yet the number of specimens from suspected cases of
the latter exceeded those from the former by approximately
three to one.
Hospital care. From the public health standpoint it is unfor-
tunate that in the great majority of cases the symptoms of ve-
nereal disease are so mild as to make it impossible to keep the pa-
tient in a hospital until he is no longer a danger to the commu-
nity. Even were the best and most abundant hospital facilities
supplied free of cost, their use would be restricted. As a matter
of fact, however, the venereal patient is regarded with aversion,
and the majority of hospitals bar such patients at the very stage
in which they are most dangerous.
In New York "of 30 general hospitals, only 10 receive patients
with recognized cases of syphilis in actively infectious stages;
but once admitted on some other diagnosis, 27 give care and
treatment, although only 17 provide the services of a syphilolo-
gist. Only 9 receive adult patients with gonorrheal infection
needing hospital treatment, and two of this number specify that
only surgical cases are accepted. Three city hospitals receive
and treat active gonorrhea in little girls. Thirteen of the 30
will not receive medical cases with known complications of syphi-
lis or gonorrhea. . . . Again it may be inferred that these
conditions are probably typical of every part of the United States."
(Snow.)
The late Dr. Prince A. Morrow called our lack of provision
for the care of venereal patients a disgrace to our civilization.
Without discussing the motives which have led to this condi-
tion it must be said that from the standpoint of prevention and
the protection of the community, the moral side of venereal dis-
ease should be submerged, so far at least as the actual care of the
infected is concerned. The problem of the sanitarian is to pre-
188 SOCIAL HYGIENE
vent the spread of infection, and every patient properly cared for
is a focus of infection put out of business.
Legal Control. The importance of hospital facilities, furnished
without cost when necessary, is so apparent as to require no
argument. The hospital is a prime factor in the treatment of
syphilis by salvarsan, its facilities making for success, and as the
stay required is short, the expense to the public is not great for
the individual case. Certainly the protection afforded the public
is well worth the cost.
Dispensaries. Dispensaries play a large part in the treatment
of venereal patients, but, even when well conducted, leave much
to be desired. Here again patients will not continue treatment
until a certain cure has resulted. When the urgent symptoms
are relieved visits grow irregular or cease. In the city of New
York, Platt says that in 1913, 1,250,000 persons were treated
for venereal disease in 122 clinics It is impossible to obtain
the results as a whole, but those from some of the best will
give an idea of the situation.
In four clinics "that stand well among the best," the results
for gonorrhea were: 8 per cent of patients discharged as cured;
17 per cent ceased treatment of their own accord, improved but
not cured; 75 per cent ceased treatment unimproved. These 75
per cent made one-half of the total visits to the clinic."
In Boston, Davis reported 11.4 per cent of 450 cases of gonor-
rhea treated at the Boston Dispensary as cured. Dr. Sanford
reported a series treated at the Lakeside Hospital Dispensary in
Cleveland, in which 12 per cent were cured. These results are
far from encouraging, and illustrate the limitations of the dis-
pensary as conducted at present in extinguishing foci of infec-
tion.
There is reason for hoping that the extension of social service
to patients with venereal disease will better existing conditions.
Such service has proved most valuable in practically every other
class of disease, and, where it has been tried in venereal cases,
the results indicate that it is a power for good. The rapid ex-
tension of social service to this class of patients should be en-
couraged in every way possible.
PROPHYLAXIS OF VENEREAL DISEASES 189
Medicinal treatment. The discoveries of recent years have
developed preventive treatments for those who have been ex-
posed. The success and general introduction of such medica-
ments would inevitably increase immorality. The sanitarian
must to a certain extent overlook the moral question involved.
His duty is primarily to prevent the spread of infection and to
limit the incidence of disease. Supposing for the moment that
infection could be uniformly prevented by the use of prevent-
ives in the shape of drugs, would general instruction in their
use lessen to any notable extent the cases of infection? Intelli-
gent laymen can undoubtedly apply them successfully, but it is
certain that the majority of those from whom venereal cases are
recruited — immature boys, careless men, defective girls, all of
them more or less apt to be under the influence of alcohol — can
never be expected to use these methods intelligently, nor within
the period after exposure when they can be expected to produce
favorable result^. Experience has shown that such prevent-
ives require expert handling, and it is doubtful whether their
general use would accomplish markedly good results, entirely
apart from the moral questions involved.
The experience of the Army and Navy is interesting and in-
structive.
The Navy. Efforts at compulsory prophylaxis were made in
1907, and were taken up generally throughout the Navy in 1909.
"The admission rate for chancroid has never been so high as it
was in 1914. The admission rate for gonorrhea shows a slight
increase over the previous year; while the admission rate for
syphilis has shown a slight drop, lower, in fact, than the preced-
ing five years." (Kept. Surgeon Gen'l, 1915.) The damage
rate per 1000 has fallen from 7.51 hi 1907 to 6.71 in 1914, and
this improvement seems to be due largely to the lower damage
rate from syphilis. The Surgeon General believes that delay in
application is one of the chief factors in the failure of venereal
prophylaxis, though he says: "ignorance, intoxication, and in-
difference can not be discounted."
Damage rate per 1000 before and after prophylaxis propaganda :
190
SOCIAL HYGIENE
GONORRHEA
CHANCROID
SYPHILIS
Six years preceding prophylaxis
Six years subsequent to prophylaxis
1.06
1.47
0.440
0.451
3.59
3.21
The admission rate makes a very much worse showing than
the damage rate, but is not given because it is misleading owing
to the fact that in 1909 a new statistical report of the sick was
adopted, which apparently greatly increased the admission for
venereal disease.
In commenting on these figures Surgeon Halcomb, United
States Navy, says flatly "Has the propaganda of venereal pro-
phylaxis failed? I think it has." The improvement which is
noted only in respect to syphilis he believes is due to improved
methods of treatment — not to prophylaxis.
The Army. In the Army special measures for prevention be-
gan in 1910.
In the United States the admission rate for 1914 was 89.84
per 1000, as compared with 85.83 for 1913. For the total Amer-
ican troops the rate for 1914 was 110.69 per 1000, as compared
with 97.22 for 1913. There was less syphilis, but more gonorrhea
(203 cases) and chancroid (308 cases). The non-effective rate
for the United States was: 1914, 3.75; 1913, 3.58; 1912, 5.96;
1911, 8.82; 1910, 10.14. In this respect a steady improvement
is shown, and the admission rate is smaller than for 1912. The
increase for 1914 is explained by the mobilization of the troops,
but it is evident that prophylaxis fell far short of its aims.
Reports from posts are unanimous in saying that the lapse of
tune between exposure and preventive treatment was excessive,
thus accounting for many failures.
At many post exchanges prophylactic packages are for sale
at cost, yet there is practically no demand for them.
In the Army "punitive prophylaxis" is enforced, that is, men
do not receive pay for the time lost from duty on account of
venereal disease.
I have gone at some length into the results of prophylaxis in
the Army and Navy, because we have in them a selected group
PROPHYLAXIS OF VENEREAL DISEASES 191
of men in close touch constantly with medical officers who have
been enthusiastic in pushing the propaganda for the prevention
of venereal disease, and in the Army a penalty has been added.
With such results in a selected group constantly under pressure
from their officers, it seems to me futile to expect too much from
such measures among the general public.
In the German and Austrian armies artificial prophylaxis has
diminished the number of venereal cases, but has not prevented
their occurrence.
In a campaign against any disease all measures which help
even a little must be resorted to. Artificial prophylaxis, in spite
of its shortcomings, has its place.
The law has frequently been invoked in the control of venereal
disease but with little success.
Control of Prostitution. It goes without saying that the aboli-
tion of prostitution would end venereal disease in a short time.
How this can be brought about has puzzled much wiser heads
than mine. Regulation has proved a failure. Suppression has
not been successful. The public and professional prostitute can
probably be controlled, but as far as I am aware, no one has
made an impression on the problem of private prostitution, in
some ways the more dangerous of the two. None the less the
making and, enforcement of laws must have a place in our
efforts at prevention.
Alcohol. The influence of alcohol in promoting illicit sex rela-
tions is well recognized. "Sine Baccho friget Venus." The
abolition of the saloon and the blind tiger comes distinctly within
the province of law.
Anatomical museums. Newspaper and toilet-room advertisers;
men's specialists. I would class these together as worthy the
best efforts looking to legal suppression. Their influence is wide-
reaching and pernicious in the extreme. The young man who
goes out from home with high ideals is the unwitting and con-
stant object of attack. The influence is against continence, and
the danger of venereal diseases is minimized.
From one end of the country to the other advertisements of
three and five day "cures" stare at one from the walls of public
192 SOCIAL HYGIENE
toilets, especially in the smaller hotels. The better class of news-
papers now refuses such advertisements, but they are still far
too common. I can not claim the experience of the specialist,
and may be inclined to exaggerate the influence of these adver-
tisers, but my ideas of the harm they do have come largely from
dealing with university students, and from the fact that such ex-
tensive advertising indicates a large body of customers.
It is unfortunate that the attitude of the average physician
duplicates that of the hospital toward venereal patients. They
are not wanted, and do not receive the same consideration as
other patients. Payment is often demanded in advance, and
the prices charged tend to drive many to the 50-cent advertising
men's specialist.
It is interesting to note how the law recently enacted in Western
Australia deals with this matter. Advertisements of medicines
or appliances for the treatment of venereal diseases are illegal.
No printed matter on the subject can be circulated in any man-
ner. For the information of those interested the Government
has published a booklet describing the nature and symptoms of
venereal disease, the modes of infection, and precautions to be
taken by infected persons.
Marriage laws. Properly constructed and rational laws pre-
venting or regulating the marriage of persons with venereal dis-
ease would be of great benefit. Legislation along these lines in
this country has not been successful, largely I believe, because
it has not been marked by the qualities mentioned. Some edu-
cational effect has resulted.
Other laws. In one or two states laws are in operation exclud-
ing those suffering from venereal disease in a communicable form
from the preparation and serving of foods. This leads to the
examination of applicants for such positions. Reports of the
working of these laws are favorable.
A number of the governmental services are requiring exami-
nation of applicants for venereal disease. The same is true of
many corporations, especially those maintaining sick benefit and
pension systems.
PROPHYLAXIS OF VENEREAL DISEASES 193
These agencies play a part in the war against venereal disease,
however small, and have some educational value.
Early marriage. The high cost of living, and the demands of
society of the present day have brought about conditions unfa-
vorable to early marriage. Marriage at or about the attainment
of maturity should be encouraged, and the aim of society should
be to remove or modify the existing conditions which militate
against it.
Education. Education in its broadest sense, including moral
training, can be relied on to accomplish much good. I know of
no satisfying program which has been worked out, and, as well
put by Snow, "nor have ways of translating knowledge into action
through the observation of high moral principles been adequately
developed." The subject requires more observation and more
study before satisfactory working plans can be formulated. One
thing is sure — that the wave of sexual slush which went over the
country a few years ago, propelled in part by sincere, though
foolish reformers and in part by the never failing crop of popular
orators who seek notoriety by espousing every new movement,
was in no proper sense educational, but distinctly injurious. For-
tunately this has passed, and the direction of the movement is
now in wise hands, so that there is good reason to expect sub-
stantial progress, though at best it will be slow.
Teachers. It is generally admitted that proper sex education
is not only wise but necessary. Who shall give it? Of those
considered for this office — parents, teachers, clergymen, doctors
—only the latter seem to have the necessary knowledge. The
first step then is to select and educate the teachers, when the
program has finally been decided upon.
Subject-matter. In considering what should be taught cer-
tain fundamentals are well established. Boys should be taught
that the reproductive function is given for the preservation
of the species and not for the gratification of sensual desire;
that its proper use leads to the highest joys while its debase-
ment brings physical, mental, and moral deterioration.
Emphasis should be laid on the fact that continence is entirely
compatible with the highest physical and mental development,
194 SOCIAL HYGIENE
that there is no such thing as sex necessity, and no damage to
the reproductive power by non-use. It should be made clear
that the practice of continence does not mean physiological non-
use and that the resorption of the secretion of the testicles has a
marked effect on the development of manly qualities.
The dangers of venereal disease must be pointed out, espe-
cially the danger to the innocent wife that is to be, and to possible
progeny. Personal fear fails to deter in the majority of men, but
every boy consciously or unconsciously looks forward to having
a home, a wife, and children. I believe that the fear of sterility
for himself or the future wife and of damage to possible progeny
often keeps a young man in the straight path when no other
considerations will.
Emphasis, however, must be laid on the building of character,
and the rewards of virtue, both mental and physical, rather
than on the danger of vice. Education must be constructive ;
it must look to the building of moral character rather than the
mere imparting of disagreeable knowledge. In all teaching about
sexual matters there is danger of putting stress in the wrong
place, of setting the mind to work on sex matters. The younger
the individual, the greater the care that must be exercised. The
ideal method of teaching the sex function to both sexes would
seem to be from the biological standpoint, not laying any more
stress on it than on any other normal function. With advanc-
ing age other matters could be brought in without the wonder or
surprise of a new discovery.
The fallacy and unfairness of the dual standard should be per-
sistently inculcated from an early age.
Conclusion. I have tried to give a fair and unbiased view of
the subject of prevention of venereal diseases. They have been
with us for many centuries and will probably remain many
more. They are spread chiefly through illicit intercourse, but
this and the prostitution which is a part of it have come in re-
sponse to primal instincts and passions, given by nature for the
preservation of the species, which are right and honorable when
under control. The problem is one with very special features
which make it most perplexing and difficult to handle. Surely
PROPHYLAXIS OF VENEREAL DISEASES 195
the field is one for the wisest heads, the kindest hearts, the san-
est judgment, the profoundest study. There is no place for the
half-baked reformer, the philanthropic charlatan, nor the gush-
ing sensation-seeker. Discussion as to whether the sanitarian or
the moralist should undertake the work is beside the mark. There
is room and need for both. Indeed, the efficient health officer of
today makes use of educational and moral means to the fullest
extent to bring about sanitary reforms. Such success as is pos-
sible will be attained by developing and utilizing every agency
and the correlation of those forces which tend to the suppression
of vice and temptation on one hand, and to the upbuilding of
character and public moral sense on the other.
If my view seems pessimistic it will deter only those who have
no business in work of such importance, it will stimulate to in-
creased effort the sincere and intelligent. Such is my hope.
THE ENGLISH VENEREAL DISEASE ORDER
The order of July 12, 1916, of the Local Government Board
puts in operation in England and Wales a system of state pro-
visions for the diagnosis and treatment of venereal diseases.
This order is practically an enactment into law of the recom-
mendations of the Royal Commission on Venereal Diseases.
Existing institutions are to be improved so that they can be
utilized for this work, and new institutions are to be avoided as
far as possible. The venereal clinics are to be a part of general
clinics, and every effort is to be made to relieve the scheme of
the stigma of the venereal diseases.
The order is in many respects epochal. It marks the first
efforts of an English-speaking country or, indeed, of any large
state, to deal with the venereal problem on a large scale by
providing facilities for diagnosis and treatment. There is a
vast difference between the state of public mind of so short a
time as ten years ago, when it was impossible to get the Eng-
lish government even to appoint a commission to consider the
venereal disease problem, and the state of public opinion today,
which causes the government to put into the form of law the rec-
ommendations of a commission in venereal diseases within four
months after its report is issued.
This act presents, under political and social conditions much
like those of the United States, an organized effort by a state to
reduce the prevalence of the venereal diseases by providing uni-
versal opportunities for treatment. As such its results will be
of great interest to us. It may be said at once that the effort
is well worth the making. Whether or not it solves satisfactorily
the problem of the venereal diseases, it gives every prospect of
being of sufficient benefit to justify its cost. It is to be hoped
that it will obtain the support both of the medical profession
and of the public to the extent necessary for its success. — The
Journal of the American Medical Association.
196
SYPHILIS, A DISEASE OF DIMINISHING SEVERITY
DOUGLAS SYMMERS, M.D.
Associate Professor of Pathology in the University and Bellevue Hospital Medical
College
Of all known diseases none excites more loathing than syphilis,
although its objective manifestations are in reality but the ex-
ternalisation of a defensive mechanism which is admirable in the
highest degree. The changes brought about in the tissues by
syphilis do not represent a wanton attempt at destruction, but
constitute an organized effort to limit the sphere of activity of
an inimical parasite by the interposition of mechanical and
chemical obstacles, and to repair injury already inflicted. In
fact, destructive changes are often entirely fortuitous, and occur
in circumstances beyond the control of the body, such, for
example, as mechanical injury and infection by pus-producing
microorganisms, so that a process primarily protective and benef-
icent, is diverted in such fashion as to threaten or destroy life.
While syphilis is universally held in righteous fear there is, I
believe, evidence to show that the disease has suffered marked
attrition in the comparatively short span of years that has elapsed
since the discovery of the New World, and, as time goes on, the
process will undoubtedly undergo still further modifications in the
direction of diminished severity until mankind ultimately will
wake to the realization that syphilis has been deprived of many
of its horrors. Strangely enough, the salvation of the world in
this respect rests, in part, upon the syphilization of humanity;
for attenuation of the virus depends upon transmission through
successive generations, and this, in turn, will modify the nature
and extent of the organic changes in the body, without which
there is no syphilis.
The origin of syphilis, like that of many other infective dis-
eases, is lost in the lore of antiquity. This much is known, how-
ever, that continental civilization came face to face with syphilis
197
198 SOCIAL HYGIENE
when the army of Charles VIII, recruited from the brothels of
France and inured to license, lifted the siege of Naples after
having been infected with a disease said to have been previously
introduced into the beleagured city by the sailors of Columbus,
freshly returned from the conquest of the New World. In this
way, an army bent upon the subjugation of the Italian peninsula
as a preliminary to a pious quest of the Holy Grail, succeeded
only in defiling a continent; for all Europe soon reeked with a
plague too horrible for words. According to one description
"Many patients were .... covered .... with a
dreadful, foul, black eruption which, with the exception of the
eyes, left no portion of the face, neck, chest or pubic region
free. They presented such a repulsive and pitiable aspect that,
deserted and left in the open air a prey to every need, they longed
for nothing but death. Others in whom the disease caused scabs,
harder than the bark of trees, on the scalp, the brow, the neck,
the back of the head, the chest, the back and other parts of the
body, tried, by scratching, to free themselves of their pains.
Still others were so covered with papules and pustules that it
was impossible to determine their number. Phagedenic ulcers
destroyed the genitalia, the lips, the chin, the region of the eyes
and the bones. The ulceration even involved the esophagus and
many perished from starvation." (Griinpeck, Osier.)
In the past four hundred years the fury of the disease has abated
to an enormous extent, but even at the present moment its ravages
are terrific. Nevertheless, latter-day syphilis presents indications
of a tendency to become milder with each passing generation, an
opinion which I venture partly on considerations of immunity,
and partly on the basis of a long series of post-mortem observa-
tions at the New York City, New York and Hudson Street, and
Bellevue Hospitals — institutions which receive a class of patients
among whom syphilis is common; the disease, as a rule, pursuing
a course unobstructed by systematic treatment and favored by
vicious habits, and yet the destructive changes in the body are
far less marked than formerly. By this, however, I do jiot mean
to imply that antisyphilitic treatment is not doing an| immense
service to humanity in ameliorating individual attacks of syphi-
SYPHILIS, A DISEASE OF DIMINISHING SEVERITY 199
lis, for the combination of salvarsan, mercury, and the iodides,
intelligently applied, is, perhaps, the greatest single boon known
to medicine.
The severity of syphilis is not to be measured by its subjective
manifestations, which, nevertheless, are numerous and often in-
tense, but by the quality of the changes brought about in the
several organs of the body. Syphilis, as described by medieval
writers, was undoubtedly a septicemic disease characterized by
overwhelming intoxication and by widespread destructive changes
in the skin, mucous membranes, and bones. Death must have
occurred in the course of days or a few weeks at the longest. In
other words, the disease was exceedingly malignant, and of a
type so rarely encountered at the present moment as to be re-
garded in the light of a curiosity. Patients are occasionally ob-
served, even now, in whom the disease pursues a rapid course and
in whom specific treatment avails little or nothing, death occur-
ring in six months or a year, but even this variety of so-called
malignant syphilis is mild compared to the disease of the fif-
teenth century, while the usual course of modern syphilis is no-
toriously slow, measuring its progress by years rather than by
weeks or months.
In by far the greater number of cases observed by syphilog-
raphers of the present, treatment is partially or completely suc-
cessful in controlling the disease, or the disease controls itself
irrespective of treatment, for even in circumstances of neglect
the anatomical changes are often surprisingly mild and some-
times totally absent, as exemplified by positive Wassermann re-
actions during life without anatomical changes discoverable by
post-mortem examination. Thus, of 4880 subjects submitted to
careful post-mortem examination at Bellevue Hospital, ana-
tomical confirmation of the existence of syphilis was found in
only 314, or in 6.5 per cent. On the other hand, since the ad-
vent of the Wassermann reaction the test has been systematic-
ally applied in Bellevue Hospital, and of the enormous numbers
of patients thus investigated over 25 per cent., including many
in whom there were no reasons for suspecting syphilis, but in
whom the reaction was carried out as a routine measure, yielded
200 SOCIAL HYGIENE
a positive result. Comparable figures, I am informed, have
been obtained in other hospitals in New York City. In addi-
tion to the figure yielded by the Wassermann reaction, clinical
observation confirms the impression that syphilis is more com-
mon than post-mortem statistics indicate. In fact, the differ-
ence is so striking as to justify the conclusion that enormous
numbers of patients run the gamut of syphilis without sustaining
bodily injuries of a permanent nature. The pathological anat-
omy of syphilis of the aorta, for example, teaches a great lesson
in this respect; for, of 70 advanced cases minutely studied by
Dr. G. H. Wallace and myself, 24 of the patients admitted hav-
ing abandoned treatment after a few weeks or months, or of
having undertaken no treatment at all, and yet the structural
changes in this great vessel — the most vulnerable spot in the
whole body — arose only after the lapse of many years.
In 314 subjects of syphilis studied by myself at Belle vue Hos-
pital there were, of course, various combinations of disease con-
ditions in the organs. That syphilis by no means works its
ravages in the vital organs to the exclusion of less important
tissues, is shown by the fact that, in 41.7 per cent, of the Belle-
vue Hospital cases, the changes involved such relatively unim-
portant structures as the skin, the base of the tongue, the bones,
etc., while in the remaining cases (58.3 per cent.) syphilitic le-
sions were observed in the heart, respiratory system, and the
cerebrospinal axis. In certain of the latter cases the pathologi-
cal alterations were of slight or even negligible intensity, while
in others they gave rise to great suffering during life and con-
tributed in large measure to death.
Syphilis makes its debut in the form of a modest and appar-
ently harmless sore, which represents a localized inflammatory
reaction and marks the point of entrance of the infecting spiro-
chetae. By the time the chancre appears, however, the spiro-
chetae have not only entered the neighboring tissue spaces, but
have been so widely distributed through the body that the pa-
tient scarcely has time to respond to a sense of danger before his
tissues are overwhelmed by a horde of parasites.
The protective forces of the body, however, are not slow to
SYPHILIS, A DISEASE OF DIMINISHING SEVERITY 201
fall into action. In fact the chancre itself is the first defensive
barrier erected by the body, and, although it occurs too late to
stem the tide of infection, it is soon followed by regional and
then by general enlargement of the lymph nodes, representing an
incalculable increase in the number of cells available for phagocy-
tosis. That other and more subtle defenses are brought into
play is shown by the fact that the patient has already developed
resistance to a second inoculation by the same variety of spiro-
chete. That is to say, after the initial sore of syphilis makes its
appearance it is practically impossible to produce a second chan-
cre in the same body by reinoculation, and this resistance to a
second infection by the same organism is not only continued
throughout the disease, but its disappearance under treatment is
held to occur more or less synchronously with cure. Similar
results have been obtained with experimental syphilis in mon-
keys.
That syphilis is attended by local immunity in certain organs
has long been maintained, and there is a certain amount of evi-
dence in support of the contention. It is a matter of not infre-
quent clinical observation that, when the primary lesion of syphi-
lis is located in some portion of the genitalia, the course of the
disease is not apt to be marked by any extraordinary degree of
severity, but that, when the chancre is extra-genital, e.g., on the
finger or lip, as so often occurs in syphilis of the innocent, the
disease is not only attended by extensive destructive changes,
but is often more refractory to treatment than in ordinary cir-
cumstances. In order to explain these differences it has been
assumed that the spirochetae in their peregrinations through the
tissues of the genital region are in some manner reduced in viru-
lence or otherwise modified, whereas no such change is brought
about in tissues, which, ordinarily, are remote from the field of
contact and consequently unaccustomed to infection by the
spirocheta pallida. The doctrine of local tissue immunity as ap-
plied in this instance, is comparable to the observation that all
.infective diseases, including syphilis, pursue a much more active
course when freshly introduced among a strange people. There
are those, however, who maintain that syphilis of extra-genital
202 SOCIAL HYGIENE
origin is not recognized as readily as the genital variety, and
that the neglect thus occasioned is responsible for the increased
severity of the secondary changes, since genital sores are in-
stantly viewed with suspicion, while chancres in other parts are
apt to heal without exciting anxiety on the part of either patient
or physician.
However this may be, local immunity in syphilis is a well es-
tablished fact. In the human body the prostate gland seems to
enjoy absolute immunity, for in it structural changes due to
syphilis are, I believe, unknown. That certain other organs are
relatively immune is shown by the fact that, in the active stages
of syphilis, the spirochetae are universally distributed through-
out the body and yet the organs in question are seldom the seat
of syphilitic changes. In animals local tissue immunity is even
better exemplified, as in the experimental syphilis of rabbits,
where only the eyes and testicles are susceptible to structural
changes due to the action of the spirochetae, although every
other organ in the body is likewise teeming with living parasites.
Local tissue immunity, however, is by no means limited to syphi-
lis, but is a well recognized quality in a variety of other diseases.
For example, in disseminated tuberculosis the pancreas almost
invariably escapes, while in those not very rare instances of gen-
eralized distribution of secondary cancerous growths, certain
tissues frequently are spared, notably the spleen and the heart
and skeletal muscles, although in both tuberculosis and cancer
the organs hi question, in common with every other tissue
in the body, must have been equally subjected to the danger
of implantation.
Since the fact has been established that infection by the spi-
rocheta of syphilis so changes the tissues in man that reinfection
is impracticable, it appears to be probable that the insuscepti-
bility thus produced is capable of being transmitted in modified
degree, and that the gradually diminishing severity of the or-
ganic changes in syphilis is due to a process of vaccination car-
ried through an almost interminable progeny. The probability,
is supported by experimental evidence. For example, an attend-
ant at the Pasteur Institute noticed a small lesion on the lip that
SYPHILIS, A DISEASE OF DIMINISHING SEVERITY 203
was presumably due to contamination by one of the animals
infected with syphilis, and inoculations of material from the lip
into monkeys yielded a positive result. Nevertheless, neither
the attendant himself nor any of the inoculated animals, includ-
ing three chimpanzees, developed the symptoms of syphilis that
almost invariably follow the initial sore. On the strength of
this observation, Metchnikoff and Roux inoculated a non-syphi-
litic human subject with syphilitic virus which had been car-
ried through five generations of monkeys, and in him the result-
ing manifestations of syphilis were likewise exceedingly mild.
From experience of this sort it seems reasonable to infer that
passage through the lower animals may so attenuate the virus
of syphilis as to afford a possible means of artificial protection by
vaccination. While our knowledge in this regard is altogether
too limited to justify more than tentative conclusions, it is
strongly suggestive of a natural tendency on the part of syphilis
to afford relative protection to the progeny of parents in one or
both of whom syphilis is latent. It is to be concluded that a
child born in such circumstances is capable of being inoculated
by syphilis, but that the type of infection would be mild, and so
on, ad infinitum. This explanation may be invoked to account
for the positive Wassermann reactions which are not uncom-
monly obtained in individuals who present no signs of syphilis
during life and in whom post-mortem examination reveals no
anatomical changes indicative of the disease. For the same
reason, the conclusion is inevitable, I think, that the relative
mildness of latter-day syphilis is ascribable largely to widespread
contamination of mankind through almost countless years, and
that syphilization must continue in order that humanity may ul-
timately be purified, since eradication of the disease by artificial
means alone is obviously impossible.
SUMMARY.
1. There was a time when syphilis was an exceedingly vicious
disease attended by extensive destructive changes in various or-
gans resulting in rapid death. Latter-day syphilis, on the con-
trary, is essentially a disease of slow evolution, marking its prog-
204 SOCIAL HYGIENE
ress by years rather than by weeks or months, and is attended
by changes in the body that are comparatively mild and limited
in extent. Thus, post-mortem statistics affirm that less than 7
per cent, of bodies reveal anatomical indications of syphilis,
while in the living patient the Wassermann reaction is positive
in over 25 per cent, of all persons investigated. The difference
is striking, and justifies the deduction that many individuals be-
come infected by syphilis without sustaining bodily injuries of a
detectable nature. At the same tune it is a noteworthy fact
that, of all syphilitic lesions encountered at autopsy, a large per-
centage involves organs of negligible importance as far as life is
concerned, and that even syphilitic changes in such tissues as
the heart, brain, and lungs, are often compatible with life.
2. Clinical observations carried over a long period of years,
and studies in the immunity of syphilis, furnish highly suggestive
evidence in support of the view that mankind is extensively, if
not uniformly, syphilized in greater or less degree, and that, in
future generations, the process will become progressively milder
and ultimately assume a place among diseases of negligible
intensity.
PROSTITUTION IN ITS RELATION TO THE ARMY ON
THE MEXICAN BORDER
M. J. EXNER, M.D.
It is a matter of history that prostitution follows the army.
In all the European armies at the present time vice and its con-
sequences constitute one of the most serious, if not the most
serious, of army problems. In some of these armies the wastage
from venereal disease has been frightful. The reliable facts at
hand show that during the first eighteen months of the war
one of the great powers had more men incapacitated for serv-
ice by venereal disease contracted in the mobilization camps
than in all the fighting at the front.
From the standpoint of military strength and efficiency, such
waste is serious. From the standpoint of social wholesomeness,
it is more serious; for it means that not only will these men
bring back into the social structure a vast volume of venereal
disease to wreck the lives of innocent women and children, but
they will bring back into it other influences, attitudes, and
practices which will destroy homes, cause misery, and degenerate
society.
Is such physical and moral wastage inevitable? Is it neces-
sary? Some experience in connection with the army on the
Mexican border indicates that it is not.
It was my privilege to spend seven weeks among the troops
on the border and in Mexico. I visited all the principal mili-
tary camps; I dealt with a large number of men individually and
intimately with regard to their personal sex problems; I dis-
cussed the vice situation at length with many officers of the
medical staffs and with commanders; I secured official data with
regard to venereal prophylactic treatment and venereal disease ;
and I observed all the vice districts in company with compe-
tent guides. I shall briefly state some of my observations and
impressions.
205
206 SOCIAL HYGIENE
It was to be expected that se/rious conditions with regard to
prostitution would develop in connection with the army on the
border, unless prompt, vigorous, up-to-date measures for its
control were enforced. As soon as the order to mobilize went
forth, the vice interests in various parts of the country also be-
gan to mobilize their forces and to move them to the border.
In a number of communities in the vicinity of which troops
were located not only were the existing prostitution facilities
augmented, but new vice districts were hurriedly built. The
environment of practically all the camps quickly became, if it
was not already, such as presented the severest temptations to
immorality — an environment which only those who were power-
fully fortified by moral principle and will could withstand.
We must take account of the fact that under such circum-
stances the soldier is subjected to unusual moral strain, not only
from without, but also from within. Let us glance at some of
the reasons why this is so.
The vast majority of the men, especially the National Guard,
are in their adolescent years — many of them mere boys — the
period in which the developing love-instinct, with its strong
sexual element and driving desires, powerfully asserts, itself.
It is the period when desire is strong and the will is weak. It
is the period when the individual takes the reins of life into his
own hands and when he is driven by a strong urge from within
to try life for himself in every aspect in which it presents it-
self. If there is ever a time when the man needs every pos-
sible moral support and influence to steady him and keep him
true to his best self, this is the time.
Another factor which tends greatly to weaken the soldier's
moral resistance is the fact that he is away from the restraining
and supporting influence of the home and home society. He has
been uprooted out of his normal environment and transplanted
into one in which the most powerful influences pull the other
way.
Again, the man in uniform is a marked man. In civilian
clothes he is one of the common mass. The uniform sets him
off from the mass. Unfortunately, this works for the advantage
of the forces of evil more than of the forces of good.
THE ARMY ON THE MEXICAN BORDER 207
A factor which greatly enhances the moral strain upon the
soldier is the process of leveling down to the lower element to
which there is a powerful tendency in the military camp, or
wherever a heterogeneous body of men is gathered together
under conditions of enforced intimacy. In the tent or mess hall
it is as a rule the coarser element that creates the atmosphere
of the group. They take supreme delight in retailing their ob-
scene stories and giving expression to the foul imagery of their
minds in vulgar talk or jest. When we face the fact that, as yet,
for most young men these obscene conversations with their fel-
lows are about their only source of ready information on matters
of love and sex, questions in which they have a deep instinctive
interest and which they are burning to have interpreted, we can
better appreciate the sensualizing, distorting effect of such
an atmosphere. Those of us who know fully the degrading at-
mosphere that prevails in promiscuous male groups, such as are
found in the average military camp, can but have a pro-
found admiration for that small proportion of men who are able
to live in it day after day and month after month and success-
fully resist being drawn into lives of immorality. The terrific
down-pull of the military camp, as of all similar male group
life, cannot easily be exaggerated.
Loneliness also contributes to the cause of immorality in the
soldier. Nothing on the border impressed me more forcefully
than the loneliness-in-the-crowd of many of the soldiers. I
have seen hundreds of them walking the streets of border towns
at night, with the restlessness and gnawing of loneliness ex-
pressed in face and manner. Many have told me that they
visited immoral houses not .because of any strong craving for
immoral relations but because of their desire for sympathetic
companionship with the opposite sex, which desire is strength-
ened by absence from home.
The influences which we have enumerated, which tend to
weaken the moral resistance of the soldier, call for thorough
moral sanitation in the environment, so that the soldier may be
given a fair chance to keep his moral balance. Let us see what
has been the actual situation.
208 SOCIAL HYGIENE
Extensive prostitution in its worst forms was accessible to all
military camps on the border and in Mexico, in most cases
easily accessible, with the exception of outposts and a few points
where the evil was greatly reduced by vigorous repressive meas-
ures on the part of the military authorities. I will cite a few
typical examples. In doing so I shall indicate the communities
by letter, in order to avoid seeming to attach undue blame to
individual commanders. While many officers have not done
what they should have done and what they had authority to do
to minimize the evil, blame for the bad conditions which have
existed must rest much more largely upon the civil authorities
of the communities in or near which troops were located. How-
ever inadequate and misdirected the efforts of the military au-
thorities may have been, they at least did something, and while
that something did not lessen, for the most part, the practice
of prostitution, it did serve to keep venereal disease at a low
rate. The communities, on the other hand, so far as I know
without exception, not only failed to cooperate adequately with
the military authorities in suppressing prostitution or making
it inaccessible to the soldiers, but many of them vigorously op-
posed such measures on the ground that it would hurt business
or for political reasons.
Community A is a border town, on the outskirts of which
three military camps were located. In the town a district of
white and Mexican women was situated in which prostitution was
extensively practiced without restraint on the part of civil or
military authorities. One frequenter of the district estimated
that there were about fifty women in the district. One house of
seven women catered to officers only. Most of the houses were
unsanitary Mexican shacks, and in these the women were of very
low grade. At many of these places men were observed to be
standing in line to await their turn. Here, as at most other
points, the district was "regulated," by the military authorities.
The regulation consisted of compulsory examination of women,
on the average of once in two weeks, the patrol of the district by
the military police, and the enforcement of certain regulations
aimed at preventing serious disturbances. With the exception
THE ARMY ON THE MEXICAN BORDER 209
of three points, these regulations were not designed to restrict
the practice of prostitution, but only in a measure to reduce
its consequences and to avoid disturbances. In most places
guards were stationed in the houses of prostitution for that
purpose. That this sort of guard duty became thoroughly
demoralizing to the guards, goes without saying. They had
nothing to do but amuse themselves with the women, and as a
rule they became very familiar with them.
In this place many saloons were run in defiance of the "dry
law" and in the evening they were constantly crowded with
soldiers. While stalled in an automobile by the roadside one
pay-day evening, I witnessed for an hour and a half a constant
procession of drunken soldiers, reeling in the mud toward
camp. A large proportion of them seemed to be mere boys.
Community B is a town of about 15,000, where a consider-
able body of troops was located. It had three distinct vice dis-
tricts, a Mexican, a negro, and a white, the last having six
large houses with many women. During my two visits to the
white district, in company with a member of the military police,
a constant procession of soldiers was going in and out of the
houses. The negro district consisted of a large number of
scattered shacks. The Mexican district was so extensive and so
scattered that it was found impossible to prevent serious dis-
order by patroling it. Many fights and stabbing frays oc-
curred. Therefore, the military authorities issued an orde; for-
bidding soldiers to enter this district, and stationed guards to
enforce the order. It was strictly enforced, and I was unable
to find any soldiers in the district. This demonstrated the
ability of the officers to make prostitution inaccessible to the sol-
dier under conditions where the civil authorities refused to co-
operate in making it so, as was the case here. It would have
been a far easier task to have made the negro and the white dis-
tricts inaccessible to the men also, but they were permitted to
operate without restriction because in them it was possible to
keep down serious rowdying. The civil authorities were op-
posed to abolishing or restricting prostil ution because of political
complications.
210 SOCIAL HYGIENE
Community C is a border town in which the Mexican popula-
tion far exceeds the white. White, negro, and Mexican prostitu-
tion was extensive and operated without restraint by civil or
military authorities. My guide informed me that there were
five white houses, with from six to ten women each, — one pre-
tentious house of Italian women catered to officers only, — six
houses of Mexican women, many scattered negro houses, and
much clandestine prostitution.
The "dry law" seemed to be entirely disregarded. Beer
saloons operated openly, and some of them actually within the
limits of the military camp.
Community D is one of the large cities of the southwest, in the
vicinity of which at the time of my visit over 50,000 troops were
stationed. Here prostitution was carried on very extensively
without restriction beyond the usual "regulation." Not only
was the old notorious segregated district in full operation, but
an extensive new "crib system" had been built in another part
of the city. In but a very few cities in this country can any-
thing so bad be found. From noon until early morning soldiers
in great numbers were found in these districts. In the evening
they were thronged, and before many of the "crib" doors soldiers
stood in line.
In answer to questions, one of these women, who was below the
average in attractiveness, stated that on a good night she served
about 50 men, and that on the previous Saturday she had served
60, and on Sunday 40. We learned from reliable sources that
many other women served a much larger number. This woman
estimated that there were about 200 white professional prosti-
tutes in the city. This was probably much below the truth.
This does not take account of the Mexican, negro, and clandestine
prostitution, all of which was extensive. A military medical
officer of high rank, in trying to show that prostitution was
really quite limited, said "I do not believe that there are more
than 500 prostitutes in the city."
The chief medical officer of one of the divisions told me that a
few days before a prostitute came to a medical friend of his in
the city for treatment. She was found to be in the active stage
THE ARMY ON THE MEXICAN BORDER 211
of syphilis, and during the previous two days had had sexual
relations with 120 men.
Community E is a little, straggling village of huts, but when
troops were stationed on its outskirts provision for prostitution
was quickly made. It was carried on in unsanitary adobe
shacks, one section for white, and one section for negro women.
The striking feature here was that the district was situated
within the lines of military camps and was protected and " regu-
lated" by the military authorities. The only restriction to its
operation was that soldiers were not allowed to visit the district
within certain hours of the day.
I need not further enumerate examples. These are typical
of the whole border situation, with a few exceptions, of which we
shall speak later.
What seems to me to have been the most inexcusable situation
with reference to prostitution was found in connection with the
troops in Mexico. At each of the two points where the main
bodies of troops were located, a prostitution district was main-
tained within the lines of the camp and supervised by military
officers. No man could gain entrance to the district without
having a certificate showing him to be free from disease and
without the necessary two dollars. The women were housed in
adobe shacks, and, according to the statement of quite a number of
the men, they were for the most part repulsive Mexican women.
Many of the men were resentful because of the low order of
women provided. One man seemed to voice the sentiment of
many when he said "It's an insult to the troops. If they want
to provide something of the kind, let them give us something
decent."
When we consider that in these instances the military com-
manders had no established prostitution nor any complications
with municipal authorities to deal with, and that the men were
not allowed to enter Mexican communities, it is difficult to find
any excuse for the situation. In these instances prostitution
was deliberately provided by the officers, on the assumption
that it was necessary for the contentment or well-being of the
men. This was borne out in my discussion of the matter with
212 SOCIAL HYGIENE
officers. One cavalry officer of high rank attempted to justify
the matter something like this: "You must remember that we
have among the troops men of a very low order — men with
little brains and powerful passions. If prostitution were not
provided, these men would disobey orders, go to Mexican vil-
lages and get mixed up with the women and thereby possibly
bring on war." According to this officer's argument, prostitu-
tion was necessary to guard against the possible failure of mili-
tary discipline. He failed to see that to guard against the pos-
sible breach of discipline on the part of the lowest element,
which he admitted to constitute but a small proportion of the
rank and file of the troops, he would deliberately stimulate a
process of leveling down the whole body of troops to this low
element and increase the evil many-fold.
Let us now look at several points where prostitution was
more or less restricted by the commanders.
Community F was a small border town where several regi-
ments of southern troops were located. As soon as the camp was
established, a " syndicate" proceeded hastily to knock together
a long board shack, partitioned off into " cribs" for prostitution
purposes. The chaplains together sought to secure an injunction
against this venture, but the district judge said that nothing could
be done. It was discovered that in the absence of the judge from
his district, the judge of a neighboring district would issue an
injunction. Taking advantage of this, the chaplains secured an
injunction, and the building stands unfinished today. Prosti-
tutes who had come to occupy it left town. Unfortunately
nothing was done to put a check to the Mexican clandestine
prostitution which was very extensive and very bad. A large
amount of venereal disease contracted in the mobilization camps
had been brought with the troops so that practically all the
prostitutes quickly became infected, and a high venereal rate
existed among the men.
Community G is a border town of considerable size, where a
large body of regular troops and guards from southern states were
located. Existing prostitution facilities were being augmented,
when the post commander demanded the immediate abolishing
THE ARMY ON THE MEXICAN BORDER 213
of all segregated prostitution on threat of removing the troops
to another locality. Needless to say, the civil authorities com-
plied with the demand, and most of the women left town. Un-
fortunately here, too, the problem was thereby considered solved,
and the more serious one of clandestine prostitution was not
touched. Here, also, this was complicated by the fact that a
large amount of venereal disease was brought to the border
from the mobilization camp in the vicinity of large southern
cities and that therefore the prostitutes became quickly infected.
At the time of my visit, three southern regiments had just ar-
rived. On inspection one revealed forty-three cases of venereal
disease, and the second thirty-seven cases. The third had not
yet been examined.
Camp H, in which a very large body of troops was stationed,
was situated practically in the desert near a very small com-
munity, in which open prostitution did not exist, and some miles
away from other small communities. Here, therefore, prosti-
tution was difficult of access, not so much by virtue of repressive
measures, but by virtue of location. One house of white women
was operating near a smaller camp some miles away, and there
were no very ready means of transportation.
Camp I was a large camp, located near two small towns.
Here, also prostitution and saloons sought to establish them-
selves. But the commander suppressed both absolutely with an
iron hand and never relaxed his vigilance. As fast as any
sources of prostitution or of the sale of intoxicants could be lo-
cated, he got rid of them assuming the authority to do so when
he did not technically possess it, on the ground of military
efficiency. Prostitution was practically inaccessible to this large
contingent of troops, except as a few men might secure leave to
visit larger centers many miles away. An example of the com-
mander's methods may be of interest.
A saloon keeper opened a saloon near the camp. The com-
mander told him he could not sell "booze" to his men, and ad-
vised him to move on. The saloon keeper replied "I have my
license; you cannot stop me." The commander again assured
him that he could not sell liquor to his men, and again advised
214 SOCIAL HYGIENE
him to leave. The saloon keeper answered "I'll show you."
The commander issued an order that no soldier should visit the
place, and stationed a guard before the door to enforce the
order. The saloon keeper remained a week, after which he
departed, not being able to do any business. At no other point
were vice and drink so consistently and thoroughly suppressed.
Now, it will be of interest to inquire what has been the re-
action of these repressive measures on the men in this command.
According to the arguments of many officers, in support of pros-
titution, we should expect extreme discontent, clamoring for
prostitution facilities, revolt, mutiny. The facts are, that no
more contented, more orderly, better disciplined, better trained,
more efficient, or more loyal body of troops could be found any-
where on the border. These facts can readily be verified from
anyone conversant with the situation. Furthermore, these men
were proud of the moral reputation of their regiments. Many of
the men said to me, with a ring of pride, "Oh, we have a clean
bunch here." This feeling of group pride was everywhere con-
spicuous among the military units of this camp, and was in it-
self a great restraining influence. It was unique; I found it
nowhere else. The fact that prostitution was actually not in-
dulged in to any extent by these men is shown in that this camp
had by far the lowest prophylaxis rate as will be seen later.
This thorough test of the application of repressive measures
with reference to prostitution and drink with so large a body of
troops for so long a time, is sufficient utterly to refute the con-
tention of so large a proportion of army officers that sexual in-
dulgence is necessary for the contentment and well-being of the
men. The soldier is human, and men in the unstable period of
adolescence, under the unusual moral strain incident to mili-
tary service, cannot be expected to keep clean when prostitution
in its most flagrant forms is placed right under their noses, with
the sanction and encouragement of their officers. But give them
a reasonably wholesome environment and place a high value upon
clean manhood and moral integrity, and they will measure up to
what is expected of them and of their own better selves, just as
did the men of Camp I.
THE ARMY ON THE MEXICAN BORDER 215
It is pretty generally known that the army has been employing
a system of venereal prophylaxis, aimed at reducing the amount of
venereal disease. This has been carried out with fair consistency
on the Mexican border. Every soldier who has sexual relations
with a strange woman is required to report to the medical officers
to receive prophylactic treatment within six hours. If a man
contracts venereal disease and the records do not show that he
reported for prophylaxis, he is arrested, his pay is taken from
him, and he is deprived of other privileges. It is a policy to
treat the man who contracts venereal disease under these condi-
tions with very little sympathy. This system seems to be work-
ing fairly satisfactorily. While a good many men depend upon
prophylactic measures of their own, and others take the risk
without any, probably two-thirds of the men actually do report
for treatment. These records give us an approximate idea of
the actual extent of prostitution. I have worked out the data
on the basis of a monthly rate, though the records secured cover
periods varying from a month to four months. The monthly
rates of prophylactic treatments were as follows: —
Monthly rate
per cent.
Camp 1 0.566
Camp H 3.78
Camp E 11.2
Camp B 14.0
Camp F 15 . 4
Camp C 16.56
Camp G 20.4
We see from these figures that the two Camps I and H, in
which prostitution was most inaccessible to the men, had by far
the lowest prophylaxis rate — 0.566 per cent, in Camp I, and 3.78
per cent, in Camp H, as against from 11 per cent, to 20 per cent,
in the other camps. Experience on the border clearly establishes
the fact that the extent of prostitution is in direct ratio to its
accessibility.
One of the most interesting and most significant facts which
this study brings out is the apparent success with which the sys-
tem of prophylactic treatment is meeting in preventing venereal
216
SOCIAL HYGIENE
disease. Whichever way our sympathies may lie in the discus-
sion of the desirability of "making prostitution safe" by em-
ploying prophylactic measures, we must take account of the
fact that it does actually seem to accomplish the reduction of
venereal disease in large measure, and we cannot escape the con-
clusion that this is, in itself, a great social gain. One can
but be impressed with the very low venereal rate found among
the troops as compared with the extent of sexual indulgence and
with the venereal rate which was common before such measures
were employed. By far the largest proportion of venereal dis-
ease found among the troops was contracted in the mobilization
camps before prophylactic measures were instituted. The vene-
real rates of cases contracted on the border, of the units from
which I was able to secure them, follow: —
CAMP
NUMBER OF
MEN
PERIOD
NUMBER OF
NEW CASES
NUMBER OF
OLD CASES
AVERAGE
MONTHLY HATE
OF NEW CASES
months
per cent.
1
7,000
2|
3
32
0.017
H
2,850
4
3
17
0.026
D
12,928
1
28
Not given
0.216
B
1,244 -
4
9
20
0.4
C
1,019
2*
8
8
0.31
G
1,165
2
19
Not given
1.63
The column marked "old cases" represents cases of disease
brought to the border from the barracks or mobilization camps,
and contracted before prophylactic measures were instituted.
They are not included in figuring the rate. The record of old
cases is not very accurate. Some regiments not given here
brought a much larger proportion of cases to the border. I
have already stated that at the time of my visit two regiments
had just brought 80 cases to Camp G. There were 7000 men
in this camp on October 1, and at that time 134 cases of vene-
real disease were found on inspection. This includes the 80
cases just mentioned. One southern regiment of which I know
developed a frightful venereal rate in its mobilization camp,
near one of the big southern cities. It had 76 new cases at one
time.
THE ARMY ON THE MEXICAN BORDER
217
The following record of prophylactic treatment and venereal
cases of a regiment of regulars covering nearly two-and-a-half
years, a record kept with great accuracy, further shows the
effectiveness of venereal prophylaxis.
MONTH AND YEAR
STRENGTH OP
REGIMENT
NUMBER OP
PROPHYLACTIC
TREATMENTS
VENEREAL
CASES
May, 1914 827
June, 1914 757
July, 1914 700
August, 1914 684
September, 1914 726
November, 1914 824
December, 1914 788
January, 1915 723
February, 1915 653
March, 1915 744
April, 1915 791
May, 1915 788
June, 1915 793
July, 1915 811
August, 1915 841
September, 1915 839
October, 1915 840
November, 1915 815
December, 1915 800
January, 1916 833
February, 1916 940
March, 1916 927
April, 1916 921
May, 1916 913
June, 1916 900
July, 1916 901
August, 1916 1004
September, 1916 1068
October, 1916. . . 1046
53
103
146
178
196
227
151
278
379
354
397
678
663
657
523
490
332
305
350
402
450
370
405
450
285
372
280
420
450
11
5
5
8
4
3
5
9
5
18
Upon comparing the venereal rate under prophylactic treat-
ment with the amount of indulgence in prostitution, as indi-
cated by the prophylaxis rate, we find it surprisingly low. We
cannot escape the conclusion that venereal prophylaxis as now
carried out in the army proves effective in large measure.
It is significant that the two camps in which prostitution was
most inaccessible have by far the lowest venereal rate.
218 SOCIAL HYGIENE
We have shown the limited extent to which prostitution on the
border was suppressed or rendered inaccessible to the soldiers.
Why was this so? What has been the attitude of the military
authorities? It would be unfair to say that it was one of indif-
ference. It is known that the Secretary of War at Washington
was seriously concerned over the government's responsibility to
the troops in this matter; that he made himself conversant with
the facts, and that he made urgent recommendations and specific
suggestions to the commanders of posts with reference to mini-
mizing prostitution on the border, and that he gave them au-
thority to change the location of their troops, if necessary, to
accomplish that end. Had these recommendations been fully
carried out, we should probably have come nearer to solving the
prostitution problem on the border than has ever been done in
relation to any army. Why was it not done? While indif-
ference, or worse, must be ascribed to some officers, it would
be unjust to ascribe indifference in the matter to most of the
officers of rank who were in command of large bodies of troops.
For the most part the commanders of troops and the chiefs of
medical staffs were deeply concerned about the problem of pros-
titution, but they were concerned almost wholly about its re-
sults, not about prostitution itself; and all their energies were
directed to minimizing venereal disease. I rarely met an
officer who did not take for granted that prostitution could not
or should not be abolished. They assumed that it is neces-
sary for the contentment and well-being of the men, or, at least,
that it is inevitable. Many a medical officer told me, with
great pride, of what he regarded as his up-to-date manner of
dealing with the problem — inspection of prostitutes, prophylactic
treatment of exposed men, and lectures on venereal disease.
Whenever I suggested the possibility of attacking not only the
results of prostitution, but prostitution itself, I was looked upon
as "too idealistic," or as a dreaming, unpractical reformer.
With but rare exceptions army officers, both high and low, are
unfamiliar with modern studies of prostitution, such, for ex-
ample, as have been made by the Bureau of Social Hygiene,
and with modern methods of dealing with it. Segregation of
THE ARMY ON THE MEXICAN BORDER 219
prostitutes, a method which has been so completely shown to
be ineffective, that it has not even a crutch to stand on, is
generally regarded as the best solution of the problem.
In closing I wish to sum up some of my observations and
conclusions : —
1. The experience on the Mexican border shows that, so long
as the handling of the problem of prostitution as it affects the
army, is left to the discretion of the individual commanders,
there can be no hope of a satisfactory solution. Their attitude
is too varied, and their knowledge of the problem too backward.
There is needed as clearly defined a policy of moral sanitation
as the government has of physical sanitation, and that policy
must be made effective in uniform procedure through military
order from headquarters. Any policy with reference to this
question to be sound, or effective in preserving the moral in-
tegrity of the soldier, must be based on the assumption that
sexual indulgence is unnecessary.
Prostitution in relation to the army is a question with which
the citizens of this country as a whole must more fully concern
themselves, for it is not likely that the army will proceed in
advance of public opinion and demand.
2. The extent of the practice of prostitution is in direct ratio
to its accessibility. Large numbers of men are drawn to the
segregated vice districts from curiosity who will not seek pros-
titution when it is inconspicuous or difficult of access. I have
shown that by far the lowest proportion of illicit indulgence was
found in the two camps where prostitution was the least
accessible.
3. The repressive measures enforced against prostitution in
Camp I, with completely happy results, clearly show the incor-
rectness of the contention that prostitution is a necessity in
connection with the army. The proportion of men who rebel
at such restrictions and will seek prostitution at whatever cost
is comparatively small. My observation leads me to believe
that while the problem at some other points was more complex,
a consistent application of similar methods at these points would
have reduced the evil at least 75 per cent.
220 SOCIAL HYGIENE
4. The most serious problem is in connection with the mobi-
lization camps and home barracks. In the case of all the troops
on the border, a vastly larger proportion of venereal disease was
contracted before reaching the border than was contracted
afterwards. This accords with the experience of the European
armies in the present war. A policy of timely education, re-
straint, and prophylaxis, in connection with mobilization is
imperative.
5. The venereal prophylactic measures carried out in the army
have in large degree proven effective in preventing venereal
disease. This has been a gain not only in army efficiency, but
apparently a great social gain. But to regard this as the whole
problem is to be very shortsighted. From the social point of
view the question is not only one of the effect of venereal dis-
ease upon the social body, serious as that is. The more far-
reaching evil is the state of mind and of character which lies
back of it. The greatest evil to society results from the shat-
tered ideals, lowered standards, sensualized minds, and per-
verted practices, which are brought into home life and society — •
by these men who represent in large measure the cream of the
young manhood of the nation. To safeguard the home and
society against these basic evils, we must not only abolish vene-
real disease, but we must minimize, so far as possible, prostitu-
tion itself.
THE GIRLS ON THE BORDER AND WHAT THEY DID
FOR THE MILITIA
ELIZABETH BOIES
Secretary, Department of Method, National Board of the Young Women's Christian
Associations
"Were there any girls on the border?" is the first question
which rises in the astounded reader's mind. If asked to de-
scribe the border the average civilian would probably say,
"Well, there is the Rio Grande, something like the Hudson I
suppose, and the rest must be desert and sage brush, and of
course there are the soldiers and the Mexicans." The very-
last item he would think of would be girls. The first shock to
one's preconceived ideas of the border is that in summer the
Rio Grande is more like a narrow stream than the Hudson,
and the second surprise is that in certain places on the border
there are a great many girls.
From years of experience with girls and from an intimate
knowledge of the course of reasoning of wage-earning women and
girls, the National Board of the Young Women's Christian As-
sociations had a strong suspicion that wherever conditions of
life are abnormal, there will be found girls and there will be need
of friendly service and protection. Consequently the last week
of June, when men and supplies were being rushed to the south-
west, and when the Young Men's Christian Association was
building recreation huts in the camps and sending men down to
run them, the Young Women's Christian Association was un-
dertaking to help meet a national situation by looking out for
girls in those border towns.
Following an unwritten law that any plan of work must be
based upon accurate first hand information and knowledge of
conditions and needs, two Y. W. C. A. secretaries were sent to
visit and study the border from Brownsville on the Gulf to
221
222 SOCIAL HYGIENE
Nogales and were given power and funds to establish any work
which would meet the need of special protection.
The border towns, large and small, in July were beehives of
industry. Not only were thousands of troops going borderward,
but clothes and food were being shipped in and had to be
handled. The shopkeepers were overrun with militia buying
souvenirs and postcards to send home. Every person wished
he or she were three instead of one. No one was thinking of
the future ; there were so many more things to be done each day
than could possibly be done — so many obvious things. Train-
loads of dirty and travel-tired soldiers were passing through
the cities and it required all the energy and patriotism of the
women to provide sandwiches and coffee for the militia in the
middle of summer. Swimming-pool and rest-room projects to
relieve the discomfort and monotony of desert life in the midst
of summer were uppermost in people's minds. And so people
were at first surprised, or indifferent to the questions which
were asked by the two Y. W. C. A. workers: "What about the
life of girls and young women in the town? How many girls
are there and how many are living away from home? What
are the home surroundings, the home influences? What is
there for a lively up-and-coming girl to do with her leisure
time?" The reply was usually a blank stare and the assertion
that they felt there was little cause for concern.
After two or three weeks of investigation, which consisted of
conferences with everyone from the girls themselves, their
mothers, and their school teachers to probation officers and
chiefs of police, two distinct types of communities stood out.
The first is best illustrated by the towns in the lower Rio Grande
valley — the small towns of perhaps a few hundred or a few thou-
sand white inhabitants. In these towns there were compara-
tively few girls, and still fewer working girls and girls living
away from home. There were individual cases where a friendly
hand was needed, but this could usually be supplied by some
socially-minded woman in the town, and, in general, public
opinion and home influences had a fairly strong restraining in-
fluence. The fact that the commanding general had almost
THE GIRLS ON THE BORDER 223
complete control of the life of the militia while off duty as well
as when on duty, exercised a very effective tonic on the morals
and sobriety of the town, and the conditions from the point of
view of young women were less serious.
The situation was different in the larger cities. There the
complex conditions of city life, the ease with which liquor could
be bought, the freedom which a city permits and the sense that
one is unknown, added to the presence of hordes of the army and
the militia in the streets when off duty, created a different at-
mosphere. Here the normal restraints of family and friends
were weak. One found all types of girls — girls who were restive
under family restrictions, and who availed themselves of every
chance to get out from under them; girls whose homes were
small and bare and who had no place to see their friends except
on the street. There were considerable numbers of recently
arrived working girls in these cities, for it was known that times
were good and that jobs were plenty. The girls at home and
those from away were all alike in one or two respects; they had
the hopes and ambitions that girls have everywhere. They
wanted pretty clothes and good tunes. There was very little
in the way of clean, wholesome amusement. As one girl said,
" There's nothing to do but go to the movies or sit at home and
rock." And most girls do not care to rock much when down
on the streets there is companionship, something going on, bright
lights, and the social soda fountains. Here too was found that
type of girl familiar to every city west of the Missouri and the
lower Mississippi — the migrant girl who is seeing the country
and working her way at the same tune. She may stay for a
few weeks or a year or two but when she has saved a little
money she will move on. The western communities produce
different types of girls just as they do different types of men.
As the secretary directing the work in one of these cities said:
"I have never seen so many young girls fifteen to eighteen
with no one to care for them — most of them married and all with
life stories." The psychology of the working girl, old or young,
is different from that of her sister who has lived a protected life.
She covers up her real feelings under a mask of assumed in-
224 SOCIAL HYGIENE
difference. She is distrustful and suspicious of people, and
particularly of her girl acquaintances about her. "Every
friend I have ever had has let me in bad." She has had many
hard knocks and one can hardly blame her for the desire to
"get everything that is coming to her." She has a philosophy
of life far beyond her years, but underneath is a loyalty and a
straightforward honesty and uprightness that can be developed
and turned to better purpose.
Though the casual person might have seen no occasion for
special protection for the girls in these border towns, an observ-
ing man or woman saw beneath the surface, and as one said,
"I am greatly concerned for the future; the situation has poten-
tialities for evil and disaster for our young women." There were
others who voiced that same feeling, sometimes a school teacher, a
policewoman, a physician, or a business woman, who felt re-
lieved to share their anxiety with one who had had experience
with such situations. All pledged themselves to help in any
work that would help to give girls higher ideals and a desire to
make the most of themselves.
It was decided to open three centers in those places where
there were the greatest number of girls — San Antonio, El Paso,
in Texas, and Douglas, Arizona. In the first two there were
local Y. W. C. A.'s established so that headquarters were al-
ready available. Additional workers of experience were secured
from different parts of the country to inaugurate a city-wide
work. Two objectives were behind the opening of these centers.
One was to organize the wage-earning girls and young women
of the city into self-governing clubs which should have educa-
tional, recreational, and social service features; to enlist the
older business woman to protect and feel responsible for the
young girl just entering a wage-earning career; to bring to each
a sense of comradeship with other working women and a sense
of her opportunity to help make her city a better place to
live in.
The second objective was more difficult to achieve. After
visiting the dance halls and movies and watching the street life
with its limitless temptations, it was evident that the work was
THE GIRLS ON THE BORDER 225
only half done unless recreation was standardized, and the
girls given a chance to meet young men friends under proper
auspices. The Young Women's Christian Association recog-
nized the fact that girls and boys would meet, that they were
already doing it on the street corners and in the parks. It
seemed urgent to provide a place where girls could bring their
friends as they would do in their own homes. The Young
Women's Christian Association wanted to go further and to
provide wholesome parties and good times. The need was ex-
pressed on all sides. "Wont you get up a party so that my men
can meet some nice girls?" was the frank request of a captain
to the president of the Young Women's Christian Association.
So the secretaries put it up to the club girls that they were
hostesses for the men who had come to the border from other
parts of the country and that these men would go back to their
sisters and friends and wives and would tell about the kind of
hospitality that the southern cities had given them. Each
girl was made to feel that it was her responsibility to treat the
boys and men as they would like to have their brothers and
friends treated, were they sent to a northern city, and to make
the boys want to report the very nicest things that a man could
say about a girl.
After a survey and districting of the business section of the city
and a personal visit and talk by one of the secretaries, clubs were
organized in every one of the larger stores, factories, and offices
and among girls of leisure as well in San Antonio. Coming
directly from work, the girls first had a ten-cent supper at the
Association building, then met for a business meeting followed
by some course of study which the club had decided upon such
as Household Economics, Travel Course, First Aid to Beauty,
Citizenship, or First Aid and Home Nursing. At the end of
the evening all the clubs in the building would come down to the
gymnasium and swimming pool.
Through the club girls a series of socials was planned, to
which the militia men were invited whom the Y. M. C. A.
knew. A party a week did not get around the regiments fast
enough, so there had to be two, and then the men showed their
226 SOCIAL HYGIENE
appreciation by asking that they might entertain the girls and
the committee of volunteers who had helped them. The Third
and Fourth Illinois Infantry were not satisfied with anything less
than the best that the city afforded, a banquet at the Gunter
Hotel, where General and Mrs. Funston were the guests of
honor.
The Christmas entertainments were highly appreciated. The
very thought of Christmas away from home was " sickening,"
and so general was the dread of the holidays that special effort
was made to entertain the men. On the 23d of December, men
from the medical corps in the base hospital were invited for a
candy pull; on Sunday, soldiers came to Vespers and stayed to a
simple supper which seemed wonderful to them because of
" table cloths, butter, and real coffee." Christmas day the
Y. M. C. A. planned activities at camp while the Y. W. C. A.
invited to their building through newspapers, posters, and per-
sonal letters all girls who were away from home. Then the parties
continued — "Virginia, New Hampshire, and the Texas Engineers
were combined on one night; Washington and Mississippi, the
next; the Third and Fourth Illinois on Thursday; Friday the
Wisconsin troops; and Saturday the West Virginia men. Each
group had prepared its stunt and was much concerned over its
success, and every group brought its band.
The men were so eager to come that they usually arrived an
hour before time and had to be turned loose in the gymnasium,
or were pressed into service to help. The five big army trucks,
always spilling over with men, got the habit of drawing up in
front of the Y. W. C. A. building, and as the men stood massed
in a solid block waiting to go into the building it was an im-
pressive sight. It was from the little incidents and the hearty
enthusiastic response of the men that one realized how worth
while it all was. As one of the army Y. M. C. A. secretaries
said, "It is impossible to estimate what the Y. W. C. A. has
meant to the men." The men seemed to respond and to under-
stand just what their relation to the girls was and they did a
great deal in helping to make that effort of the Association
what it was intended to be, constructive wholesome recreation.
THE GIRLS ON THE BORDER 227
When there was a party every day in the week there were not
enough girls to go round, but every one had such a good tune
and the spirit of Christmas was so evident that it did not matter.
In that short week about a thousand girls entertained fourteen
hundred men, and that was not the end, for social affairs con-
tinued and in addition there were many affairs given by different
groups of men and chaperoned by the club leaders and secretaries.
A soldier was overheard to say to another, "I haven't met a
decent girl since I have been in - — ." "Why," said the other
one, "hasn't the Y. W. C. A. entertained you yet? WeU! I
suppose they haven't gotten to your regiment, but they will."
Through these parties the men were introduced and invited to
homes in the city and made to feel that the city welcomed them
in the friendliest spirit.
The two other centres had similar activities, showed equal
ingenuity in enlisting the leadership of the girls in their cities
and in offering hospitality to the militia. El Paso equipped an
outdoor recreation centre for tennis and roller skating. Re-
ceptions were given to the wives and mothers and sisters of the
militia, who often came to the city knowing no one in it.
In Douglas, nothing had been done for the girls and young
women there and the city was "dead" so far as clean amuse-
ment for them was concerned. A Young Women's Club was
organized in September and a director installed. The club now
has more than one thousand members, representing all groups
in the city — rich and poor, old and young, from the girls selling
near-beer to the young society matron and the Red Cross nurse
from the army hospital. At the initiative and under the direc-
tion of the club, the first community Christmas celebration took
place in Douglas, the army band providing the music and a very
large chorus of townspeople the singing — the tree being brought
for miles across the desert from mountains in the east.
The question will be asked — "Was it all worth while?" It
was a great expenditure of effort for just parties, and clubs, and
band concerts, and good fellowship. Would the Y. W. C. A.
do it again, and are there any lessons that can be learned from
this experiment?
228 SOCIAL HYGIENE
There is one conviction that every Y. W. C. A. secretary had
and that is that the army life is not necessarily evil, but that
exploitation, environment, and deadly monotony are responsible
for much of the immorality that is traditionally supposed to be
inherent in it. One thing is fundamentally true and that is
that boys will seek pleasures, and if good fun is not available
they will turn to the unwholesome. Time off even though it-
may come only every third day means that nearly one-third of
the camp will be in town, sitting on the benches and literally
covering the carefully-nurtured green grass in the parks. It is
natural that normal girls should want men friends, and that
men should welcome an opportunity to get acquainted. The
importance of the whole situation is that the acquaintance may
have something more of dignity than picking up a friend in the
movie and wandering home at a late hour by devious ways.
To the National Board of the Y. W. C. A. the work on the
border seemed supremely worth while, not only from the men's
point of view but from the girls'. The situation for the young
women was saved through placing upon them the responsibility
for hospitality to the visiting troops.
WHAT ENGLAND IS DOING FOR THE VENEREALLY
DISEASED
The National Council for Combating Venereal Diseases
Report of a Meeting at the Mansion House, London1
A meeting at the invitation of the Lord Mayor of London, to
consider an urgent problem of national health was held under
the auspices of the British National Council for Combating Vene-
real Diseases at the Mansion House, London, on Tuesday af-
ternoon, October 24, 1916. In the unavoidable absence of the
Lord Mayor, the chair was occupied by the President of the
Council, Lord Sydenham of Combe, G.C.S.I., Chairman of the
Royal Commission on Venereal Diseases. The meeting was
also addressed by Mr. Walter Long, M.P., President of the
Local Government Board, Mr. Herbert Samuel, M.P., Secre-
tary of State for Home Affairs, Mr. A. F. Buxton, Chairman of
the London County Council, and Sir Thomas Barlow, M.D.
The President: Mr. Samuel, Mr. Long, ladies and gentlemen, the
Lord Mayor has asked me to express his great regret that he can not
be with us this afternoon. He has gone to pay a visit to the Grand
Fleet, and this was the only day on which that visit could be paid. I
am quite certain we shall not grudge him the privilege of seeing that
magnificent spectacle. The Lord Mayor has asked me to take his
place, and I do so with the very greatest diffidence, feeling certain it is
impossible for me in any adequate way to fill the gap which his absence
1 This report is printed by courtesy of the British National Council for Combat-
ing Venereal Diseases. It embodies in outline the measures proposed to give
effect to recommendations of the Royal Commission on Venereal Diseases, es-
pecially those having to do with a provision, at public expense, of facilities
for the diagnosis and treatment of these diseases. Plans for carrying into effect
the requirements of the Local Government Board for such provision, noticed in
SOCIAL HYGIENE, October, 1916, have been worked out by the London County
Council's Public Health Committee, effective January 1, 1917, and by the public
authorities of many other cities and counties.
229
230 SOCIAL HYGIENE
has created here this afternoon. The National Council is most grate-
ful to the Lord Mayor for lending us this magnificent and historic hall
to enable us to discuss this most important question; and also for all
the kindly interest which he has shown in our work. I imagine that
never before has a meeting been held at the Mansion House to deal with
this most painful but all-important national question. It seems to me
therefore, that, perhaps, a special significance attaches to this meeting,
because it may mean the end of a long conspiracy of silence which has
done infinite harm to the cause (Hear, hear), by forbidding the spread
of necessary knowledge, by creating some false ideas of duty, by alien-
ating sympathy where sympathy was due, and also by preventing the
adoption of valid measures for combating what we feel to be a gigantic
public evil.
In 1913, His Majesty's government, in response to a strong request
of a number of men who had realised the terrible effects which venereal
diseases were producing in our midst, appointed a Royal Commission
to investigate all the circumstances, and to propose remedial measures.
In this country, and in some foreign countries, there had been previous
partial attempts to deal with the problem, but the degree of success had
been exceedingly small, and nowhere, until this Commission was ap-
pointed, had a real effort been made to deal with the whole question on
the broadest possible lines. The Commission took a great mass of evi-
dence, and initiated some further investigations of its own, some of
which led to very startling results. We were unanimous on every es-
sential point, and our main conclusions amounted, really, to two : a
grave warning, and a message of hope to the nation.
For reasons arising, mainly, out of this unfortunate silence, which
must now be abandoned, we found it quite impossible to arrive at any
accurate statistics as to the prevalence of the diseases among the civil
population, but we found it is much larger than has generally been ex-
pected, because it is only in recent years that a large number of other
ailments and of mental and physical defects have been traced directly
to venereal disease. And I am afraid it is certain that as medical sci-
ence progresses, and as further investigations into this subject are car-
ried on, that there will be a large addition to the number of diseases
which are, directly or indirectly, connected with those which we are
met to consider. The picture which slowly unfolded itself before the
eyes of the Royal Commission was darkened by tragedies of many
kinds. The effect of acquired venereal disease on individuals is creat-
ing national loss on a very large scale, both by shortening life and by
WHAT ENGLAND IS DOING 231
reducing working power, with the result of an immense total annual
economic loss to the country.
There has been a tendency, as you all know, to regard these diseases
as the just punishment of the vices of the individual who has acquired
them. That view is not tenable in the light of the knowledge that we
possess, and I hope it will be abandoned. (Hear, hear.) Such disease
may be, and is, every day, acquired by persons who are completely and
absolutely innocent. Then we must remember that the effects of the
many congenital manifestations of these diseases defy all estimate, and
from the national point of view, they are probably more insidious than
the effects which arise from direct infection. Sterility, still-births, in-
fant mortality "are all largely due to venereal diseases: and Dr. Mott,
whom I am glad to see on the platform, and whose great knowledge
was most valuable to the Royal Commission, investigated a number
of family histories, which show the appalling results of the in-
fection in one or other of the parents. In one series of 34 infected
mothers, there were 175 confinements, which yielded 104 infant deaths,
41 seriously diseased children, and only 30 apparently healthy, who may,
for all we know, develop the disease at a later stage of their lives.
Then there was another investigation, of 150 families. There were, in
them, 1001 pregnancies, with 172 still-births, and 229 infant deaths:
and of the 600 children who lived, 390 were diseased. In other words,
of 1001 potentially healthy children, there were only 210 apparently
immune, and even they, as I said before, may show some symptoms at
a later period of their lives.
Now anyone who reflects upon those figures must realise the appall-
ing loss and suffering caused by these diseases; and they must realise
also, that these diseases are playing a great part in filling our hospitals
and infirmaries, our blind and deaf schools, and our lunatic asylums.
I will not trouble you with any more figures on the part of our re-
port, which constitutes the warning to which I have referred.
The other main conclusion at which we arrived is, that we now have
wonderfully accurate methods of diagnosing these diseases, and also
singularly effective means of treatment if the treatment is given at the
earliest possible stages. And that, ladies and gentlemen, is our mes-
sage of hope. And we believe that if our proposals are adopted, and
if the people of this country can be brought to see the grave danger
which arises from these diseases, and to know that early treatment is
vital; if there is to be any hope of cure, then we think that, in time,
these diseases can be brought under full control, if not stamped out
232 SOCIAL HYGIENE
altogether. (Applause.) Of all the diseases which afflict humanity,
there are none which inflict greater injury to public health as a whole.
But also, fortunately, there are none which respond so readily to treat-
ment of the right kind, given to the patient at the right time. I sup-
pose that our great offices of state must have some receptacles filled
with Blue Books, compiled with the utmost care and at great public
expense, mines of information almost wholly wasted, but full of pro-
posals of public importance which the public never heard of. That
was not the fate of our report. Very soon after it was issued, we ar-
ranged a deputation to Mr. Long. Mr. Long received us with welcome
(Hear, hear) and showed us that he fully understood the gravity of
the situation, and that he was prepared to take immediate steps to
cope with it. And the first necessary step of all, without which all
other steps must be futile, is to provide treatment-centres, where the
best treatment can be given, and to provide, also, laboratory facili-
ties where diagnosis can be rendered available to all medical officers.
It is essential, we thought — and I think you will agree with me — that
the treatment should be free, that there should be no public stigma at-
tached to those who seek that treatment, and that it should be made
available at such hours as will meet the needs of the working classes
(Hear, hear.) The Treasury accepted the proposal that 75 per cent,
of the cost of these treatment centres and laboratories should fall upon
state funds, and that the remaining 25 per cent, should be borne by the
local authorities. Dr. Newsholme, whose knowledge and experience
of administration was most valuable to the Commission, has worked
out all the details of the schemes, and these are now beginning to take
practical form in various parts of the country. I am sure we agree that
the provision of ample facilities for treatment among the civil popula-
tion, which are now totally lacking, is the first necessity in our fight
against venereal disease. (Hear, hear.) Success in that fight depends
upon the closest possible cooperation and good-will between the County
and Borough Councils, hospital authorities and the medical profes-
sion. I do most earnestly appeal to those three most important bodies
to help this national cause by every means in their power. Local
authorities are wisely giving much more attention to public health
than they used to do, especially in connection with the guarding of
infant life. Now, they can do nothing which will more certainly in-
crease -the birth-rate, decrease infant mortality, and add to the num-
ber of healthy citizens, than by helping in every way they can to stamp
out venereal diseases from the population. (Applause.) I hope that
WHAT ENGLAND IS DOING 233
some other speaker will deal with the economic aspect of this question.
I will only say again that the total loss of productive power, and the
public expenditure which is entailed, in various directions, by the prev-
alence of venereal disease in our midst must reach enormous figures.
The federal government of Australia have decided that they can save,
in their old-age pension list alone, more than it is now proposed to de-
vote to a campaign against these diseases. Hospital authorities, in the
past, have too much neglected this side of their duty. Many of them
refuse patients in the early stage, the stage at which they can be treated
with effect, although their wards may be, and often are, full of patients
in the advanced stages, stages when medical help is of very little use
or of no use. By giving treatment in the early stages, they would save
an immense amount of expenditure as compared with the treatment
of patients at a stage when treatment is of less value. The London
Hospital has lately given a very bright example, which shows what
can be done elsewhere, if all the hospital authorities will rise to this
great occasion. (Applause.) A short time ago, the Grocers' Company,
with true insight, presented to that hospital a ward for venereal dis-
ease alone. That ward is now in full operation, and there is a well-
equipped laboratory attached to it. Patients, male and female, are
admitted to that ward through the skin department, and each has a
separate room. The London Hospital can already treat 1500 cases in
the year, and we may well feel grateful to the Grocers' Company for
their generosity in an object of this sort. (Applause.)
The Commission received evidence to the effect that too many mem-
bers of the medical profession are not at present fully conversant with
all the manifestations of venereal disease, or with modern methods of
diagnosis and treatment. All that will, doubtless, be remedied by the
medical schools in course of time. But, meanwhile, I do hope that all
private practitioners and all Panel Doctors, who must always be our
first line of defence against disease, will make the fullest use of the
facilities for diagnosis which will now be rendered available to them,
and that they will either master the technique of treatment themselves,
or that they will direct their patients to places where they can receive
that treatment. (Hear, hear.)
Now, ladies and gentlemen, I have dealt only with essential medical
measures for dealing with these most dangerous diseases : but there are
many other measures and methods which are also required. There
is no disease which practically plays such a baneful part as those dis-
eases which we are considering today. Some so-called "quack" medi-
234 SOCIAL HYGIENE
cines are probably beneficial; others may do no harm, but they have
no effect of any kind. But quack remedies in relation to venereal dis-
eases are doubly dangerous. In the first place the desire for conceal-
ment causes very large numbers of people to resort to quacks; and in
the second place, quack remedies which promise a cure are frequently
persisted in until the time when an effective cure could be obtained has
passed away. I can assure you that cruel tragedies arise from that
cause, and I do think that a very heavy responsibility rests upon all
newspapers who publish quack advertisements of that kind. (Applause.)
This very important aspect of the question has been closely investi-
gated by the Select Committee on Patent Medicines, and I do hope
there will be a general agreement that advertisements of this kind must
be put a stop to. (Applause.) If it is possible to go still further and
prohibit unqualified treatment of all cases of venereal disease (Hear,
hear) it would constitute a great protection to a large class of gullible
people, and it would also be a great safeguard to our public health.
(Applause.)
The Commission made thirty-three other definite proposals and I
think you would not easily forgive me if I were to go through each one
of them. All these proposals of ours are important, but in different
degrees, and some would require legislation, which I hope the Govern-
ment will undertake. And I am quite sure there are none of them
which involve such legislation as the House of Commons at the present
time would not readily pass. There can be no doubt that the spread
of knowledge, or of the knowledge of the appalling results of these dis-
eases, not only to the individual who acquires such disease, but to the
innocent and unborn children and to the race as a whole, would greatly
assist the state, municipal, and private efforts in combating these dis-
eases. But the need for prompt action is terribly urgent. Tens of
thousands of the men best qualified to transmit the highest qualities
of our race have fallen already upon the field, and the end is not yet.
We must abolish all hindrances to our birth-rate, of which venereal
diseases must take almost the first place. What we have to do is to
rear the greatest possible number of healthy children in the shortest
time: and we can only do that if we abolish what is the main source of
sterility and the cause of so many of those grave evils to which I have
referred. We now know that these causes are distinctly preventable,
and it would be criminal if we did not make the fullest use of every
opportunity which science has made ready to our hands.
All previous war experience shows an increase of venereal disease,
for reasons which are well known, and already, I am afraid, it is certain
WHAT ENGLAND IS DOING 235
that the number of new infections is far above the normal. And when
peace comes, there is the danger of grave and widespread dissemina-
tion of these diseases. It is for that that we must be prepared, and
there is no tune to be lost. Meanwhile there are certain preventive
and protective measures for which we may look to the military authori-
ties and the civil authorities: to military discipline and the very wide
powers which have been conferred by the Defence of the Realm Act:
they give good opportunities for guarding our soldiers, and none of
those opportunities must be neglected. All sources of infection must,
as far as possible, be barred from them. Good lectures, of the right
kind, delivered by the right men, should be addressed to all recruits,
and be repeated afterwards. I am glad to know that such lectures have
been given, even behind the front in France, with the most excellent
results. (Hear, hear.) I hope also, that the police will exercise the
very considerable powers that they have, and that the Home Secretary,
if he finds that those powers are not sufficient, will ask -for increased
powers. (Hear, hear.) Women police and women patrols can render
services of the greatest importance in watching, guiding, and warning
their sex, services much more than ever important at a time of national
excitement and abnormal conditions such as those in which we are living.
Now ladies and gentlemen, I have only touched on some aspects of
a very great national problem. It is a problem which, like most others,
cannot be solved by the State alone. The cooperation of all the forces
— moral, scientific, social, and philanthropic — which are working for
the public good is wanted in fullest measure. The cause is, surely, one
which can unite all religious denominations and all political parties.
The crusade against intemperance and vice can be strongly reinforced
by the knowledge which is now available to us: and the claim for de-
cent housing and for a real living wage can be pressed with new power.
If after this fiery trial through which we are passing, the life of the
country is to emerge purer and higher than it was before, and if the
vigour of our race is not to be permanently impaired by the cruel losses
which the war has brought, and if our citizens in the future are to be
numerous enough and strong enough, mentally and physically, to
accomplish the very difficult tasks which He before them, then this
dire scourge of venereal disease must be faced and conquered. (Loud
applause.)
Mr. Walter Long, M.P. (President of the Local Government Board) : Lord
Sydenham, ladies and gentlemen, I am sure that we shall all regret the
absence of the Lord Mayor. He was good enough to communicate
23G SOCIAL HYGIENE
with me, and assure me that nothing but an engagement of the char-
acter to which Lord Sydenham has referred would have prevented him
from being here. He also was good enough to tell me how strong is
the personal interest he takes in the movement on whose behalf we are
gathered this afternoon. I am very glad to know, from the speech we
have just listened to, that Lord Sydenham has covered the ground so
completely — although he told us there were many other branches of
the subject to which he would have liked to refer — yet he has so fully
covered the ground that it will not be necessary for me to speak on this
subject except from one point of view, namely, that of a Minister in
charge of the particular department which is charged with the work
which we this afternoon have got in hand. It will not, therefore, be
necessary for me to detain you for more than a very short time. I
propose, really, to tell you only, as briefly as I can, how the position
stands at the moment, and, very shortly, what are the reasons which
have led the Government, whom I represent on this particular occa-
sion, to adopt the policy which we are preparing and are proposing to
carry out in the country.
In the first place, ladies and gentlemen, I think I may say, in con-
firmation of and supplementing what fell from Lord Sydenham, that
we have made a very great advance. He referred to the termination
of the long period of silence out of which so many evils have grown.
But we have got some more direct advantages than the resumption of
open and plain discussion of these problems. There may be — and
probably there are — differences of opinion as to the remedies to be
applied, as to the form that administration should take; but there is,
I think, today no dispute in any quarter as to the reality and the grav-
ity of the scourge with which we have got to deal. (Applause.) I
think it has become impossible any longer to conceal from the British
public that these diseases are terrible in their nature, and almost over-
whelming in the effect that they have upon the health, the strength and
the very life of our people, and that they ought to be, and must be,
eradicated from our midst. (Applause.) Another subject for con-
gratulation is that the Royal Commission which was appointed not so
very long ago, reported much more rapidly than many of us would
have thought to have been possible; and today we have on record not
only the splendid character of their labours, but — what is of infinitely
more value to us as a practical people — the knowledge that they have
produced real and beneficial results, results which have already, as
Lord Sydenham told you, been accepted by the Government, been
WHAT ENGLAND IS DOING 237
accepted, in very large measure, by the country, and are being carried
out today by local authorities and hospitals with a goodwill and a
determination which it is impossible either to exaggerate or sufficiently
commend. The cooperation that we are receiving from the hospitals
is worthy of all praise. There have been of course, as there must in-
evitably be, some few cases in which difficulties have arisen, but I am
glad to be able to tell you that already the patience, the skill, and the
unselfish devotion to duty of the officials of my Department have suc-
ceeded in overcoming nearly all of those obstacles, and today we are
able to report that our new programme of beneficial and life-saving
work is well launched on its way. (Applause.) I am very confident
that the New Year will see the scheme for London and Greater London
ready to be embarked upon in all its details. And I think this admir-
able result will not be confined to greater London. In many other of
our local areas work has proceeded, and is proceeding, very rapidly, and
I believe that the New Year will see a real attempt made to deal, in
what we believe to be an effective way, with these dread scourges.
Lord Sydenham has referred to the effect of this terrible war, this
war that we are determined, as an Empire, to carry on to the only finish
which is possible (Applause), one which will makes its recurrence an
impossibility. But while this is our primary duty, to carry on this
war successfully, it is also our duty to face the new problems at home
created by the war, to some of which problems Lord Sydenham has
referred. As he well told you, in language far better than I could hope
to employ, this war has made a great inroad upon the best of our man-
hood, and we are bound, in self-defence, to take every possible step
today to see that the lives of our men and women, and above all of our
children, are rendered, so far as that is humanly possible, immune from
diseases which we believe we can eradicate if only we have the will
and the determination. (Applause.)
Now, ladies and gentlemen, what must be the keynote of our policy?
In the speech to which we have just listened, in the Report of the Royal
Commission, in the evidence given to that Commission by distinguished
men who have studied these problems, one thing, I think, emerges more
prominently and more clearly than anything else, and it is this: that
if we are going to deal with these unfortunate sufferers, we must make
it as easy for them as we can to get treatment which will give them re-
lief, and which will prevent them handing on this scourge to others.
And that has been the principle which we have laid down at the Local
Government Board, with a steady determination ancl belief in the
238 SOCIAL HYGIENE
plan which we have adopted. I said a moment ago that the hospitals
have met us more than half-way, and I want to say here today, on
behalf of the Government, how profoundly indebted we are to them for
the public spirit which they have shown in dealing with this great prob-
lem. Lord Sydenham reminded us of the well-known fact that these
diseases bring with them much that is grievous and even degrading
for the sufferers; and it has been the practice of the public to talk on
these diseases as if they ought always to be dealt with as crimes. Lord
Sydenham has told you how hopelessly unjust any such policy would
be. (Hear, hear.)
He has told you, what I believe to be a statistical fact, that at least
half of the cases are cases in which the disease has been acquired quite
innocently. I believe that evidence is beyond dispute, and therefore
if you have first of all to deal with the fact — and it is a fact — that
people who get this complaint feel that if it is known they will be looked
down upon by their fellow men and women, and therefore are natur-
ally inclined to conceal the fact and to take no open steps for remedy:
if you know that, and if you know the second great central fact that
at least half the sufferers have acquired these diseases through no fault
of their own, then, surely, the policy which we must adopt is one which
will make it as easy as is consistent with efficiency for these people to
be treated in a satisfactory manner.
Lord Sydenham referred to one or two of the suggestions which the
Royal Commission made, and told you — and therefore it is unneces-
sary for me. to go into it — practically what we are proposing to do. I
have briefly referred to some of the advantages which we have gained.
Of course there are difficulties to be faced, and of course there are
critics. Some critics are with us heart and soul in the object which we
have in view, but their criticism is, perhaps, the most dangerous of all,
because of their enthusiasm and of the evident knowledge and authority
with which they speak. And I want to say a word, quite frankly and
openly, to them this afternoon. We are told, in some quarters, that all
our plans will fail unless we adopt what is known as compulsory notifi-
cation and compulsory treatment. Well, ladies and gentlemen, let me
say at once, that if anybody thinks that the Government have refrained
from adopting these methods as part of their scheme because they are
afraid to do so, because they are prejudiced in some way against them,
these people are wholly mistaken. I say for the Government that if
it is clear to us that a particular policy is the right one, so impressed
WHAT ENGLAND IS DOING 239
are we with the gravity of the case and the urgent necessity for action,
that no fear, no prejudice would deter us from adopting it. (Applause.)
But what are the facts? In the first place, you have got the Royal
Commission, which realised the dangers and difficulties of compulsory
notification and compulsory treatment, and they did not recommend
them. I have no prejudice in this matter, and I can safely say, with-
out claiming any power to be able to deal successfully with a case of this
kind, that at all events I am not actuated by any fear. If I thought
the policy of compulsory notification was the right one, I would do my
best to secure its approval by my colleagues, and I would do my best
to secure its passage through Parliament. And if we do not adopt that
policy, it is for reasons — which I will briefly give you — that instead of
helping us it would retard our efforts, and it would interfere with the
success of our policy. (Applause).
May I just say this? Some years ago, when I occupied another
office in the government of that day, it fell to my lot to have to deal
with a disease — which. I am not, for a moment, trying to compare with
this one — a disease, however, which brought a great deal of suffering
upon human beings. My policy was at once met with a great deal of
opposition. There were people who held all sorts of views, with which
I entirely disagreed, who really opposed the whole thing. They said
it was not practicable, they said it was inhumane, that it could not be
done on the lines I laid down. They said "if you will only do what we
think right you will succeed." That is the kind of critic whom I today
want to appeal to. Ladies and gentlemen, somebody has got to dis-
charge what has to be done, somebody has got to take the responsi-
bility for the policy adopted, and that somebody is for the moment,
myself, as a member of His Majesty's Government. (Hear, hear.)
We have not come to our decisions lightly, I have not decided upon
this policy without the fullest consultation, not only with my advisers
at the Local Government Board, but with other experts, trained men
and women, who have examined these problems from every point of
view for many a day past. It is our deliberate policy. And although
we shut the door today to no amendment or alteration of our policy
which we find to be desirable, I want it to be clearly understood that we
have deliberately decided upon the lines that we have laid down, and for
the present along these lines we mean to proceed. (Applause.) And I
appeal, as Lord Sydenham did, to all those who have the good of the
country at heart to, for the moment at all events, put aside their own
240 SOCIAL HYGIENE
particular view, or their own particular remedy which they would like
to see adopted, and aid us, and those who are working with us, in the
prosecution of this great campaign.
When I was muzzling dogs (laughter) I used to be told — and a very
effective argument it was — "What on earth is the good of muzzling a
dog in a particular area? If I am walking with my dog in that par-
ticular area my dog is muzzled, but if I go over the ditch or through
the gate into the next parish, he is not muzzled. How can you defend
it?" My reply was that if you cut your ringer you do not put stick-
ing-plaster over the whole of your body. What happened? I was
right, and they were wrong: my policy succeeded ("No!") Somebody
says "No," but he cannot get away from hard facts. In five years we
had cleared that disease out of the country. (Cheers.) I have not
quoted that as an exact illustration, and I do not want to interfere with
the harmony of this meeting by reviving some of those by-gone con-
troversies. I only quoted it for this reason : that I have at all events
had administrative experience in dealing with these problems. I
know the difficulties, in Parliament and out. The policy I have adopted
is one in support of which I have the authority of the great mass of
trained opinion, scientific medical opinion, administrative experience
in this country.
Lord Sydenham said he hoped we would deal with the advertisements
of quack medicines, and treatment by quack doctors. (Hear, hear.)
If public opinion supports a policy of that kind, and if I can find — which
let me say, I have not yet done — a real working proposal which would
have those effects, I shall do my best to carry it through Parliament.
(Hear, hear.) I shall be ready to do my best for that purpose.
Ladies and gentlemen, I do not desire to trespass further upon your
time. I am only here today to say to you, on behalf of the Govern-
ment, that we are in earnest, that we know the gravity of the problem
that we are called upon to solve: that our minds are not paralysed by
fear of unpopularity (Hear, hear), that they are not weakened by any
prejudices already possessing us. We are ready to listen to suggestions,
come they from where they may so long as they come from those who,
after they have had their say, are prepared to accept our decision and
to join with us in clearing the country of this hideous curse. (Ap-
plause.) That is the object which we have in view, and, so far as I
am concerned — and my colleagues at the Local Government Board,
those with whom I am working, will, I know, cooperate with me — we
shall cooperate with the local authorities and the hospital of the coun-
WHAT ENGLAND IS DOING 241
try in doing this work in the most efficient and rapid way that can be
possible. (Cheers.)
Mr. Herbert Samuel, M.P. (Secretary of State for Home Affairs):2
Mr. Chairman, ladies and gentlemen, the President of the Local Gov-
ernment Board and I have come to this meeting today in order to bear
witness to the keen and active interest which the Government takes in
the work of this National Council for Combating Venereal Diseases.
And I think that we on behalf of the Government, and you, represen-
tatives of the public at large, ought together to express our gratitude
to Lord Sydenham and to his colleagues on that Council for undertaking
the great work on which they are engaged, for the time and the energy
which they are spending in its prosecution. It is a work both neces-
sary and distasteful, and the more distasteful it is the more grateful
we should be to those who consent to undertake it. (Applause.) Mr.
Long, speaking on behalf of the Local Government Board, has referred
mainly to questions relating to the treatment and the cure of these
diseases, questions that present many difficulties, which are being rap-
idly overcome by the energy of the Local Government Board under
his direction.
The Home Office is concerned, perhaps, more directly with what
may be called the preventive or the penal side of this question: and
that aspect of it is indeed surrounded by difficulties even greater. These
diseases arise undoubtedly, in very large degree, from the practice of
prostitution: and the question is often asked whether more active
measures could not be adopted by the authorities to limit prostitution.
I have discussed the matter, on more than one occasion, with the Com-
missioner of Police of the metropolis, and with others. The action of
the police is hampered hi no small degree by the restrictions imposed
by the statute law. It is generally assumed that any person may be
charged with soliciting who is seen soliciting, or who is apparently a
prostitute. That is not so. One has to prove, in a court of law, that
the person is a common prostitute. And it is not sufficient to be able
to prove one offence : you have to prove, on evidence, that she has solic-
ited, not on a particular occasion, but on other occasions. That imposes
2 Certain fresh legislation was foreshadowed in the Home Secretary's speech,
and at his suggestion, recommendations were prepared by the National Coun-
cil, and submitted to him for consideration. These recommendations included:
(1) The suppression of advertisements by quacks. (2) Making the transmission
of venereal disease by a person who was aware that he was in an infectious con-
dition, a criminal offence.
242 SOCIAL HYGIENE
very great difficulty in the enforcement of the law. But it is somewhat
doubtful whether Parliament would consent to extend too far the right
of summary arrest of women in the streets, with the possibility of grave
errors, such as, apparently, arose in one or two notorious cases some
years ago. In addition, the penalty that can be imposed when the
case is proved, is only a fine, unless the woman has been behaving in
a riotous or an indecent manner. Nevertheless, in spite of these limi-
tations, in London alone the metropolitan police recently, that is to
say in the years 1914, 1915 and the first eight months of this year,
have brought before the police courts no fewer than 16,400 cases. Of
those, 1200 were discharged by the magistrates, 2000 were dealt with
by imprisonment, and the remaining 13,000 were fined or bound over.
I must confess that these measures, although they proved great activity
on the part of the authorities, can not be regarded as providing any
really effective remedy for the evil. (Applause.)
With respect to the conditions that surrounded some of our soldiers'
camps, I secured, some months ago, the passage of an order in council
empowering the local authorities to remove from an area in which large
numbers of soldiers are gathered together, any woman who had been
convicted of soliciting or other similar offence. (Hear, hear.) That
order in council has been put into force in a number of localities, and,
I am told, has had a most beneficent and useful effect.
We are also, at the Home Office, anxious to encourage the employ-
ment of women police and women patrols (Applause), whose work is
calculated to be of great benefit in this movement, and not long ago,
in this session, Parliament consented to enact that women police em-
ployed by the local authorities might be paid from police funds on the
same footing as male constables, and that Treasury grants could be
received in respect of them. (Applause.)
But all these matters dealing with prostitution touch only a part,
although perhaps the most important part, of this aspect of the problem :
for it is unhappily the case — so I am informed by many who are in a
position to know — that these diseases are spread through the agency
of a number of quite young girls, who are not of the professional prosti-
tute class, and who can not be touched by any of the measures directed
against prostitution. And, of course, none of these measures touch
the transmission of these diseases by men.
Mr. Long said something with respect to compulsory notification.
At first sight, the argument in favour of compulsory notification seems
unanswerable. People say if you pass a law to the effect that where an
WHAT ENGLAND IS DOING 243
individual is suffering from scarlatina, a notification has to be sent to
the health authority, and if a person suffering from notifiable infectious
disease does anything to spread the infection, that person is liable to a
penalty, it seems illogical, inconsistent and indeed unendurable that the
same measure should not be applied in respect of this grave and dan-
gerous disease and class of diseases. (Hear, hear.) It is urged, also,
that the present proposal which is made in some quarters by — amongst
others — a number of distinguished ladies who wrote yesterday to the
press, the present proposal, it is \irged, is not nearly on all fours with
the old contagious diseases acts, which were so repugnant to public
feeling, because it is not proposed that there should be anything in the
nature of compulsory medical inspection beforehand, or anything ap-
proximating to a system of licensing. The objection to what is, of
course, a measure which should be obviously adopted, is that in the
conviction of many persons well qualified to speak, such a measure
would not have the effect which is desired, that is to say, the stamp-
ing out of the disea.se, but would rather have the opposite effect.
("No," "Yes.") And I will tell you why. Hitherto, the disease has
been spread because it has been kept secret, and those who suffer from
it have not allowed themselves to be medically treated. The efforts
that are now being made by the President of the Local Government
Board and by the hospital and health authorities throughout the coun-
try, are directed at providing full opportunities for cure, and at induc-
ing people to avail themselves of those opportunities when they are
provided. It is useless to provide the opportunities if people will not
come forward to use them. Now, it is thought that if any person,
when he presents himself for treatment, knows that he is put upon such
a list, and that he is to be subject to control until his cure is effected,
that the result probably will be not to induce people to come forward
for treatment, but to deter them (Hear, hear) from coming forward for
treatment. It is said you may pass your law, which, in theory, is so
admirable, but you will not be able effectively to enforce it, while the
very attempt to enforce it will militate against the success of the ef-
forts which you are making to provide a cure. (Applause.) I should
be chary of speaking on my own authority on such a point as this if
it had not been examined by the Royal Commission, consisting of men
of expert authority, and the Chairman of today presiding over it. Fif-
teen members, men and women drawn from various schools of opinion,
who spent two years on the examination of this problem, who heard
very many witnesses, most of whom gave evidence on this very question
244 SOCIAL HYGIENE
of compulsory notification, came to the conclusion — it is not always
that a Royal Commission of fifteen members presents an unanimous
report— they came to the unanimous conclusion that, in the existing
circumstances, compulsory notification was not desirable, and that it
would do much more harm than good. (Applause.) In those circum-
stances I do not see how we could anticipate that, even if the Govern-
ment, in the face of that authority, came to Parliament with such a
proposal, the legislature could be induced to enact it.
There is one point which I would like to lay before this great meeting
for its consideration, which was not presented to this Royal Commis-
sion, and was not examined by them. When I embarked upon the
study of this matter in detail, as the Report of the Royal Commission
necessarily required me to do in view of the office which I have the
honour to hold, I confess that to my surprise I found that a person may
knowingly and deliberately do that which is calculated to transmit this
disease to another person, and yet in so doing commits no offence against
the law. It appears to me intolerable that one person, whether man
or woman, should be permitted by the law, without penalty, to commit
so grave an outrage against another. (Applause.) It is, morally, a
crime (Applause) to do this thing knowingly: ought it not to be made
legally a crime? (Applause.) If one man assaults another, and in-
jures him physically, he is liable to imprisonment. If one person puts
poison into another's food, he is sent to penal servitude. But if he
knowingly does that which transmits poison to another person by con-
tagion, he goes scot-free. (Shame!) Therefore I suggest to you
whether the law ought not to enact that where a person does any act,
including soliciting for prostitution, who knows she is infected with
this disease — or a man who knows he is infected with this disease (Ap-
plause)— does any act calculated to cause its transmission to another
person, that individual should be liable to heavy penalties at the hands
of the law. (Applause.) It is true that in many cases it would be
difficult of proof, especially the fact of knowledge, but there is a class
of case which might, in my opinion, be dealt with in this way, and
that is the people, whether men or women, who find their way into
prison or other state institutions, are there medically examined, and
on leaving are still in an infectious state. If they received formal noti-
fication that they were in an infectious state, that would be evidence
against them if they were charged subsequently with the major offence.
And that would be an inducement to them to do what now they refuse
to do, namely, to go into a hospital or other institution and remain
there until they are cured.
WHAT ENGLAND IS DOING 245
There is another allied matter which, perhaps, public attention should
be directed to, and that is the question whether or not persons convicted
of these offences, such as solicitation, living, in the case of men, on the
earnings of prostitution, and other offences connected with sex rela-
tions, whether these persons, if they are found, in prison, to be suffer-
ing from these diseases in an infectious stage, ought not to be detained
in some institution — not necessarily a prison — until they are cured.
(Hear, hear.) That is a matter upon which I should be rather chary of
expressing an opinion, but upon which I should be glad to receive opin-
ions of the nation at large, for I am now engaged in proposals to be
laid before Parliament dealing with many of the topics which have been
discussed today, and the more information I can obtain as to the atti-
tude of the public mind towards these matters, the more valuable it
will be to me in the preparation of legislative proposals. (Applause.)
There are many who say "Oh, the Government is very powerful, let
the Government do all that is necessary." And true it is that the Gov-
ernment has great authority, through possessing the initiative of legis-
lation, and through being able to wield the authority of the law, through
having at its command the resources of the great departments of state.
But those of us who have been engaged for many years in the work of
the Government know well how impotent any government is unless
it has the whole-hearted support of public opinion behind it. (Hear,
hear.) And it is right that it should be so, for in a free country such
as this, the management of public affairs ought not to depend merely
upon the idiosyncrasies of the individuals who happen to be in power ;
their task is to carry into effect the declared will of the nation as a
whole. (Applause.) Hence, ladies and gentlemen, the great value of
the organization, the National Council for Combating Venereal Dis-
eases, under whose auspices we are met here today. Theirs is the task
of rousing and directing public opinion; and in harmony and coopera-
tion with them you may rely upon it that the Government will be very
ready to use, so far as they can be used, the powerful agencies which
are in the hands of the state. (Loud applause.)
Mr. A. F. Buxton (Chairman, London County Council): My lord,
ladies and gentlemen, I have the honour, at the moment, to represent
the London County Council, and because of that I am limited in what
I shall say. My remarks will have nothing to do with the medical
treatment, nothing to do with the care of the patients from the medical
point of view, but solely with administration, and the powers which
may be given the authorities from that standpoint. And, as a preface,
I may remind you that this is not wholly a new business for the Lon-
246 SOCIAL HYGIENE
don County Council. We already have the administration of certain
powers which have been given us for the medical examination and treat-
ment of all the children in the schools, some 750,000 of them, I think
the number is. We already have the administration of the acts con-
cerning the treatment of tuberculosis. Perhaps I am prejudiced but I
believe I am right in referring to other people who will tell us that the
work of the Council in those directions is well done (Hear, hear) ; at
any rate, I hope so.
As regards this immediate question, the Council was, first of all,
invited by the Local Government Board to draw up a scheme for dis-
cussion, so as to have something to go upon. And when a scheme had
been prepared, a conference was held at the offices of the Local Gov-
ernment Board. I think the most important point in the calling of
that conference was the fact that it not only included representatives
from London, but embraced representatives from the surrounding coun-
ties, and there were some other public bodies also represented. The
conference, therefore, looked like developing a large and somewhat
powerful scheme. The point of, perhaps, greatest importance was as
to where these powers should be put into force. You can imagine,
ladies, and gentlemen, that there is such a thing as municipal pride;
and you know, I daresay, that the members of the London County
Council, like those of any other public body, are all very human indeed.
(Hear, hear.) And some of them might like to dot all about London
separate clinics, with the complete paraphernalia in each separately,
so that they would be conveniently situated for everybody in the Lon-
don area. That may seem all very well at first sight, but I put it aside
at once, for I think you will agree with me that the scheme which we did
adopt was the stronger one, from the administrative point of view, both
as to efficiency and reducing the cost. The conference, including the
representatives from outside London, agreed to cooperate in a scheme,
and that scheme embodied negotiations with the existing institutions,
that is to say, the hospitals which already existed, and endeavouring,
as far as possible, to do the work through them. I would not dare to
mention this definitely if it were not that I have a very sanguine hope
that although the Council has not finally adopted this scheme, it will
come to fructification before very long: you must not expect these
things to go through in a week. We are, perhaps, a little bit like the
"tanks" at the front: we go rather slowly sometimes, but when we do
get there we are rather effective. And I have every hope that the
scheme now before us will come to realisation at a very early date next
WHAT ENGLAND IS DOING 247
year. Such a scheme — and of course I have only gone into the outside
principles of it — I think we shall all agree will help towards, first of all
and chiefly, efficiency. It is manifestly better for the community—
and we must look at something more than London, after all — better
for the community, for the people of Essex, the people of Hertfordshire,
the people of Kent, to have available for them that extraordinarily good
advice which they would find in the London hospitals, and might not
be able to reach otherwise. (Hear, hear.) Shortly, that is the ad-
vantage they will get. On the other hand, London gains an advan-
tage, because whereas the cost of administering this act in London by
itself amounts to a fairly large figure, they are so much in the way of
estimates at present — though the scheme would bring in double the
number as for London alone, it does not double the cost, it only increases
it by something like 25 per cent. Of this cost, it is hoped that his Ma-
jesty's Government will find 75 per cent, and the remaining 25 per cent
will be divided among the different localities, in a proportion which at
present is a subject of discussion whether it is to be on the basis of the
populations, or the number of patients, I can not say. Wo shall have
further light upon the matter, perhaps, after an experiment for twelve
months.
I do not wish to keep this meeting longer than to just give a skeleton
of the scheme which I have outlined. The importance of the scheme
as a whole is infinitely greater than is the importance of the mere de-
tails as to how it is to be administered. But I think it will give this
meeting confidence if those present realise that the scheme I have al-
luded to is simple, businesslike and economical.
I would also like to mention that it is proposed that the treatment
should be given, or could be if anyone desires to do so, in cooperation
with his own doctor. He need not, for this purpose, hand himself over
to the care of doctors who are strangers to him, at an institution sev-
eral miles from home. This provision by which he can act with his
own doctor will, I think, give people confidence. (Hear, hear.)
There is one other point which, before I sit down, I would like to
lay stress upon. I want you to understand clearly about the hospitals.
The County Council has no desire to interfere either with the manage-
ment of the hospitals or with the cure of the patients while they are
under the care of the hospitals. (Hear, hear.) It would not be dig-
nified for us to seek to do so; indeed, it would be somewhat imperti-
nent, and it is a principle which I hope we shall always carry out when
we are dealing with such magnificent institutions as the hospitals of
248 SOCIAL HYGIENE
London, and of which you, Mr. Chairman, have so kindly spoken this
afternoon. (Applause.)
Sir Thomas Barlow: Every thoughtful person will agree that the
problem of how best to deal with venereal diseases is one of the most
difficult which the present generation has to consider.
It requires wisdom, experience, knowledge of human nature and
knowledge of our present medical resources. The solution of the prob-
lem also requires us to remember that in a democratic country we
ought to endeavour to convince and to convert before we attempt coer-
cion.
I hope that everybody in this room either has, or will, carefully read
the summary of results presented in the last report of the Royal Com-
mission, or the very concise analysis of it which has been prepared by
Dr. Douglas White. We of the National Council contend that this
summary represents a reasonable and practical policy which deserves
adoption as the fundamental step to be taken in the problem before us.
We maintain that in spite of many divergences of opinion this funda-
mental step deserves the support of all conscientious people.
Now, what is the plan of the Commission which has been accepted
by the Government and which is in process of enactment?
It is that this national menace and national evil should be met by
national methods.
Treatment centres shall be formed in the principal towns and these
shall likewise supply the needs of surrounding districts which shall work
in conjunction with the towns.
The first desideratum is accurate and guiding diagnosis. In a large
number of venereal cases no special chemical or microscopic examina-
tion is necessary. But in some cases it is imperative. When a clini-
cal pathological laboratory in connection with a university or a medical
school is available that is the most desirable installation where the in-
vestigations can be made. But in many county towns where no med-
ical school laboratory exists there is an excellent laboratory in connec-
tion with the departent of the medical officer of health.
Arrangements will have to be made for the examination of blood and
of other material sent by any medical man so that dependable reports
can be obtained as in the case of diphtheria and tubercle.
In the late cases of syphilitic infection the diagnostic investigation
is often of great importance as a guide to the continuance or renewal of
special treatment. As to the treatment centres themselves, whenever
they can be established in near proximity to the laboratory it is obvi-
WHAT ENGLAND IS DOING 249
ously most advantageous. For this reason the medical school hos-
pitals come in the first line of defence. Bat in county towns the prin-
ciple is obviously desirable. Other hospitals, such as those for women
and children and lying-in institutions, workhouse infirmaries, asylums
and rescue homes are also suitable; lock hospitals have done splendid
work and obviously come into the scheme, but it is not recommended
that these should be multiplied but rather that preference should be
given to special departments in general hospitals. We wish above all
things to get people to come to these treatment centres. For that
reason (1) the treatment is to be free. It is not desired that patients
able to pay should leave their own doctors, but it is considered wise
that the treatment should be open to all who wish to come. (2) With the
object of making it easier for working men to attend, it is argued that
evening clinics should be instituted and that these clinics should not
be specially labeled. If diseases other than venereal can be treated
at the same time it is advantageous. It is not desirable that evening
attendance should become identified only with venereal complaints .
and nothing else. It has been found in some towns that afternoon
clinics are more convenient for working women and evening clinics
for working men.
What will be required in the way of in-patient accommodation?
In the vast majority of early cases these diseases are suitable for
out-patient treatment and the patients can continue their work.
But when salvarsan or its substitutes are injected it is desirable that
the patient should, after the first injection, be under observation for
some hours. In general it is well to have a casualty bed available for
the night.
But what is to be the arrangement in our medical school hospitals,
county and special hospitals, which are really voluntary institutions?
The cooperation of these hospitals is entirely a voluntary thing on
their part. The local government have the power to institute special
centres and there will be no difficulty whatever in adapting the work-
house infirmary and the asylums. It has already been done with the
greatest advantage in several cases. But it would be a terrible thing
if the medical school and county hospitals held aloof from this national
need, and refused help.
The Treasury is prepared to pay 75 per cent of the cost of diagnosis
and treatment. Twenty-five per cent is to be paid by the munici-
pality. It therefore only remains to hospital authorities to give fa-
cilities for the institution of departments with the minimum of dislo-
250 SOCIAL HYGIENE
cation of administration. With respect to the gratuitous distribution
of salvarsan to medical practitioners for panel practice, it is considered
desirable that they should satisfy the special officer of the clinic that
they are efficient in the technique of its administration and then there
is no objection withholding it. It is hoped that arrangements might
be made whereby general practitioners might take part as clinical as-
sistants in these clinics and so acquire thorough and up-to-date ac-
quaintance with new methods both of diagnosis and treatment.
In order to secure the confidence of the patients it is not contem-
plated that any records of names and addresses should be communi-
cated to other people. The only objects of registration would be to
control the supply of salvarsan and to keep such memoranda as would
be advantageous to the patients if treatment for relapses should be
desirable at a future period.
Now I wish to point out that the only compulsion in these measures
is the compulsion of the municipal authorities to supply facilities for
the treatment centres to be established and maintained. Otherwise it
is essentially voluntary.
The participation of the hospital authorities is voluntary. If they
do not wish to come in, the municipal bodies may start centres of their
own. The participation of the patients is absolutely voluntary.
The cooperation of the general practitioners of the neighbourhood is
voluntary.
I should like to deal with these groups of persons seriatim.
(1) The municipal bodies. There is ample opportunity for subur-
ban and country districts surrounding a large town to combine with
the town which is central to the district. The Chairman of the London
County Council has explained what London is about to do. This plan
will secure the best machinery for getting skilled personnel and the
dependable diagnosis treatment. Our contention is that it is a logical
development of the municipal obligations for sanitation for the treat-
ment of other infectious diseases and for the maternal and child centres
all of which are now getting freely recognized and adopted. With re-
gard to the hospitals we have to consider (a) the governors who repre-
sent the subscribers, (b) the honorary and medical staffs.
(a) The Governors. In some hospitals there are express regulations
forbidding the admission of venereal cases. We consider that in the
interest of humanity these regulations should be abrogated. We have to
remember that these diseases entail great suffering on innocent victims
WHAT ENGLAND IS DOING 251
and that those who are the original offenders often bitterly repent their
wrongdoing and deserve the best endeavours for their relief and restora-
tion to economic efficiency. It ought to be definitely understood that
arrangements should be made to safeguard other cases from infection.
This is easily done with a very little modification of existing arrange-
ments. Venereal diseases are in their early stages generally out-patient
diseases. A small ward with three or four beds will meet the require-
ments of severe and complicated early cases.
It is to be remembered that the early administration of salvarsan not
only is supremely advantageous for the patients but is also the quickest
method of rendering a syphilitic patient non-infective to his neighbours.
Late nervous sequelae of syphilis are free from risk of infection to
others and are already treated in most general hospitals.
(b) With regard to the medical staff. The Local Government Board
plan suggests the setting apart of a specially trained officer for the
venereal clinic to carry out the details of skilled treatment.
It may be sometimes found expedient that a junior member of the
honorary staff shall with proper remuneration take this duty, or a
special officer may be appointed ad hoc.
But in any case it is hoped that the staff will retain their hold on the
diagnosis and treatment of venereal cases. The arrangements for the
special officer will vary with the size of the clinic and other local needs.
The medical officer of health and the municipal authorities only require
guarantees that the special officer is efficient and that he is on the spot.
The plan has many analogies with the arrangements found suitable for
a tuberculosis department in a general hospital, but it will be simpler
and less expensive because there is so very slight need of in-patient
accommodation. There may be some difficulty in arranging for eve-
ning clinics. But if this is not done you will not be able to secure the
attendance of working men, and the result will be only a partial suc-
cess. It is desirable if possible to treat cases other than venereal ones
at evening clinics. We don't wish to render evening attendance tanta-
mount to an acknowledgment of venereal trouble. We must respect
the confidences of the patients. Registration should be limited to what
is required for keeping an account of the expense of the special reme-
dies and to what is needed for the good of the patients, especially as
regards relapse of symptoms and giving information of what has been
previously learned in diagnosis and treatment. We ought I think to
consider the needs especially of respectable married women. They can
252 SOCIAL HYGIENE
often attend in the afternoon more conveniently than at night. If
there is a demand for them we ought to encourage women's hospitals
officered by women.
With respect to the general practitioners: it is most undesirable
that they should look upon these treatment centres as being devised
to take away their patients from them. At present an enormous num-
ber of venereal cases are treated by either quacks or by druggists. If
the general practitioners will help to make these hospital clinics a suc-
cess and meanwhile make themselves thoroughly equipped with the
new methods we ought to look forward to bringing a large proportion
of the working class population into a hearty recognition of the great
superiority of treatment based on scientific knowledge and in the long
run restore these patients from the hands of quacks into the hands of
qualified practitioners.
It is hoped that they will bring their patients for the initial treatment
and carry on the later stages under their own supervision and bring
them to the clinic again if difficult relapses or complications occur.
With regard to the methods for acquiring acquaintance with new
methods I should like to state that the Director General of the Army
Medical Service has recalled Colonel Harrison to the Military Hospital,
Rochester ' Row, and has sanctioned his giving instruction in these
methods to civil practitioners. Classes for this kind of instruction are
already in operation.
To som up the whole question you may say, What do you propose?
To this I answer, (1) Get the treatment centres established as soon
as possible, bearing in mind the difficulties arising from the very limited
number of medical men available and the necessity of special equip-
ment in the new methods.
(2) Get legislative powers to deal with quack advertisements and
quacks.
(3) Give voluntary methods a fair trial. If they do not succeed be
prepared to dispassionately reconsider compulsory treatment, but don't
broach it now or you will effectually strangle the treatment centres and
you will drive people more and more to the quacks.
Finally you must realise that compulsory notification by itself is no
use and that we simply do not possess the adequate machinery or per-
sonnel for compulsory treatment even if we thought it a right measure
to adopt.
SOCIAL HYGIENE LEGISLATION IN 19161
A SUMMARY OF BILLS BEARING UPON SOCIAL HYGIENE, INTRO-
DUCED IN THE SEVERAL STATE LEGISLATURES HAVING SES-
SIONS IN 1916.
Part I contains a summary of bills under subject headings arranged
in two divisions under each subject: (1) Bills which became laws,
and (2) Bills introduced but which failed of passage. The arrange-
ment is by states in alphabetical order. The subject headings are: —
(1) Age of consent, adultery, concu- (5) Venereal diseases and marriage;
binage, rape, and seduction; (6) Children;
(2) Prostitution; (7) Miscellaneous.
(3) Injunction and abatement laws;
(4) State reformatories and industrial
homes for girls;
Part II con tarns a list of bills introduced in each legislature, a brief
statement of subject-matter or purpose, place of introduction, i.e., the
Assembly or House or Senate, the calendar number, and, in each in-
stance where the bill became law, the reference where it may be found.2
PART 1
1. AGE OF CONSENT, ADULTERY, CONCUBINAGE, RAPE, AND SEDUCTION
Mississippi: S. B. 95; Rape. To change penalty to life imprisonment.
Signed by Governor.
New York: S. B. 836. Seduction. To make felony, by false pretense of
marriage. Ch. 196, Laws 1916.
Virginia: S. B. 20. Age of Consent. To increase to fifteen years. Ch.
478, Laws 1916.
1 For 1915 legislation see SOCIAL HYGIENE, Vol 11, No. 2, April, 1916, p. 245.
2 The abbreviation Ch. (with number), and "Signed by Governor," following
the description of a bill, indicate that the bill became a law.
The abbreviation preceding the description of a bill shows the Assembly,
House, or Senate number of a bill.
The following abbreviations are used: Ch., Chapter; A.B., Assembly Bill;
H. B., House Bill; S.B., Senate Bill; Sec., Section; No., Number.
253
254 SOCIAL HYGIENE
The following bills failed of passage : —
Kentucky: S. B. 221. Seduction. To make felony, under promise of mar-
riage to girl under 21.
H. B. 64. Seduction. To reopen case if defendant deserts within three
years after marriage.
Louisiana: H. B. 85. Concubinage, to make felony.
Massachusetts: S. B. 197. Age of Consent. To increase to eighteen years.
H. B. 547. Adultery, divorce for. To provide for inserting name of co-
respondent.
H. B. 647. Rape. To require physician to notify authorities of, of child
under sixteen.
New York: A. B. 1575. Adultery. Not to excuse witness in prosecution
for, on ground that testimony is self-incriminating.
South Carolina: H. B. 887. Seduction. To increase penalty.
Virginia: S. B. 370. Seduction. To make, of unmarried female under
eighteen, a felony.
H. B. 696. Seduction. To amend Code, Section 3677, regarding females of
previous chaste character.
2. PKOSTITUTION
A. Laws which may be classified as White Slave Traffic Acts, or Amendments
thereof
Kentucky: S. B. 316. Pandering. To prohibit. Ch. 49, Laws 1916.
The following bills relating to prostitution failed of passage: —
New York: S. B. 351. Prostitutes. To prohibit fining, upon conviction.
S. B. 943. Prostitution. To provide for apprehending female guilty of.
B. Hotels and restaurants
The following bills failed of passage: —
Kentucky: H. B. 476. Female employees. To make seduction or assault of
by hotel guest, a felony.
Massachusetts: H. B. 998. Hotels. To authorize cities and towns to exam-
ine physically employees in.
New Jersey: A. B. 50. Females, to forbid employment as waitresses, etc.,
in dance halls, etc., where liquor is sold.
New York: A. B. 1244. Hotels. To make misdemeanor, to register at hotel
with woman under assumed name.
3. INJUNCTION AND ABATEMENT LAWS
New Jersey: A. B. 337. Ch. 154, Laws 1916.
Virginia: H. B. 288. Ch. 463, Laws 1916.
The following bills failed of passage : —
Kentucky: H. B. 128.
Louisiana: H. B. 25.
Maryland: H. B. 502.
Mississippi: S. B. 347.
South Carolina: S. B. 613.
SOCIAL HYGIENE LEGISLATION IN 1916 255
4. STATE REFORMATORIES AND INDUSTRIAL SCHOOLS FOR GIRLS
Kentucky: S. B. 160. Homes. To provide separate homes of reform for
girls. Signed by Governor.
The following bill failed of passage : —
Massachusetts: H. B. 2143. Reformatory for women. To construct depart-
ment at, for female defective delinquents.
5. VENEREAL DISEASES AND MARRIAGE
Massachusetts: H. B. 1882. Syphilis. Appropriation of $10,000, to State
Board of Health, to manufacture and distribute medicine. Ch. 47, Laws 1916.
New York: A. B. 865. Marriage. To make felony for married person to
take out license to marry another. Ch. 482, Laws 1916.
South Carolina: S. B. 668. Wassermann tests. State Board of Health to
make, without charge. Act 551, Laws 1916.
6. CHILDREN
Kentucky: S. B. 78. Children. To make desertion of, under sixteen, a felony.
Signed by Governor.
Maryland: H. B. 587. Delinquent children. To give circuit courts control
of, employ psychologists, etc. Ch. 326, Laws 1916.
H. B. 669. Child. To prevent separating, under six months, from mother,
to place in institution, unless necessary. Ch. 210, Laws 1916.
Massachusetts: S. B. 373. Delinquent child. To provide for juvenile ses-
sion of court on trial of, Ch. 243, Laws 1916.
The following bills failed of passage : —
Kentucky: S. B. 57. Children and wife. To make misdemeanor to abandon
or fail to support.
Massachusetts: S. B. 231. Defective children. To commit, growing up in
idleness and ignorance, to county training schools.
H. B. 122. Children. To be committed to care of probation officer on neglect
of parents.
New Jersey: S. B. 124. Children. To appoint commission to study and
revise laws concerning welfare of.
S. B. 230. Children and wife. To make abandonment and non-support of, a
misdemeanor.
New York: S. B. 1260. Children. To provide juvenile employment bureaus.
Rhode Island: H. B. 33. Child welfare. To provide local boards of, in
each county.
South Carolina: S. B. 661. Contributory delinquency. To punish person
responsible for, in case of child under sixteen.
S. B. 849. Illegitimate children. To be legitimatized by subsequent mar-
riage of parents.
Virginia: H. B. 578. Girls. To protect, under eighteen.
H. B. 694. Children and wife. To make desertion of, or neglect to support,
a misdemeanor.
256 SOCIAL HYGIENE
MISCELLANEOUS
New Jersey: S. B. 209. Playgrounds. To authorize use of parks as. Ch.
59, Laws 1916.
S. B. 210. Playgrounds. To authorize boards of education to improve
and equip as. Ch. 227, Laws 1916.
The following bills failed of passage: —
Louisiana: S. B. 331. Abortion. To make felony to attempt to procure.
New Jersey: S. B. 255. Pyschopathic Hospital. To establish.
New York: S. B. 378. Playgrounds. To authorize villages to establish.
S. B. 394. Mental deficiency. To appropriate $10,000 to establish clearing
house for, to investigate causes.
Rhode Island: H. B. 41. Morality. To amend Section 18, Ch. 347, General
Laws, relating to offenses against.
South Carolina: H. B/886. Bastardy. To amend Section 894, C.C. 1912,
concerning annual payment of penalty for.
PART 11
Kentucky: S. B. 57. Wife and children. To make misdemeanor to abandon
or fail to support.
S.B. 78. Children. To make desertion of, under sixteen, a felony. Signed
by Governor.
S. B. 160. Girls. To provide separate homes of reform for. Signed by
Governor.
S. B. 221. Seduction. To make felony under promise of marriage to girl
under twenty-one.
S. B. 316. Pandering. To prohibit. Ch. 49, Laws 1916.
H. B. 64. Seduction. To reopen case if defendant deserts within three
years after marriage.
H. B. 128. Injunction and abatement.
H. B. 476. Hotel employees. To make seduction or assault of, by guest,
a felony.
Louisiana: H. B. 25. Injunction and abatement.
H. B. 85. Concubinage. To make felony.
H. B. 331. Abortion. To make felony to attempt to procure.
Maryland: H. B. 502. Injunction and abatement law.
H. B. 587. Delinquent children. To give Circuit Courts control of, employ
psychologists, etc. Ch. 326, L. 1916.
H. B. 669. Child. To prevent separating, under six months, from mother, to
place in institution, unless necessary. Ch. 210, L. 1916.
Massachusetts: S. B. 197. Age of Consent. To increase to 18 years. (Amend-
ing Section 23, Ch. 207, R.L.)
S. B. 231. Defective children. To commit, growing up in idleness and
ignorance, to county training schools.
S. B. 373. Delinquent child. To provide for juvenile session of Court on
trial of. Ch. 243, L. 1916.
SOCIAL HYGIENE LEGISLATION IN 1916 257
H. B. 122. Minor children. To be committed to care of probation officer
on neglect of parents.
H. B. 547. Divorce for adultery. To provide for inserting name of core-
spondent.
H. B. 647. Rape. To require physician to notify authorities of, of child
under sixteen.
H. B. 998. Hotels. To authorize cities and towns to examine employees in.
H. B. 1882. Syphilis. Appropriation of ten thousand dollars to state board
of health to manufacture and distribute medicine. Ch. 47, Laws 1916.
H. B. 2143. Reformatory for women. To construct department at, for female
defective delinquents.
Mississippi: S. B. 95. Rape. To change penalty to life imprisonment.
Signed by Governor.
S. B. 347. Injunction and abatement.
New Jersey: S. B. 124. Children. To appoint commission to study and
revise laws concerning the welfare of.
S. B. 209. Playgrounds. To authorize use of parks as. Ch. 59, L. 1916.
S. B. 210. Playgrounds. To authorize boards of education to improve and
equip. Ch. 227, L. 1916.
S. B. 230. Abandonment and non-support. To make misdemeanor, of wife
and children.
S. B. 255. Psychopathic Hospital. To establish.
A. B. 50. Females. To forbid employment as waitresses, etc., in dance
halls, etc., where liquor sold.
A. B. 337. Injunction and abatement law. Ch. 154, L. 1916.
New York: S. B. 351. Prostitutes. To prohibit fining upon conviction.
S. B. 378. Playgrounds. To authorize villages to establish.
S. B. 394. Mental deficiency. To appropriate ten thousand dollars to estab-
lish clearing house for; to investigate causes.
S. B. 836. Seduction. By false pretence of marriage, to make felony. Ch.
196, L. 1916.
S. B. 943. Prostitution. To provide for apprehending female guilty of.
S. B. 1260. Children. To provide for juvenile employment bureaus.
A. B. 865. Marriage. To make felony for married person to take out license
to marry another. Ch. 482, L. 1916.
A. B. 1244. Hotel. To make misdemeanor, registering at hotel with woman
under assumed namd.
A. B. 1575. Adultery. Not to excuse witness in prosecution for, on ground
that testimony is self-incriminating.
Rhode Island: H. B. 33. Child welfare. To provide for local boards in each
county.
H. B. 41. Morality. To amend section 18. Ch. 347, Gen. Laws, relating to
offences against.
South Carolina: S. B. 613. Injunction and abatement .
S. B. 661. Contributory delinquency. To punish person responsible for, in
case of child under sixteen.
S. B. 668. Wassermann tests State Board of Health to make without charge
Act 551, L. 1916.
258 SOCIAL HYGIENE
H. B. 849. Illegitimate children. To be legitimatized by subsequent mar-
riage of parents.
H. B. 887. Seduction. To increase penalty.
H. B. 886. Bastardy. To amend Sec. 894, C.C. 1912, concerning annual
payment of penalty for.
Virginia: S. B. 20. Age of consent. To increase to 15 years. Ch. 478, Laws
1916.
S. B. 370. Seduction. To make, of unmarried female under eighteen, a felony.
H. B. 288. Injunction and abatement law. Ch. 463, L. 1916.
H. B. 578. Girls. To protect, under eighteen.
H. B. 694. Wife and children. To make desertion of or neglect to support,
misdemeanor.
H. B. 696. Seduction. To amend Code, Section 3677, regarding females of
previous chaste character.
THE BROOKLYN HOSPITAL DISPENSARY, GENITO-
URINARY DEPARTMENT
The accompanying charts show the growth of the organiza-
tion of the genito-urinary department of the Brooklyn Hospital
Dispensary, since the appearance of Dr. Thomson's article in
the January, 1916, issue of SOCIAL HYGIENE.
For the purpose of calling the patient's attention to appoint-
ments, a placard is hung on the door of the clinic where the
patient sees it at each visit as he opens the door. The old card
used before the reorganization and the establishment of the
syphilis division was worded as follows: —
YOU MUST COME TO THE CLINIC REGULARLY FOR TREATMENT
If You Have a Green Card If You Have a Yellow Card
[Green Card] [Yellow Card]
Come Every Wednesday Come Every Thursday
For Syphilis For Syphilis
Come Every Monday and Friday Come Every Tuesday and Saturday
For Gonorrhea For Gonorrhea
DO NOT STOP TREATMENT UNTIL THE DOCTOR TELLS YOU THAT
YOU ARE WELL
The new door card which has been used since the reorganiza-
tion is as follows : —
YOU MUST COME TO THE CLINIC REGULARLY FOR TREATMENT
If You Have a Green Card
[Green Card]
Come Monday and Friday
(Unless Doctor tells you to come
Wednesday)
If You Have a Yellow Card Stamped G.U.S.T.
[Yellow Card, Stamped G.U.S.T.]
You Must Come Every Thursday
DO NOT STOP TREATMENT UNTIL THE DOCTOR TELLS YOU THAT
YOU ARE WELL
259
SCHEME OF ORGANIZATION, BROOKLYN HOSPITAL DISPENSARY
GENITO-URINARY DEPARTMENT
GENITO- URINARY- DEPARTMENT
• CHIEF -OF -CLINIC
MONDAY- WEDNESDAY- FRIDAY
CHIEF OF DIVISION
TUESDAY -THURSDAY • .SATURDAY
CHIEF OF DIVISION
EVENING
PAY CLWIC
AFTERNOOK
ciTtrrc
AFTERNOOK
CLINIC
rVINIHC
FAY CLINIC
IXnrVIOMLIZATron
»WVACV
VOCTOIU AH»
PAID TO* worn
•M
A-rrtMrr- TO
LITTLE PRIVACY
PCCTOR5 NOT
KODITINC «R-
MM
HISTO*V
•nUATMtNT
AND PATH-
ATT J HO INS TAKU
TAir THROWN
ALL arm EACH
• „.
1
I 1 1
As it was prior to September 14, 1916
Brooklyn Hospital Dispensary Organization Scheme
of Gen ito~ Urinary Department
Associate Sut^eori
Director of Clinic
1
-Division I
Tucs Tli ur Sat -Division II
Thursday -
y Gonorrhea
Urology Murfu«s
Gonorrhea
Syphilis
QsauLuit fiuyam
Purr lur Hoy Cluuc
Cksislani Sun/em
(3\uf of Division
(Jauianl Surqeo*
Knctv Day Clinic
UssitlarU Suttt&n
Afbrnwn Qmir
IRM.
Evening Clinic
GScuJonspvrwrek
flfteriiooii dime
Night Clinic
*t)PM
Qxiluic but
'Jhorvuqh
t!UU> FVivacy
DodoK must
sent m
afternaaiduuf
'Trains
Doctors
Stiiar ill.
fluff t1 fliHtC •J'll
Ax-tws
Doctor takes
cur through all
sii-pti-.u-ii visit
Routine
Service
C Stallone
Inioiilheach
Medicine
T^pcwn ter- Charge of Rccoitis- Orderly Catv of Equipment, ere
Follow-uu- CorrvsiKHiiiLTice.fU; ^ foists Doctors m Treatment
' '
Social Service
Investigate Indigent cafes
Inten&ivc Study Familial £yphilJ6
Statistical Opei-lung of End Results
As it is since reorganization and formation of special syphilis division
260
THE BROOKLYN HOSPITAL DISPENSARY
261
The following figures will serve to show the growth in attend-
ance in the syphilis division of the clinic which is the feature of
the reorganization scheme: —
Active cases, January 1, 1916 108
New cases admitted during 1916 313
New cases admitted up to January 20, 1917 45
Dropped, to date, as closed cases.
Active cases, January 20, 1917.
466
97
369
The record of the clinic in the number of visits made by pa-
tients is interesting by comparison with some figures published
in the June, 1915, issue of SOCIAL HYGIENE in an article, "Sur-
vey of Venereal Clinics in New York City" by B. S. Barringer
and Philip S. Platt; these figures are for syphilis cases only.
BROOKLYN HOSPITAL CLINIC
CLINIC A (SEE ABOVE ARTICLE)
NUMBER OP VISITS
Patients
Percentage
Patients
Percentage
1
45
11
34
29
2-5
98
29
35
29
6-10
711
17
15
13
10-20
901
21
10
9
20+
931
24
22
19
1 The majority in these groups are still under treatment and some in each are
moving up from time to time into the higher groups. Deducting from the total,
15 discharged as cured, 65 discharged as improved (all of whom have had at least
three doses of salvarsan), and 89 discharged unimproved, there remain of
the 420 original patients included in the Brooklyn Hospital percentage, 251 who
are still under treatment.
Nearly three times as large a proportion dropped out after one
visit at "Clinic A" as at the Brooklyn Hospital, and twice as
many made ten to twenty visits at the Brooklyn Hospital.
This result has been obtained through continued effort both on
the part of the physicians in dealing with the patients at the
clinic and by means of continued follow-up work. A careful
record of attendance is kept and three follow-up notices are sent
262 SOCIAL HYGIENE
out, one week apart, to patients failing to report for treatment.
These notices are sent out as first-class mail in envelopes bear-
ing only the street number of the dispensary. The total volume
of follow-up work, including first, second, and third notices,
where all were necessary, involved the sending out of 1653
notices. Of this number 102 were returned by the post-office as
"wrong address;" 97 patients were heard from by mail, tele-
phone, or otherwise, and 377 returned for treatment. This does
not mean that out of 1653 patients only 377 returned, because,
as already noted, this number of notices included in some cases
three or more to the same patient, the period covered is from
September 14, 1916, to January 20, 1917.
BOOK REVIEWS
SLAVERY OF PROSTITUTION — A PLEA FOR EMANCIPATION. By Maude
E. Miner, Secretary of the New York Probation and Protective
Association. New York: The Macmillan Company, 1916. 308
p. $1.50.
Miss Miner presents her interesting book to the public as a survey
of existing conditions, but looking toward new and better ways of
attacking the vice problem. The book is a comprehensive treatment
of the "supply" side of the evil, presenting in a practical light the
many vicious influences surrounding the potential and actual pros-
titute. The information is presented in a sympathetic and popular
way and should be on the desk of both the social worker and the in-
terested layman for reading and study.
Miss Miner has gained her information through a specific study of
one thousand or more cases, and during intimate knowledge of many
thousands of girls while probation officer in the night court, head of
Waverley House, and as secretary of the Probation and Protective
Association in New York City. Miss Miner is convinced that the
girls are by no means necessarily vicious or depraved, and that they
can be saved both by reclamation and by prevention.
She sets forth most strikingly the nature of the prostitute's en-
slavement. It is not a physical slavery, but one much more subtle
and harder to break away from — moral slavery. It is the breaking
down of moral fiber, the fear of facing the world from which she has
stepped down, the hold that her distorted emotions have upon her —
it is these shackles that hold the unfortunate girl to her life of com-
mercialized vice. To those who have questioned the validity of the
term "White Slavery," Miss Miner's splendid analysis will present a
new meaning.
The first four chapters deal with existing conditions. They pre-
sent the girls' own stories in the night court; the personal factors, as,
for example, who the girls are, their age, nationality, etc.; and the
social factors. In broken, overcrowded, and sweat-shop homes, in
anti-social work and low wages, in bad recreational facilities, Miss
Miner finds important reasons for the girls' downfall. The fourth
chapter deals with the White Slave trade. It sets forth the traffickers'
methods of procuring, showing how procurers go even to the extreme
of actually marrying the girls in order to secure them for the business.
263
264 SOCIAL HYGIENE
Chapter V deals with legislation and the difficulties and results of
law enforcement, pointing out, for example, the too frequent lack of
cooperation between police and court.
Chapters VI-X deal with remedial agencies and measures. At
Waverley House in New York the girls in greatest distress are provided
with a temporary home. Here they are carefully examined and as-
signed accordingly to a home for the feeble-minded, to a house of cor-
rection, to a hospital, or to Hillcrest Farm, which is maintained in
conjunction with Waverley House. If they are in condition to work
the effort is made to place them in a suitable position. The brief stay
at Waverley House offers a wholesome, though all too transitory,
home environment with due religious and recreational influences and
training in domestic work. Miss Miner sets forth clearly the urgent
need of a municipal house of detention with adequate facilities for
providing such an environment for all needy girls and for detaining
witnesses and less hardened girls who should not be subjected to the
evil influences of a prison.
The accomplishments of Hillcrest Farm offer great encouragement
and inspiration. Girls go there to be built up and regenerated, away
from the pitfalls and sordid viciousness of their former lives. Wonders
are accomplished not only in physical recuperation, but in the restora-
tion of hope and in a new-found determination to go right and make
good in the world.
Emphasis is placed on the task of qualified probation officers, and
of agencies for industrial training, recreation, and religion. The
Girls' Protective League — a voluntary organization of girls who are
interested and effective in ascertaining and improving the conditions
of working girls and in helping those in great need — shows what can
be done for girls by girls themselves.
Miss Miner closes her informative and sympathetic account of the
conditions which lead to the enslavement of thousands of our young
and often innocent girls in this most heinous of all evils, with an appeal
to all of us to do our share in instituting social measures of reform.
J. and M. R-M.
THE WAY LIFE BEGINS. By Bertha Chapman Cady and Vernon
Mosher Cady. New York: American Social Hygiene Association,
1917. 78 p. $1.25.
For a long time there has been needed a simple, concise, straight-
forward book for the average, intelligent parent, giving him or her the
BOOK REVIEWS 265
essentials of the knowledge of the origin of life. This, the authors of
The Way Life Begins have done, and done well. Their book is simple,
intelligible to the layman who has no preliminary knowledge of the
subject, and accurate in its scientific statements. And it is brief —
not so long as to appall and frighten away the average person. Better
yet, it is inherently interesting, and logically effective — and, above all,
it is absolutely free from that pseudo-religious affectation that makes
nearly all of such work nauseating. Most men, and especially women,
who write on this subject, seem to think it a matter to be treated in a
way different from other subjects of physiological importance. There
is no more reason for inserting the word "God" in every other sentence
of a book on this subject than in a book on the operation of the diges-
tion or the construction of the human eye. These wonders of the
Creator's handiwork are no more wonderful, no more mysterious, no
more awe-inspiring, no more essential to the continuity of the race,
no more expressive of the majesty of the Divine will, than in the in-
scrutable chemistry of the soil, or the mystery of why the stomach
does not digest itself.
Although the book is written in simple language it may be that
many mothers — and it will be used most of all by mothers — will find
some of the words and statements incomprehensible, for there are thou-
sands of women who come to the point of childbirth without even the
most rudimentary knowledge of the physiology, to say nothing of the
terminology, of the process going on within them. They have been
subjected to an experience for which they had not the slightest intel-
lectual preparation, the whole process has been to them a thing of
perhaps even disgust and horror. The great mitigation is in the fact
that there is going to be a child, a dear baby of their own. For most
of them that goes far to take the curse off. There seems to be need
for a book that will approach the subject from this situation as a
point of departure, and that will lead the mind of the woman reader,
married or unmarried, into a different feeling about the whole matter.
This is done in The Way Life Begins by inference and perhaps it is just
as well not to complicate this particular book with consideration of
that matter.
Another thing: it seems very important that parents should face
the fact that in their boys and girls (boys especially but girls also —
far more than people realize) there burns the same fire of sex impulse,
passion, lust, call it what you will — that has burned in themselves;
very likely far more intensely; and that there must be a close under-
266 SOCIAL HYGIENE
standing of this in its bearing upon the most commonplace facts and
relationships of life. There are many instances of people who have
made a real effort to give children information such as is found in this
book, only to discover that servant girls have undermined the care of
the parents who never had the smallest suspicion that their boys were
"going astray" right under their noses.
In the concluding chapter, the authors deal with the general moral
bearing of the subject, and it is clear and satisfying, but perhaps too
general and discursive and sociological to "get over" effectively to the
ordinary parent — a good deal more emphasis could be placed with
benefit on specific matters. For example, very pointed recognition
might be made of the fact that the fashions in women's dress are usu-
ally designed to emphasize the femaleness of the woman's body. It
never fails; the fashions change in order to compel the purchase of
new things, but they always emphasize the sex element. Now, this
may be a thing to be viewed with complacency as it concerns grown
people; so long as women are compelled by economic necessity to
compete for men in order to keep clothes on their backs, food in their
stomachs, and roofs over their heads; to compete for men whose train-
ing and lives are such as to emphasize the material aspects of their
existence — this may be more or less unavoidable. But, at the same time
that we pretend to be sheltering our boys and girls from the sexual
appeal, to dress the latter as we are dressing them now, and to sur-
round the former in their adolescence with suggestion increasingly
inciting — it's a thing that parents ought to think about definitely and
sanely. Moreover, girls should be given a very clear notion of the
mischief they may do in their relations with boys who already have on
hand a struggle sufficiently hard. It may make them self-conscious,
to be sure — no doubt it would be better to keep them in ignorance if
you could do it, but you can't! and however dangerous knowledge
may be, ignorance is vastly more so. And knowledge is a thing to be
given straight if at all. It may be risky to tell the truth to children,
but it's a million times more risky to lie to them!
Be all this as it may, the authors are to be congratulated upon
their book; for it is by far the best of its kind that has appeared.
J. P. G.
BOOK REVIEWS 267
THE KINGDOM OF THE MIND. How TO PROMOTE INTELLIGENT LIVING
AND AVERT MENTAL DISASTER. By James Mortimer Keniston.
New York and London: G. P. Putnam's Sons, 1916. 245 p.
$1.25.
PSYCHOLOGY OF THE UNCONSCIOUS. A STUDY OF THE TRANSFORMA-
TIONS AND SYMBOLISMS OF THE LIBIDO. By Dr. C. G. Jung.
Authorized translation, with introduction by Beatrice M. Hinkle,
M.D. New York: Moffat, Yard and Company, 1916. 566 p.
$4.00.
THREE CONTRIBUTIONS TO THE THEORY OF SEX. By Prof. Dr. Sig-
mund Freud, LL.D. Authorized translation by A. A. Brill,
Ph.B., M.D. New York: Nervous and Mental Disease Publish-
ing Company, 1916. 117 p. $2.00.
Men of earnest purpose and sincere desire to aid mankind are seek-
ing to guide him to a control of his mental powers and to assist in
stemming the increasing tide of mental breakdown and suffering.
These three books recently published set before us the two methods of
approach toward this very practical problem.
The underlying purpose is none the less sincere in either method but
the one has long proved its futility unless the broader and more dynamic
spirit of the second be infused into it. Keniston would bring his hear-
ers and readers to a healthy and effective knowledge and control of
the in dividual "Kingdom of the Mind." He has had long experience
with that failure which results in mental disease. Yet his book disap-
points. His admonitory platitudes under the old classification of the
"faculties" of the mind are bewildering and hopelessly lacking in stimu-
lation or practical information concerning one's ability to get hold of
latent or recalcitrant powers and secure a driving mastery which will
utilize them all toward some real purpose. He has not fulfilled in any
degree the promise that seemed to lie in the preface — to take into ac-
count ''everything about man — his ancestry, inheritance, environment,
occupation, age, mode of life, habits, propensities."
Such a catalogue must, at any rate, be unified, just as must his de-
tailed advice, in some impelling conception which takes account of
man's place as a developing product and agent amid all that makes and
has made his environment. This stimulating and expanding concep-
tion forms the theme of Jung's Psychology of the Unconscious. It is a
268 SOCIAL HYGIENE
study which reaches into the profoundest depths in order to under-
stand man's dynamic nature, to find its moving power, "libido" it has
come to be called. He would discover how, racially and individually,
this libido passes through a series of transformations in its seeking for
adequate expression. The trend of this energy, this libido, is upward
in the progressive path of continuous creation. Nevertheless, it has,
on the other hand, to reckon with another tendency, that regressive
one which would draw man to the paths of indolence, of pleasure attain-
ment, which is represented by the safe and pleasant security of his
infantile existence at the source of life. The author has presented the
marvelous range through which this struggle of the libido has swept
in the effort of adjustment of the individual, as well as in the upward
evolution of the race, with a consideration of the symbolic forms through
which it has sought expresssion and by which it has continued to mount,
giving a new view of their value and contribution to development. It
is a book of broad conceptions of the unity of racial and individual
effort and of the failures and successes which attend the continuous
upward striving.
Freud's masterly study of infantile sexuality gives in clearer detail
the early components which enter into this great endeavor, as they
contribute to the final complete success in creative fulfilment as rep-
resented first of all in matured sexuality or as they become pitfalls,
fixation points, which stop and hold the libido from complete develop-
ment and thus prepare for the maladjustments which are mental sick-
ness. With his rare courage he strikes straight at factors in the child's
development which psychoanalysis has found do exist and do exert
this power for good or ill in later life. They have remained unrecog-
nized and unvalued because they are those factors which have fallen
necessarily under repression in the process of education and hence the
antagonism to our recognition of them. None the less are they there-
fore of utmost importance in the understanding of the human being
and his mental weal or woe.
Thus homilitic advice, as that of Keniston, concerning the mental
life can have value only when it is informed by such an inspiriting and
compelling dynamic unity, which finds the primary sources of man's
endeavors, failures, and successes and seizes also the unlimited possi-
bilities of well directed energy.
S. E. J.
269
MY BIRTH. By Armenhouie T. Lamson. New York: TheMacmillan
Co., 1916. 190 p. $1.25.
This book is an attempt to describe the development of the human
fetus in autobiographical form for the delectation of the general public.
We could hope that the general public would not take kindly to the
experiment but we fear it will. The topic is so new, has been so hid-
den away, as the author truly observes, in inaccessible medical works,
and so shrouded in unintelligible medical polysyllables that the general
public will gulp down "ectoderm" and "chromosome" and "notochord7*
in a passionate longing to be informed.
That the judicious continue to grieve is beside the point. The smat-
terings of embryology herein set forth by this pre-suckling are harm-
less enough. But the language is the language of the debutante.
How that dear old professor of biology will shudder at the Odyssey
of the ovum.
"The outer wall of the ovary .... broke and I was dis-
carded. ... As I had no means of self-locomotion, I was entirely
at the mercy of the elements about me in the lower abdominal cavity,
where it was dark and all quiet, except for the mysterious gurgling
within the intestines
"When I recovered from the shock of such a sudden and forceful
transportation, I found myself in a narrow tubelike passage, called
'Fallopian tube.' As it was very dark and very close about me, I was
sure my end was at hand. But then a great miracle took place. I sud-
denly felt myself forcefully held and lovingly embraced by a friendly
little stranger, known as the male germ cell or 'Spermatozoon/ during
which act the male element disappeared within my body."
But the professor of biology will not use this volume as a textbook;
have no fear.
E. L. K, Jr.
THE EUGENIC MARRIAGE. A PERSONAL GUIDE TO THE NEW SCIENCE
OF BETTER LIVING AND BETTER BABIES. By W. Grant Hague,
M.D. New York: Review of Reviews Company, 1916. Four
vols. 656 p. with illustrations. $1.50.
Eugenics is hardly recognizable in the presentation of Dr. Hague; it
includes everything down to the evils of patent medicines (four chap-
ters), the national menace of delicatessen stores, and the best means
to make children stop sucking their thumbs- What he does say about
270 SOCIAL HYGIENE
eugenics, properly so called, is marked by a good deal of error and exag-
geration, and a failure to understand what eugenics is, as well as by
enthusiasm and sincerity. A great deal of space is devoted to sex
hygiene, but the author's remarks are so frequently exaggerated and
alarmist that they are likely to do more harm than good. "It has
been conclusively demonstrated," he tells us in italics, that if condi-
tions remain as they are now, "every second child born in this country,
in fifty years, will be unfit; and, in one hundred years, the American
race will have ceased to exist." But the remedies he proposes for this
imaginary state of affairs would often aggravate rather than relieve the
disease. Dr. Hague has a good deal of sound advice on childbirth
and the care of children, but his four volumes are so full of misstate-
ments and loose thinking that they can not be recommended as a reli-
able guide.
P. P.
THE PURCHASE OF WOMEN — THE GREAT ECONOMIC BLUNDER. By the
late Dr. Elizabeth Blackwell. London: G. Bell and Sons.
First printed. 1886, reprinted, 1916. 54 p. 3d.
First published thirty years ago, this voice from the past sounds as
clear today, as when first heard. In these thirty years many changes
have occurred to mitigate the evil which Dr. Blackwell writes about
so earnestly. The organized White Slavery, so common in her day,
has been almost abolished in civilized countries, and prostitution has
steadily been made more unprofitable and precarious. Still the evil
continues, and will continue until the moral and religious forces so im-
prove the character of men that this evil will be reduced to a minimum.
Dr. Blackwell's book consists of two parts. The first is a brief, logi-
cal treatise on economics, leading to a discussion of the effect of "the
purchase of women" on industry.
The second part takes up the subject in detail, showing that social
vice deteriorates character, discredits honest labor of both men and
women, depresses their wages, and forces them into a condition analo-
gous to slavery. She shows how a society which tolerates vice inevi-
tably develops hypocrisy and becomes unsound at heart.
Dr. Blackwell, at the close of her booklet, places the responsibility
for all these evil results squarely where it belongs: "Who is guilty of
this appalling conversion of women into demons; this contagion of evil
which in ever-widening circles is destroying our moral health, and in-
juring the modesty, freedom and dignity of all womanhood? The im-
BOOK REVIEWS 271
mediate cause is the man, whether prince or peasant, who purchases a
a woman for the gratification of lust. It is this purchase which draws
women into the clutches of a money-making machine which never loos-
ens its hold of the feeble creature until the essential features of woman-
hood are crushed out of recognition."
O. E. J.
THE HIDDEN SCOURGE. By Mary Scharlieb. With a foreword by the
Lord Bishop of London. London: C. A. Pearson, Ltd., 1916.
96 p. 1 s.
CRADLES OR COFFINS. By James Marchant. With a foreword by
the Lord Bishop of Birmingham. London: C. A. Pearson, Ltd.,
1916. 96 p. 1 s.
These two volumes are the first members of the timely and service-
able manuals of the National Life Series issued under the authority
of the National Council of Public Morals for Great and Greater
Britain which aims at the spiritual, moral, and physical regeneration
of the race. The first book is a clear and convincing exposition of
the calamities which follow in the wake of venereal disease. It rec-
ognizes that for some time there have been forces at work trying to
enlighten the public in this respect and that at last people are begin-
ning to awaken to the dangers. But it is also a plea for the spread of
knowledge and the growth of ideals which shall make for the purity of
personal life and the protection of public health.
The second book, as may be gathered from its rather lurid title,
is devoted to a consideration of the decreasing birth-rate and its ef-
fects upon the race. Statistics are given and facts examined which
show that not only is there a decline in the birth rate but that there
is a great and unnecessary loss of life among infants, due to ignorance
on the part of the mothers as well as to economic causes. Birth con-
trol and family limitation are touched upon, and while there is some
matter for criticism, the aim of the book is in the right direction and
it is written with a sincere purpose and should be read by thoughtful
men and women without prejudice.
THE ULTIMATE BELIEF. By A. Glutton-Brock. New York: But-
ton, 1916. 132 p. $1.
The calamity of war leads us to consider the worth of our boasted
civilization and of the systems of education determining the conduct
272 SOCIAL HYGIENE
of peoples, for the ultimate foundation of every state is a way of think-
ing. Behavior is the result of belief, and a sound belief inspiring to
strength of character should be the result of education. Our author
states that "the test of good teaching is that it shall be believed and
shall benefit those who believe it."
In his paper on "Cross Currents in English Education," Dr. Michael
Sadler quotes from a German writer as follows: "Each man is a wheel
in the huge machine which is called the German Empire, but more
rightly the German System. The wheel does not know, and does not
need to know, anything but that it must turn with all its might ac-
cording to the order of the higher wheels. Neither do the higher
wheels themselves know anything. They, too, turn as the mechanism
orders them to turn. In each subordinate member of the system, in-
telligence must limit itself to the work assigned to it to do. The elec-
tric current which drives the whole machine comes from above. One
might almost say that it comes from an unknown source, for the elec-
tric current is impersonal." This is a system which can be taught to
all alike and can be believed by all alike. It responds to the test of
good teaching in that it is believed, it gives efficiency and unity to the
people; but it is false in that it does not benefit those who believe it,
as shown by Germany's conduct in the present war.
In the English system of education, on the other hand, Mr. Glutton-
Brock sees a lack of coherence and consistency. It is not expressive
of the national purpose nor does it fully meet the national needs.
Education should offer a reasoned philosophy as to the mind of man, the
purpose of his life, the nature of the universe, thus forming the ground-
work of that ultimate belief from which results the nation's behaviour,
a teaching which will benefit those who believe it. What is this phi-
losophy upon which English education should be based so that it may
produce an efficient, united people, a people which will not fall into
the errors of the Germans and which may escape from the errors and
weaknesses peculiar to themselves?
There is need of a philosophy for all, and our author tells us what he
believes this philosophy should be — namely, the Philosophy of the
Spirit. The spirit desires goodness, truth, and beauty, each for its
own sake, and the purpose of the life of man is that he may pursue
these three desires, thereby exercising the activities of his spirit but if
pursued for ulterior ends, the nature of these desires changes.
"Spiritual education is an education in moral, intellectual and
aesthetic disinterestedness." We must have faith in the spiritual pos-
BOOK REVIEWS 273
sibilities of the child, we must help him to recognize his innate desire
for spiritual activities and to value this desire as higher than any de-
sire of the flesh. We can accomplish our object not by exhorting him
to do good for the sake of happiness, to seek truth because it is use-
ful, and beauty because it gives pleasure, but by a philosophical expla-
nation of the nature and value of his own spirituality, which will
stimulate him to see that this is not a matter to be ashamed of as pecu-
liar to himself, but is universal, to be discussed as is any plain matter
of fact, to be regarded as universally interesting.
We can succeed in the pursuit of goodness only to the degree by which
our thought is uninfluenced by considerations of personal gain, just as
is the case in the pursuit of truth. "We have fatally separated doing
good from the reasons why we do it" in our teaching of ordinary mo-
rality to the young. We enlarge upon the gain of personal happiness
from right conduct, teaching a commercial morality which youth is
keen to see through, knowing, as it does, that the consequences of right
doing are not necessarily happy. Much of the perversity of youth,
much of the belief that morality is all convention, might be cured
could we make it clear to the child "that he should do right for the
sake of doing it and that goodness consists in that and in nothing
else."
Mr. Glutton-Brock's views in regard to punishment, while by no
means new, are worth noting. The object of punishment is to pre-
vent the young from acting in a manner harmful to themselves or to
others. It should show the child how the world, outside his own
family circle, reacts to those who are troublesome as members of so-
ciety. He should be disciplined into obedience through the strength-
ening of his own innate desire to do right.
The desire for truth is the intellectual activity of the spirit. It is
concerned with thought rather than with action. For the same reason
that the spirit desires goodness for its own sake, so it desires truth for
its own sake. We must appeal to the intellectual conscience in edu-
cation. The child is to learn because knowledge is the means toward
truth, and if it is pursued without this desire for truth being kept
clearly in mind, the child can see no meaning and no beauty in
learning.
We are less conscious of the aesthetic activity than of the moral and
intellectual activities of the spirit. If it is a mistake to value goodness
as the source of happiness and truth as the source of usefulness, it is
equally so to value the aesthetic activity as the source of pleasure.
274 SOCIAL HYGIENE
The fullness of our lives depends upon the degree in which we under-
stand and value this aesthetic activity through the exercise of which we
come to realize the beauty and glory of the universe.
In his conclusions, the author states that we must hold as a dogma a
belief in the possibility of spiritual activities in every child. By edu-
cation we cannot hope to change the fundamental nature or equipment
of the individual, but by faith in the spirit that is in everyone, we can
help the child to understand and to pursue his own spiritual desires,
to realize the relation between these and the desires of the flesh, thus
leading him to that freedom which shall help him to express the best
that lies in his own individuality. An education dominated by this
ultimate belief in goodness, truth, and beauty, should strengthen the
desires of the spirit through the years before the age of puberty is
reached, thereby helping to safeguard children against the dangers of
that period. The overwhelming power of the sexual instinct is often
due to the sense of mystery and romance which it brings to youth. It
is something intensely real and personal. If imbued with the sense
of the reality and romance of life which comes through the activities
of his spiritual desires, youth will be better able to control the force of
this new physical reality which comes upon him with puberty and to
resist the desires of the flesh. Our education is to blame for its ma-
terialism in looking upon life as without romance except for this one
kind — the sexual romance of youth. The highest service which we
can render the future lies in education, and spiritual freedom is the
fundamental requisite of such service.
S. D. H. D.
READINGS IN SOCIAL PROBLEMS. By Albert Benedict Wolfe. Boston:
Ginn and Company, 1916. 804 p. $2.80.
This is another of the excellent volumes of Selections and Documents
in Economics. Though an outgrowth of work with college classes and
intended primarily for use with such, nevertheless, the problems treated
are of such universal human interest and the selections of such high ex-
cellence that many general readers will find the volume both interesting
and informing.
The readings are grouped under five books dealing respectively with
Problems of Population; Immigration; The Woman Problem; Marriage
and Divorce; and The Negro Problem in the United States. To a lim-
ited extent the selections are designed to give an historical treatment
BOOK REVIEWS 275
of the subjects. This is accomplished in some cases by statistical
tables, as for immigration and the declining birth rate, and in other
cases by selections portraying the development of ideals.
Needless to say the selections are chosen from a wide range of litera-
ture. In such a collection where material is abundant determination
of what to include and what to reject is necessarily a strain upon the
judgment and perhaps also upon the emotions. Criticism is therefore
likely to reflect merely personal bias rather than real differences in ex-
cellence. The advisability of including the negro problem at the
expense of an abbreviated treatment of questions of woman and the
family must be determined by the demands of college teachers. One
may feel that the section on eugenics should have contained some-
thing directly from the pen of Galton or Pearson and that a place should
have been found in Book III for Ward's gynaecocentric theory, etc.
But space has its limitations in all practical affairs and teachers will
find most of the selections useful, and, when so desired, readily sup-
plemented by assignments in other favorite authors.
F. H. H.
GIRLHOOD AND CHARACTER. By Mary E. Moxcey. New York: The
Abingdon Press, 1916. 400 p. $1.50.
This book is a study of the normal girl during the most significant
decade of her life, the ten years of adolescence roughly timed between
the twelfth and twenty-second years. The author has undertaken to
bring to light "the great underlying uniformities among the aspirations
and problems of girls" of whatever class and condition and measure of
earlier training, and to review the facts "from the standpoint of mod-
ern psychology and education," "adhering rigidly to facts and princi-
ples that are unassailable."
The purpose, thus stated in the preface, has been admirably carried
out. The reader is promptly inspired with confidence by the simple,
frank, and accurate statements of physiological and psychological facts,
and by the evident understanding of fundamental, educational, and
sociological principles. Miss Moxcey's exhaustive study, wide experi-
ence, and power of clear insight and accurate analysis make her a trust-
worthy guide for the vast multitude of "mothers, teachers, and older
friends of girls" to whom she dedicates her work, who share her eager-
ness to serve without her opportunities for knowledge and understanding.
After an introductory section suggesting how to "prepare the girl
for adolescence," the book treats successively the three fairly clearly
276 SOCIAL HYGIENE
defined periods of adolescence. In each part the physiological, psycho-
logical, personal, and social factors of the development are considered,
and a study is made of the social and educational problems and methods
involved, with special emphasis on the problems of moral and religious
education. The whole problem may be summed up in the author's
words as "unifying all factors of life into a consistent and proportion-
ate whole," that "there may be conserved through these young lives
all that has been found worth while in civilization and human charac-
ter," and "that each particular girl shall be able to contribute her own
gift of personality."
The problems are concrete; homely illustrations make each point
clear; the sympathetic interpretation of the young girl's need is simple
and obvious; the perplexed teacher or mother is certain to find her own
difficulties duplicated and met by means so simply expressed that she
«an use them as her own, however little she is able to analyze the
great seething forces which are hers to direct. From cover to cover
the book is brimful of practical suggestions of how to fulfil the delicate
task.
Not the least valuable features are an adequate index and a carefully
selected and classified bibliography, with a brief statement of the con-
tribution made by each book to the study of girlhood.
F. M. F.
THE AMERICAN JOURNAL OF SYPHILIS. C. V. Mosby Company, St.
Louis, Publishers.
A new quarterly journal under this title has been issued by the C.
V. Mosbey Company, St. Louis, under the managing editorship of Dr.
Loyd Thompson, Hot Springs, Arkansas. The editor is aided by
William H. Deaderick, as associate editor and a staff of department
editors and collaborators comprising nearly one hundred of the most
prominent practitioners, medical teachers, and investigators in the
United States.
The departments give an index to the wide range of subject-matter.
(1) The Parasitology of Syphilis; (2) The Pathology of Syphilis; (3)
The Therapy of Syphilis; (4) Syphilis and Dermatology; (5) Syphilis
and Neurology; (6) Syphilis and the Eye; (7) Congenital Syphilis;
(8) The Serology of Syphilis; (9) Syphilis and Urology; (10) Syphilis
and Internal Medicine; (11) Syphilis and Gynecology and Obstetrics;
(12) Syphilis and the Ear, Nose and Throat; (13) The Social Aspects
of Syphilis; (14) The Surgery of Syphilis; (15) The Roentgenology of
Syphilis; (16) Abstract of Current Syphilis Literature.
BOOK REVIEWS 277
The January (1917) number contains two hundred and sixty pages of
text devoted to interesting and valuable articles among which those
interested in social hygiene will find the following especially worth
reading and reference: — "The Sanitary Attack upon Syphilis," by
William Allen Pusey, M.D., Chicago; "A Plea for Routine Wasser-
mann Examinations for Obstetric and Gynecologic Patients in Hos-
pital and General Practice," by Reuben Peterson, M.D., Ann Arbor;
"Lues and the Baby," by L. R. DeBuys, M.D., New Orleans; "The
Teaching of Syphilis," by H. H. Hazen, M.D., Washington; "The
Place of Syphilis in Our Medical Schools and Hospitals," by Charles
J. White, M.D., Boston; "The Practical Application of the Wasser-
mann Test in the Diagnosis and Control of Treatment of Syphilis,"
by Charles F. Craig, M.D., U. S. Army; "The Importance of a Knowl-
edge of Syphilis and Especially of Visceral Syphilis for General Medical
Diagnosis," Lewellys F. Barker, M.D., Baltimore; "Rabelais' Concep-
tion of Syphilis," by Douglass W. Montgomery, M.D., San Francisco.
The continuance of the high standard set in the first number of this
new quarterly should ensure its rapid growth in usefulness and number
of subscribers.
NOTE AND COMMENT
The Mann White Slave Traffic Act. With the decision of the Su-
preme Court of the United States in the Diggs-Caminetti and Hayes
cases, rendered on January 15, 1917, the judicial interpretation of the
Mann White Slave Traffic Act is complete. Previous decisions had
upheld the constitutionality of the law and had made clear its mean-
ing with respect to commercialized vice. It remained uncertain,
however, until this decision whether the act included cases where the
element of commercialized vice was entirely absent. The court
squarely holds, although by vote of five to three, Justice McReynolds
not sitting, that in the light of the holding in United States v. Bitty,
208 U. S. 393, Congress must be deemed to have adopted the meaning
given the clause "Or for any other immoral purpose" by the Supreme
Court in that case, in which it was said : —
All will admit that full effect must be given to the intention of Congress as
gathered from the words of the statute. There can be no doubt as to what
class was aimed at by the clause forbidding the importation of alien women for
purposes of "prostitution." It refers to women who for hire or without hire
offer their bodies to indiscriminate intercourse with men. The lives and ex-
ample of such persons are in hostility to "the idea of the family, as consisting
in and springing from the union for life of one man and one woman in the holy
estate of matrimony; the sure foundation of all that is stable and noble in our
civilization; the best guaranty of that reverent morality which is the source of
all beneficent progress in social and political improvement;" Murphy v. Ramsey,
114 U. S. 15, 45 . . . . Now the addition in the last statute of the words,
"or for any other immoral purpose," after the word "prostitution," must have
been made for some practical object. Those added words show beyond ques-
tion that Congress had in view the protection of society against another class of
alien women other than those who might be brought here merely for purposes of
"prostitution." In forbidding the importation of alien women "for any other
immoral purpose," Congress evidently thought that there were purposes in
connection with the importation of alien women which, as in the case of im-
portations for prostitution, were to be deemed immoral. It may be admitted
that in accordance with the familiar rule of ejusdem generis, the immoral purpose
referred to by the words "any other immoral purpose," must be one of the
same general class or kind as the particular purpose of "prostitution" specified
in the same clause of the statute. 2 Lewis' Sunderland's Stat. Const., p. 423,
and authorities cited. But that rule cannot avail the accused in this case; for
the immoral purpose charged in the indictment is of the same general class or
kind as the one that controls in the importation of an alien woman for the pur-
278
NOTE AND COMMENT 279
pose strictly of prostitution. The prostitute may, in the popular sense, be more
degraded in character than the concubine, but the latter none the less must be
held to lead an immoral life, if any regard whatever be had to the views that
are almost universally held in this country as to the relations which may right-
fully, from the standpoint of morality, exist between man and woman in the
matter of sexual intercourse.
The fact that the last section of the Mann Act states that it should
be known and referred to as "The White Slave Traffic Act," cannot,
the court holds, be controlling in the face of the unequivocal language
employed in the other sections, nor is it proper to resort to "reports to
Congress accompanying the introduction of proposed laws" in order to
ascertain the true meaning of the legislature when the words used are
perfectly plain.
Concerning blackmail, the opinion states that "the fact, if it be so, that the
act as it is written opens the door to blackmailing operations upon a large scale
is no reason why courts should refuse to enforce it according to its terms, if within
the constitutional authority of Congress. Such considerations are more ap-
propriately addressed to the legislative branch of the government which alone
had authority to enact and may, if it sees fit, amend the law.
The dissenting opinion of Justice McKenna contends that the
phrase "or for any other immoral purpose" must, in order to be made
intelligible, be limited and that the context and the purpose of the statute
necessarily must be looked to in ascertaining the proper limitations.
He then asserts that the context and purpose of the statute very
plainly indicate that it was intended to comprehend cases of com-
mercialized vice only and he adds "blackmailers of both sexes have
arisen using the terrors of the construction now sanctioned by this
court as a help — indeed the means — for their brigandage. The re-
sult is grave and should give us pause. It certainly will not be denied
that legal authority justifies the rejection of a construction which
leads to mischievous consequences, if the statute be susceptible of
another construction." Chief Justice White and Justice Clarke con-
curred in this dissent.
The decision of the majority of the court would seem to be clearly
correct; to have held otherwise would have been judicial legislation.
The varying attitudes of United States district attorneys throughout
the country will now be harmonized and greater uniformity in the en-
forcement of the law should result. It is, however, not altogether clear
that the inclusion within the act of cases of personal immorality where
neither force or fraud nor money is involved, is desirable. Merely
280 SOCIAL HYGIENE
because such an interpretation opens the door to blackmail ought not
to control, for the same situation exists with respect to many other
salutary laws; nevertheless personal immorality across interstate lines
is not a matter which ought to concern the national government.
If the law will not be vigorously enforced in this class of cases it
would be better to amend it so as not to include them. There seems
little likelihood, however, of any amendment being passed by the
Congress.
Memorandum of Law on Cases Decided under the Mann Act
The Act is constitutional.
U. S. v. Hoke, 187 Fed. 992; 227 U. S. 308.
TJ. S. v. Bennett, 194 Fed. 630, 227 U. S. 333.
U. S. v. Westman, 182 Fed. 1017.
Transportation of persons is commerce.
Gloucester Ferry Co. v. Pennsylvania, 142 U. S. 203.
Covington Bridge Co. v. Kentucky, 154 U, S. 204.
Congress has plenary power over interstate commerce.
McCulloch v. Maryland, 4 Wheaton 421.
Gibbons v. Ogden, 9 Wheaton 1.
Power to regulate commerce includes power to prescribe conditions under
which commerce shall be conducted.
Gloucester Ferry Co. v. Pennsylvania, supra.
Northern Securities case, 193 U. S. 197.
Congress, having plenary power over interstate commerce, may prohibit it.
The Rahrer case, 140 U. S. 545.
The Addyston Pipe case, 175 U. S. 226.
Reid v. Colorado, 187 U. S. 137.
The Lottery cases, 188 U. S. 321.
The means of exercise of power over interstate commerce by Congress may
have the quality of police regulations because such power is complete.
Hipolyte Egg Co. v. U. S., 220 U. S. 45.
The argument that Congress cannot prohibit a person from traveling from
one state to another because of some intention he may have, and there-
fore that it cannot be made criminal to assist a person in so traveling, is
erroneous. It is the criminal intent plus an overt act in pursuance of
that intent, against which the Mann Act is aimed.
U. S. v. Hoke, supra.
U. S. v. Bennett, supra.
The intent of the person inducing is the intent existing when the means of trans-
portation is procured;
U. S. v. Athanasaw, 227 U. S. 326.
and*if defendant contends that his intent was innocent, evidence of other
transportations for immoral purposes is admissible.
Kinser v. U. S. 231 Fed. 856.
NOTE AND COMMENT 281
"Debauchery" means acts which eventually and necessarily and naturally lead to
a course of immorality, sexually. Whether the woman transported is pure or
impure is immaterial;
U. S. v. Athanasaw, supra.
U. S. v. Suslak, 213 Fed. 913.
and the indictment need not allege the consummation of the debauchery
by the commission of a specific act of prostitution or debauchery by the
girl.
U. S. v. Brand 229 Fed. 847.
A woman who is transported in violation of the Mann Act may be guilty of con-
spiracy to violate the Act;
U. S. v. Holte, 236 U. S. 140.
and the Act applies to a woman or girl voluntarily consenting to acts of
immorality, as well as to a "White Slave;"
Hays v. U. S. 231 Fed. 106.
but she is not an accomplice.
Hays v. U. S. supra.
Transportation need not be by common carrier;
U. S. v. Wilson, 232 U. S. 563.
U. S. v. Burch, 226 Fed. 974.
Transportation for purposes of sexual intercourse or concubinage is within the Act;
U. S. v. Flaspoller, 205 Fed. 1006.
U. S. v. John Arthur Johnson, 215 Fed. 679.
U. S. v. Burch, supra.
likewise, transportation for "any immoral purpose," apart from any com-
mercial element, is within the Act.
U. S. v. Diggs,— U. S.—
Wife can testify against husband if married at time of acts testified to;
Cohen v. U. S. 214 Fed. 223.
U. S. v. Rispoli, 189 Fed. 271.
Charles Johnson v. U. S., 221 Fed. 250, contra,
bnt not if marriage was subsequent to acts.
U. S. v. Gwynne, 209 Fed. 993.
Section VI relating to persons harboring alien prostitutes, applies only to countries
with which the treaty exists and the indictment should state the importation of
the alien prostitute from such country.
U. S. v. Davin, 189 Fed. 244.
In pursuance of a treaty obligation (under Section VI) Congress has the power to
require a person harboring an alien who is a prostitute within three years after
her arrival and who emigrated from a country with which the United States' is
in a treaty relation, to report such fact to the Commissioner-General within thirty
days of the beginning of such harboring;
U. S. v. Portale, 235 U. S. 27.
and this, irrespective of whether such harboring is in pursuance of illegal
importation;
282 SOCIAL HYGIENE
U. S. v. Portale, supra.
U. S. v. Davin, supra.
but the required certificate must be filed in the office of the Commissioner-
General of Immigration at Washington, D. C., and the offense of not filing
is not committed in the district where the woman or girl is harbored,
nor has the district court of the United States for that district jurisdiction
of the offense.
U. S. v. Lombardo 241 U. S. 73, 228 Fed. 980.
Commercialized Prostitution in New York City in 1916. The report
of the Bureau of Social Hygiene for the year ending November 1, 1916,
on commercialized prostitution in New York City, contains an intro-
duction which is significant of the possibilities of repression through
long-continued efforts in the field of law enforcement, particularly
when official and unofficial agencies cooperate. The introduction is in
full as follows : —
The Bureau of Social Hygiene issued in 1912 a volume entitled Commercialized
Prostitution in New York City, by George J. Kneeland. This volume described
in detail the situation as respects the practice of prostitution in this city at
that time. A year ago, the Bureau issued a pamphlet which endeavored to con-
trast conditions in 1915 with the conditions reported in 1912. Now, a year
later, in the present pamphlet, the Bureau presents a concrete statement of
existing conditions, as compared with the conditions disclosed in its two previous
accounts. The contrast is in the highest degree striking and encouraging. Vice
still exists; but its amount has been greatly reduced, and the damage caused
has been immensely lessened. In 1912, prostitution was open, organized, ag-
gressive, and prosperous; in 1916, it is furtive, disorganized, precarious, unsuc-
cessful. This improvement is shown in the statistics that follow; but, as a mat-
ter of fact, the real improvement is far greater than the statistics show. A
single example will make this point clear. There were 142 parlor houses in 1912;
the present statement gives 22. On the face of the figures, the parlor houses
have been cut down to one-seventh of what they were four years ago. But this
understates the achievement. For the 142 houses in 1912 harbored over 1600
inmates; they were notorious resorts, engaged in the active and open prose-
cution of their shameless business. The 22 houses now reported contain less than
50 inmates. They are hard to find, still harder to enter; they lead a brief, un-
certain, day-to-day existence; before these pages leave the press, every one of
them will probably have been snuffed out by the police. The same holds true of
vicious saloons, of vicious tenements, of streetwalking, and of pimps. Thus,
though commercialized vice continues in New York, it has been dealt a body-
blow.
The credit for this achievement must be more or less widely apportioned.
Civic organizations, such as The Committee of Fourteen, deserve to be promi-
nently mentioned; the District Attorney's office and the Criminal Courts have
recently by successive convictions performed an admirable service. But the
chief credit belongs to the Mayor and to the Commissioner of Police. For three
NOTE AND COMMENT 283
years an able, upright, clear-headed, and high-minded Police Commissioner
has pursued a sound and consistent policy, with all the backing, moral and
official, that the Mayor could bring to his support. The results are obvious:
The police force has steadily unproved in morale and efficiency; a new standard
of public decency has been set and maintained.
Prostitution has been proved to be a "modifiable phenomenon." Whether
the city has more of it or less of it depends very largely upon the policy which
the municipal government pursues in dealing with it.
A comparative statistical table showing the decrease in the volume
of prostitution in New York City since 1912 follows: —
1. VICE KESORTS
Parlor Houses
1912, 142; 1915, 23; 1916, 22
The change in the method of operating these houses is equally significant.
In the majority of them the inmates remain in their rooms, dressed in respect-
able attire, pretending to be legitimate boarders. In fact, these resorts are
to all appearances furnished-room houses.
The volume of business transacted has decreased enormously.
Tenement Houses
1912, 1172; 1915, 484; 1916, 238
The most significant change in the operation of these flats over previous
years is that a large number, in comparison, have become "call" places. . . .
It is practically impossible at present for men to enter these resorts with-
out a personal introduction to the madam from someone actually known to
her
Because of the small number of inmates and the difficulty of gaining en-
trance, it is evident that the volume of business in vice resorts of this type has
been reduced to a minimum.
Assignation and Disorderly Hotels
1912, 103; 1915, 56; 1916, 41
A marked change has taken place in the operation of disorderly hotels.
. . . . The proprietors of most of these 41 resorts will not allow a prosti-
tute to enter with a customer more than once in twenty-four hours.
Furnished Room Houses
1912, 112; 1916, 142
The results of the present study show that the situation needs the continued
attention of the police. When vice is suppressed to any extent in houses, flats,
and hotels, it is inevitable that it will at first betake itself to furnished room
houses. This has happened in New York City, and is the most serious problem
confronting the police at the present time.
284 SOCIAL HYGIENE
Massage Parlors
1912, 300; 1915, 90; 1916, 9
During the past year, the police have been especially active against "mas-
sage parlors." A systematic and persistent effort has been directed against
all such resorts of an illegal character, particularly where signs were ostenta-
tiously displayed. . . .
From 1908 to 1915 a weekly paper which carried from one to two, and some-
times three, pages of massage parlor advertisements, was sold on the news-
stands. In the majority of instances these related to disorderly resorts. Dur-
ing the latter part of 1916 these advertisements gradually decreased, until one
issue contained only four such notices. Soon after, this paper disappeared from
the news-stands.
The Board of Aldermen recently adopted an ordinance requiring massage
institutes and parlors to be licensed and although this ordinance has been in
effect but a short time, it has already given promise of weeding out the illegiti-
mate massage parlor.
2. PLACES WHICH CATER TO VICE
Disorderly saloons
1912, 308; 1915, 84; 1916, 34
Probably at no time in the history of New York City have the conditions in
saloons shown such improvement as in recent months. In former years, and
especially in 1912, a large number of saloons served as hangouts and soliciting
place for prostitutes. Such is not the case any longer.
Streets
(No statistics are given under this head, but the improvement noticeable in
1915 over conditions in 1912 has been maintained during the past year.)
The police have been so aggressive against all types of vice resorts and so-
liciting on the streets that madams and prostitutes demand introductions and
marks of identification before they will recognize a customer. Cabmen and
chauffeurs, who formerly had lists of houses and flats to which they conducted
customers, now declare that they know of very few resorts.
3. THE EXPLOITERS
The vice ring in the old sense of the word no longer exists in this city. In fact>
former promoters of commercialized prostitution in this city seem to have come to
the conclusion that "the banner years of prosperity" will never return. It is
a known fact that more than 75 former men owners and their agents, such as
procurers and pimps, have left the city with their women for more open markets.
Twenty of these men moved to a near-by city, where they became the head and
front of a string of houses which opened after a recent municipal election. The
so-called "King of the Vice Trust," with others indicted with him in 1912, is
still a fugitive from justice. During the year 1916 the District Attorney's office
successfully prosecuted five notorious procurers, most of whom were in active
business in New York in 1912. The five men received prison sentences ranging
from five and a half years to nineteen years, eleven months, and fines ranging
from $1000 to $5000. While some degree of exploitation undoubtedly exists at
the present tune, it is greatly below the level of the 1912 figures.
NOTE AND COMMENT 285
Results from Following Up a Vice Investigation. The story of the
investigation into vice conditions in Lancaster, Pennsylvania, and
of the second inquiry a year later was told in SOCIAL HYGIENE, June,
1915.1 Rev. Clifford G. Twombly, D.D., Chairman of the Commis-
sion under whose direction the work was done, says in The Churchman,
Februarys, 1917:
At the opening of the last Quarter Sessions Criminal Court in Lancaster on
September 11, 1916, the presiding judge in his charge and instructions to the
Grand Jury took occasion to say that it had been five months since a session
of the Criminal Court had been held in Lancaster County and that "in this time
there has been a notable lack of serious crimes in the county, and we are to be
congratulated on this fact." There has also been a marked decrease recently
in the fornication and bastardy cases. Is there any connection between this
state of affairs and the closing of the disorderly houses which are the breeding
places of vice and crime? It seems to us that there is, though at the tune of
the vice crusade it was constantly and confidently predicted that the result
would be just the opposite and that the closing of such resorts would mean a
large increase of vice and crime. The chief of police also is credited in the
Lancaster Intelligencer of October 9, 1916, with speaking as follows: "For a
number of years this city has been slowly but certainly undergoing a purifying
treatment. It has been cleared of dives and of their frequenters, and those
who have striven to bring home the hopes of the social workers have overwhelm-
ingly won against almost inconceivable odds. . . . With the regeneration
of the city within itself there has been created, too, the natural echo of the
work that has carried to other places; an echo that is the best and most magnetic
advertising message that could be sent out!"
What the Press Thinks about Commercialized Vice in St. Louis. The
press of St. Louis has been devoting much space to the consideration
of the problem of prostitution and its relation to the city and its gov-
ernment. The following editorials are indicative of the attempt,
essayed by more and more people, to probe beneath the surface of con-
ventional thought and seek the roots of commercialized vice from
which its more obvious manifestations spring.
CRIME AND VICE
Investigation by the grand jury of vice conditions in St. Louis and especially
of charges that disorderly resorts are protected by the police, offer promise of
rational results in the vice crusade now raging. It is the legal and sane method
of seeking information concerning vice conditions and the efficiency and honesty
of the police in dealing with them.
1 The City That Has Followed up its Report on Vice Conditions, by Rev.
Clifford G. Twombly. SOCIAL HYGIENE, June, 1915.
286 SOCIAL HYGIENE
The hysterics of some of our esteemed contemporaries, in which the city is
pictured as "engulfed in a wave of vice and crime" and demands are made for
wholesale arrests and raids, regardless of law and evidence, lead nowhere except
to conditions worse than we have. The endless chain of arrest, fine and driving
on of the miserable wretches infesting streets and dens is futile. Whither are
these creatures driven? From one city or from one place to another. The fine
is only a stimulus to vice activities. Wholesale arrests and raids result in more
outrages on decent people than effective strokes in putting down vice. . . .
The wretched instruments of vice are punished and the community is afflicted
with widespread infection, while the causes are untouched and the instigators
who profit go free.
Under our present laws and resources the best that can be done is to close
disorderly houses and keep disorderly women from street solicitation. Even
this is difficult, but morality and decency demand efficient work to this end.
If, however, the entire police force is turned into a moral squad, to spy on the
conduct of persons and seek immorality in houses and apartments, police effi-
ciency against open indecency and crime is hopeless. Inefficiency and corrup-
tion inevitably follow the application of the police spy system to morality. It
is a confession of helplessness in all the spiritual and moral factors that make for
wholesome social conditions. It puts a premium on bribery. . . .
The real cause of these recurring waves and futile crusades lies deeper than
the police and the existing courts. It is found in the inefficiency of our whole
system of dealing with crime and vice. Our criminal code and mode of procedure
is faulty; our system of courts in this city is defective; our prison and reformatory
system is bad — in some respects rotten.
If the evils from which we suffer arouse the public to a realization of the
need of rational reform in all our methods of dealing with crime and vice, much
will be accomplished. The State Legislature has before it plans for reorganiz-
ing the prison systems, for improving courts and codes and procedure in crimi-
nal proceedings, for dealing with delinquent children and first offenders. We
need means to deal humanely and effectively with female offenders.
Let us drop hysterics and apply reason to the evils that beset us. Let us
insist that the State Legislature enact the program of constructive legislation
submitted to it and begin to deal sanely and successfully with evil conditions and
causes. Deeper still are the economic conditions that foster crime and vice. —
Post Dispatch.
NOT VICE — PROFITS!
The real center of the St. Louis vice question is not vice. If it were, it could
be settled in the course of the next two weeks, and settled easily. Nobody
believes in vicej nobody apologizes for it; nobody gets up nights to protect and
shield it. The people who think that the core of the vice question is vice are
wasting their time and barking up the wrong tree.
The real center of the vice question is profits. The effective opposition to
the work of cleaning up St. Louis does not come from those who are interested
primarily in vice as vice; it comes from those who are interested primarily in
vice as a means of revenue.
NOTE AND COMMENT 287
There's money in it. That's why there's power in it, and politics in it, and
influence in it. That is why there are places in St. Louis that laugh at the
police, secure in the protection which has been theirs for years. That accounts
for those bail bonds signed in blank, those raids "tipped off" before they occur,
those prisoners released by the fiat of mysterious powers that do not come to
the light, those legal proceedings which, as farces, are so much more ridiculous
than anything ever seen on the stage.
Vice is not vice alone; it's also business. Out of the hire of bodies of women,
out of the price of the shame and degradation of girls, it pays rents, and buys
beer by the thousands of cases, and "slips" money to influential friends all up
and down the line, and — here is the most important thing of all — it supports
thousands of flashily dressed men in this town who, if it were not for the revenue
from these women, would have to earn their own board and their own clothes
and their own laundry bills and their own smokes and drinks. These men
have votes; they have leaders who know who is "right" and where these votes
may be cast to count the most.
The real battle is not with vice. It's with commercialized vice. It is with
dollars. The wretched, debauched girls are machines for making money.
There are thousands of them in St. Louis, owned, body and soul, by the male
vampires who fatten off them.
The crucial thing is not to reform a habit; it is to break up a business. Let's
hang to this, for all attempts to obscure it and to argue the question of vice as
such are just so many attempts to draw a red herring across the trail. We can-
not stop vice by law, but St. Louis may be made too hot to tolerate certain kinds
of commerce in vice, too hot to hold certain sleek beneficiaries of vice. That is
the motion now before the house. — The Republic.
A City That Reports its Venereal Disease Cases. The seventh annual
report of the city of Palo Alto, Calif., in commenting on its death rate
for 1915 of 6.25 per thousand notices among other favorable factors,
aside from the activities of the health department, "No extremes of
economic condition — we have neither the very rich nor the very poor.
No booze — Palo Alto is permanently dry. No prostitution — therefore
a low rate from the venereal diseases and their attendant ills."
Communicable diseases showing the greatest number of cases for
1915 are reported as follows: Whooping cough, 81; mumps, 63;
measles, 35; chicken pox, 30; gonorrhea, 24. No cases of syphilis
were reported during the year. In 1914 there were reported 52 cases
of gonorrhea and 10 of syphilis. It may be assumed that the reports
of venereal disease cases are reasonably complete inasmuch as the de-
partment of health claims for the city "A group of local physicians far
above those of the average community in professional ability and
public spirit."
288 SOCIAL HYGIENE
The Lakeside Hospital, Cleveland, Ohio, treats cases of syphilis in its
dermatological clinic and has since 1914 undertaken systematic fol-
low-up work for such cases through its social service department.
All patients report to the social worker stationed at the clinic who tells
them when to return.
Primary or fresh secondary cases are referred whenever possible to
the City Hospital for at least two weeks' hospital treatment. If pa-
tients are not admitted to the hospital within twenty-four hours, a
home call is made and admission secured either through persuasion or
if that fails, through the efforts of the Commissioner of Health whose
policy in such cases is to send a sanitary police officer who explains
that the patient's door may be placarded with a venereal disease
poster.
In securing regular attendance of patients who have passed the
acutely infectious state, the patient is assured that his confidence will
not be violated. An attempt is made to arouse his sense of respon-
sibility both to himself and to those with whom he comes in contact
and to reeducate him along sex hygiene lines with the purpose of in-
fluencing his conduct after a cure is effected; the hospital uses printed
instructions in English, Italian, German, Polish, and Hungarian and is
planning translations into Yiddish, Croatian, Servian, Roumanian,
and Greek. Patients who fail to return regularly for treatment are fol-
lowed up by cards of notification and personal calls. If these influences
fail, the case is referred to the health department for the attention
of the sanitary police.
Prevalence of Syphilis as Indicated by the Routine Use of the Wasser-
mann Reaction. Dr. A. A. Homer found a positive Wassermann reaction
in 17.4 per cent, of 500 cases at the Massachusetts General Hospital
(Boston Medical and Surgical Journal, February 10, 1916). Of 312
Wassermann reactions from consecutive admissions at the Boston Ma-
rine Hospital, February to October, 1916, excluding readmissions and
faulty specimens and considering doubtful reactions as negative, 77, or
24.7 per cent, were positive. Excluding 19 cases obviously syphilitic,
18.6 per cent, of the apparently non-syphilitic cases gave a positive
reaction. Including 11 obviously syphilitic cases giving the negative
reaction on account of recent treatment, the total incidence was 28.2
per cent.
Beginning in 1911, the Wassermann reaction was used at the Boston
Marine Hospital as an aid to diagnosis and doubtful cases. From that
NOTE AND COMMENT 289
date to 1916, 2863 cases were admitted and 468 Wassermanns made,
of which 191 were positive, 268 negative, and 17 doubtful; 9.1 per cent,
of all admissions were diagnosed as syphilitic.
From 1907 to 1911 few Wassermann tests were made, but 4.3 per
cent, of all cases treated in hospitals of the United States Public Health
Service were diagnosed as syphilitic. This is probably a fair average
of easily recognizable cases among such patients.
From the above data it would seem fair to conclude: —
1. That the prevalence of syphilis is much greater than is shown
by ordinary hospital and medical records, and that by the routine use
of the Wassermann reaction a large percentage of cases which certainly
could not be diagnosed without it, will be recognized and properly
treated.
2. That for the protection of the public health, to say nothing of
the relief of much individual suffering, state and city laboratories
where the Wassermann test can be obtained without cost should be
universally established, and physicians and the public at large should
be educated to its use in the same way that they have been educated
to demand examination of sputum for tuberculosis. — Wm. M. Bryan,
Passed Assistant- Surgeon, and Jas. F. Hooker, Acting Assistant Sur-
geon, United States Public Health Service. Public Health Reports,
November 24, 1916.
Prophylaxis of Venereal Diseases in Prussia. The Allgemeine
medizinische Central-Zeitung says that the health insurance organi-
zations of Prussia have established seventy free consulting dispen-
saries for sexual diseases. Realizing that defective or unsuitable
treatment of venereal diseases is a danger not only to the diseased
themselves but also a menace to the general welfare, a recent confer-
ence of the insurance organizations and of the larger medical associa-
tions unanimously voted in favor of continuing, after the war, the
measures enforced by the orders of the military commanders against
quackery in the treatment of venereal disease. The conference de-
clared that these diseases can be successfully controlled only when
quackery is legally excluded. It should be illegal for any person, not
a registered physician, to treat sexual diseases in any way. Laws
should also be passed prohibiting the dispensing of remedies against
sexual diseases by drug stores and other establishments without a
physician's prescription, and prohibiting the distribution of circulars
and pamphlets which encourage self-treatment of sexual diseases,
290 SOCIAL HYGIENE
even in veiled terms, as testimonials, expressions of gratitude, rec-
ommendations and advice. All distant treatment of sexual diseases,
as well as every public offer to treat patients of this class, should be
absolutely prohibited.
The Public Morals Association of Sydney, New South Wales, at its
second annual conference on the control of venereal diseases and sug-
gested remedies, November 16, 1916, adopted the following resolutions:
That this conference affirms it as its opinion that all public general hospitals
supported by state funds should be compelled to make provision for the treat-
ment of patients suffering from venereal disease, and that a suitable booklet,
to be provided at the public expense, on such diseases should be given to each
patient being attended at a hospital or by a private medical practitioner.
That this conference endorses the recommendation of the Royal Commis-
sion on Venereal Diseases, that instructions in these subjects should be provided
in evening continuation schools and in factories and workshops. For this
purpose the aid of properly-constituted voluntary associations should be en-
listed, and the guidance of medical practitioners should be secured.
That this conference urge upon the Government the printing and circulation
to every householder throughout the state of suitable literature dealing with
the question of venereal diseases.
That a council for combating venereal diseases should be called into exist-
ence, to be recognized by the Government as an authoritative body for the
purpose of spreading knowledge in regard to the questions of venereal diseases
in their varied aspects.
That this conference urge upon the Government the necessity for the enact-
ment of more stringent legislation providing for the suppression of advertise-
ments, and of the circulation of all printed matter dealing with sex complaints
and their treatment.
That this conference, recognising that public prostitution is one of the main
causes of the spread of venereal diseases, urges upon the authorities the neces-
sity for the better enforcement of law, to suppress houses of ill-fame, brothels,
and disorderly houses.
That this conference affirms its conviction that notification will not prove
effective in staying the ravages of venereal diseases, but if enacted is more
likely to cause the victims to avoid treatment or to seek the advice of medical
quacks.
Control of Venereal Diseases in Australia and Denmark. The
Weekly Bulletin of the New York City Department of Health, No-
vember 11, 1916, points out that the main features of the Australian
law for the control of venereal diseases, outlined in SOCIAL HYGIENE,
January, 1917, are found in the law enacted in Denmark in 1906,
which reads in part as follows: —
NOTE AND COMMENT 291
LAWS AGAINST THE SPREAD OF PUBLIC IMMORALITY AND VENEREAL INFECTION
Promulgated by His Majesty, King Frederick, March SO, 1906
(Sections 1, II, 111, relate to the regulation of prostitution.)
(Section IV relates to punishment.)
Section V. All individuals, suffering from venereal diseases, whether they
be financially able to pay the costs of their treatment or not, shall be entitled
to treatment at the expense of the community, so long as they are not able to
present proof that they are under treatment in private. All venereally in-
fected individuals are obliged to remain under treatment until fully cured.
Should the mode of life of an infected individual be such that it is not certain
that the transmission of the infection to others can be prevented, or should
the individual in question not follow out the directions given for the preven-
tion of the transmission of the infectious diseases to others, then the individual
in question shall be compulsorily interned in a hospital. The decision con-
cerning the necessity of such measures shall rest with the police authorities.
All individuals receiving the aid of the public charities shall, in the case of an
infection of this type, be transferred to the hospital.
Section VI. If, during the course of the treatment, or after the completion
thereof, it seems advisable to the physicians, during a particular case, to keep
the patient in question constantly under observation, then this physician shall
set for the patient specified intervals at which the patient is to visit the physi-
cian for the purpose of control. Should a patient not comply with the regula-
tions, or remain away in spite of notification to appear for treatment, then the
physician treating the case shall send a notification to that effect to the city
physician. The city physician shall then take measures providing for the treat-
ment of the individual by one of the communal physicians.
Section Vll. Every physician treating venereally infected individuals shall
draw their attention to the dangers of the disease, and also to the legal conse-
quences of a transmission thereof. He should particularly draw the attention
of the diseased individual to the dangers of entering upon matrimony during
the course thereof.
Section Vlll. Every physician shall, in his weekly report to the city physi-
cian or the district physician, particularly state that he has observed the
regulations contained in the foregoing paragraphs, and give the number of indi-
viduals whom he has ordered to call upon him, in accordance with the provis-
ions of Paragraph V. Breaches of Paragraphs VI and VII, or of this paragraph,
are punishable by a fine up to 200 kronen. Any individual who gives a physician
a false name or occupation or dwelling, will be punished according to the pro-
visions of Paragraph 155 of the penal code.
The Missouri Children's Code Commission has recently made a
complete revision of the laws for the welfare of children in Missouri
for submission to the legislature at its present session. The Com-
mission was appointed by the governor and a large part of the work
of compilation and comparison was done at the University of Mis-
292 SOCIAL HYGIENE
souri by the departments of political science, sociology, and law.
Many other public and private organizations gave their assistance.
Among the new measures proposed in the Children's Code are the
following: —
For the Protection of Destitute Children
Abolishing the legal stigma of illegitimacy and providing for the support of
children born out of wedlock.
Raising the age of consent in the case of a girl previously unchaste to sixteen
years.
Abolishing common law marriages.
Requiring five days' notice before the issuance of a marriage license.
Supervision of child-caring institutions and placing-out agencies by the
State Board of Charities and Correction.
For the Care of Delinquent and Neglected Children
Establishing a juvenile court in every county.
For the Care of Defective Children
Providing for compulsory commitment and detention of dependent feeble-
minded persons in institutions.
Providing for the establishment of a bureau for mental defectives in the Uni-
versity of Missouri.
Prohibiting the marriage of feeble-minded persons.
For the Protection of the Health of Children
The creation of a division of child hygiene in the State Board of Health.
For the Administration of the Laws
The establishment of county boards of public welfare composed of members
of the county court, the judge of the juvenile court, and the county school super-
intendent.
The Commission also recommended the establishment of a state
reformatory for young women, but did not include this recommendation
in the proposed code.
Deportations of Prostitutes. The annual report of the Commissioner-
General of Immigration to the Secretary of Labor for the fiscal year
ended June 30, 1916, contains the following comparison for the last
two fiscal years: —
NOTE AND COMMENT 293
Rejection and Deportation of Aliens
1915
1916
Prostitutes and other immoral women
291
439
Procurers of prostitutes
192
307
Deported after Entry
Prostitutes
204
272
Supported by the proceeds of prostitution
58
76
Sexually immoral after three years' residence
101
89
The Commissioner-General points out that these figures by no
means include all persons who ought to be rejected or deported after
entry, but that the limits of the appropriation which the Bureau of
Immigration receives prohibit it from undertaking more extensive
investigations into the character of aliens.
Repeating his statement contained in his report for the previous
year, he says: "I think it can be said without fear of contraversion
that the figures given above, notwithstanding the good showing they
represent under the circumstances of extreme difficulty that surround
this matter, really show but very small results in comparison with
what might be done with increased appropriations so as to permit a
greater allotment than is now possible for this particular purpose.
The Bureau could probably employ $250,000 in this work for the
coming year, with great benefit in ridding the country and keeping it
clear of the immoral classes now here and those constantly coming or
being brought here from abroad."
Of the 439 prostitutes who attempted to enter the country, 66 were
English, 46 French, 191 Mexican; and of the alien procurers who
attempted to import prostitutes, 43 were English and 149 Mexicans.
One hundred and seventy-two immigrants were found to have a
venereal disease — 144 males and 28 females.
Concerning white slavery, the reports of the commissioners and
inspectors in charge of local districts in the following places are
significant : —
Boston. In this field an advanced step has been taken by the designation of
one of our matrons for continuous service as special officer in the surveillance
and care of women and girls of the immoral classes. This special officer has
established working relations with the various societies and public officers in-
terested in this work, and it is believed that a constructive program gradually
may be developed and worth-while results accomplished. Lack of funds, how-
294 SOCIAL HYGIENE
ever, continues to prevent effective measures against the activities of alien
prostitutes in this district. Large numbers of Canadian prostitutes who are un-
doubtedly amenable to deportation frequent the resorts of Boston. Those of
European origin are also numerous, though less in evidence.
San Francisco. The usual number of Chinese prostitute cases were consid-
ered, with about the same results as in the previous year. One woman was
deported at her own request, she having tired of the life into which forced, and
she became quite a valuable informant for this office. This service has been
working under adverse conditions in its efforts to secure evidence in the cases
of Chinese prostitutes by reason of the shifting about of the prostitute from
hotel to hotel.
The campaign inaugurated under the red-light abatement act by the state
authorities is being still vigorously carried on, and in some instances has been
successful in closing up these dens of vice.
Seattle. A total of 69 investigations were made in the cases of immoral
women and girls, resulting in the deportation of 10 such women and girls. Five
criminal prosecutions were instituted during the year against those who prey
upon women and girls, 3 of the defendants being convicted, 1 released on de-
murrer to the indictment, and 1 acquitted.
Chicago. Segregated vice districts in the cities of this district have been
almost entirely eliminated. Constant vigilance, however, has continued neces-
sary for the discovery and apprehension of aliens and citizens engaged in the
white slave business. In Chicago this service has the advantage of being given
a recognized standing in the morals court, where an immigrant inspector is on
duty each day and carefully investigates each case, presenting evidence indic-
ative of violation of the immigration law. This arrangement has proven prac-
ticable, and, with efficiency on the part of the police department of the city,
undoubtedly will result in bringing to the attention of the Bureau of Immi-
gration the largest possible number of alien participants in the white slave
business.
Alaska. No cases bordering on white slavery were reported during the
year, and as there have been but 2 regularly appointed inspectors in the dis-
trict, it has not been possible to give this feature of the work much attention.
Until the enactment of a law making it impossible for a woman of the confirmed
prostitute class to obtain the right to remain in the country by fraudulent mar-
riage to a United States citizen it would appear a waste of time and money to
undertake many arrests of this class of undesirables.
Montreal headquarters. During the year there were 194 prostitutes, 127 pro-
curers, and 7 persons receiving proceeds of prostitution debarred by boards of
special inquiry in this district During the same time 82 prostitutes and 44
procurers or persons receiving proceeds of prostitution were deported under de-
partment warrants. Prosecutions under section 3 were brought in the federal
courts against 94 persons, with the result that conviction was obtained of 49
of the defendants, while actions against 44 were unsuccessful, 1 case still being
pending.
El Paso. During the past year there have been excluded 99 prostitutes, 144
women and girls coming for an immoral purpose, and 177 persons bringing
NOTE AND COMMENT 295
women and girls for an immoral purpose. There were deported 111 prostitutes,
21 procurers and persons bringing women and girls for an immoral purpose, 9
persons receiving the proceeds of prostitution, 12 persons employed by, in, or in
connection with houses of prostitution, and 35 women and girls coming for an
immoral purpose, in addition to which warrants of deportation in 24 cases have
not been executed.
There were convicted 20 persons for bringing women and girls for immoral
purposes, involving sentences aggregating fourteen years and six months and
fines amounting to $201; and 10 prostitutes for returning after deportation as
such, involving sentences aggregating three years and five months; in addition
to which 6 persons are awaiting trial as procurers and 8 as prostitutes.
Efforts are being made by state and municipal officers and private philan-
thropic organizations in the state of California to suppress the white slave
traffic. In California gratifying results have followed the activities of private
organizations in extending aid to those unfortunate women indicating an honest
desire to reform. A rigid enforcement of those provisions of the immigration
and Mann Acts penalizing traffic involving sexual immorality has marked the
past year and it is believed with far-reaching results.
The Life Force. The greatest force in the universe is known as
the life force. Although common to every living thing, it has never
been understood by philosophers nor has it been created by scientists.
We know, however, that in whatever form it manifests itself, the Me
force has three powers — growth, assimilation, and continuation of its
own life through new lives. This last is the great power by which our
world, with its many forms of plant and animal life, is renewed,
throughout the ages. We call this power reproduction. In plants
and animals, reproduction takes place through definite laws and at
definite seasons, controlled by the force we call nature. In human
beings, reproduction, or parenthood, is governed by mind and spirit,
but if uncontrolled, instead of being a force of life and happiness, it
becomes a means of degradation of the body, mind, and spirit, leading
to destruction.
Because of the great importance of the life force in human beings,
reproductive power is not fully received until about the twelfth or
fourteenth year. During and after this time, special facts should be
known and understood in order that the body may receive proper
care and that character and self-control may be developed. There-
fore, now that you have passed the years of childhood and since you
are responsible for the care of your own body and the development of
your own character you should know the special laws governing human
life. You should also be prepared at those times when rest and free-
296 SOCIAL HYGIENE
dom from bodily exercise are necessary, to forfeit, cheerfully, pleasure
and inclination, in order to preserve your future health.
When it is understood, reverenced, and guided in the right direction,
the life force, when not concerned in parenthood, is used in strength-
ening the body and the mind. As this great force becomes a part of
your life and is given into your keeping, it becomes your privilege to
know the facts concerning it for the development of bodily strength
and moral character. Some of this information you may get from
books concerning which your Guide will advise you. From older
persons whom you respect you may learn important truths. Never
should you seek facts from those who by word or action show that
they would treat lightly or even degrade the power of life. — The
Woodcraft Manual for Girls.
Guardians of the Law, Take Heed!
LET SOME ONE ELSE DO IT
A not uncommon but none the less erroneous idea of public duty is reflected
by police and prosecuting officials when they declare their inability to sup-
press questionable resorts or practices unless "the neighbors are willing to
swear out warrants." It has often happened that information concerning vio-
lation of the laws and ordinances, and concerning the existence of disreputable
and immoral establishments constituting a nuisance is laid before officials by
reliable citizens — only to be received with the discouraging suggestion that if
the informants will sign the complaints, the officers will see what they can do
about it.
Herein is shown a lack of initiative that goes far toward explaining the prev-
alence of crime and the spread of vice. In the first place, if the law officers do
not know of the existence of such evils until told about them, they are not as
alert and observant as they ought to be and not qualified for their positions;
but if, after receiving the information from reliable sources, they still decline
to act unless the citizen assumes the role of complainant, they are guilty of an
inertia and indifference that render them liable to the most damaging suspicion.
Not upon the citizen, but upon the officers of the law — prosecuting attorneys,
sheriffs, police departments, etc. — rests the responsibility for the suppression of
vice, the prevention of crime and the arrest of lawbreakers. They are anxious
enough to obtain the positions to which these duties belong, and are never back-
ward about accepting the salary. It is a vicious misconception on their part
to assume that they must work only within the narrow rut of routine, and wait
for the public to do everything outside of it. . . . . Deseret News, Salt
Lake City).
NOTE AND COMMENT 297
Two Reports. The conclusions reached by the Bureau of Social
Hygiene concerning the reduction of prostitution in New York City
are borne out by the reports published in February of the Society for
the Prevention of Crime and of the Committee of Fourteen. Both
are of unusual interest, the former because it is the first to be issued
by the Society since 1909 and covers among many others its successful
activities during the past seven years; in suppressing innumerable
gambling schemes the latter because it discusses in admirable fashion
the problem of prostitution in New York City from the point of
view of law enforcement.
The question may very properly arise as to why so many unofficial
agencies exist in New York City for the suppression of prostitution.
Although these two reports show that the work of the Society and the
Committee overlap at some points as, for instance, in the prosecution
of assignation hotels, yet such overlapping is merely incidental and the
purposes of the two organizations are, as a matter of fact, different,
while the functions of the Bureau of Social Hygiene are chiefly scien-
tific investigation and publication. The Society's report, covering
as it does a period of seven years, shows great progress in the sup-
pression of policy playing, mercantile lotteries, and other forms of
gambling. The fight against habit-forming drugs has been exceed-
ingly difficult and new legislation, it is suggested, should be enacted.
As to prostitution, the Society says that "Probably we have never
known a time when commercialized vice was so little protected as it is
today. The inevitable results have been: (1) The exodus from New
York City of many professional prostitutes and 'pimps.' (2) A
gradual, but so complete change in the methods of the remaining pros-
titutes, as to require changes in the laws governing this vice."
It finds that it is now able to work in conjunction with the police
department much more effectively than ever in the past and its policy
is to leave the actual suppression of assignation hotels and tenement-
house prostitution to the department, merely supplying the infor-
mation upon which police action is subsequently based.
The report of the Committee of Fourteen contains a review of its
work in the past twelve years by the retiring chairman, John P. Peters,
D.D. It is a record of accomplishment such as few law enforcing
agencies can boast. Much of the success of the Committee may be
traced to the thoroughness with which its work is done and its con-
stant endeavor to cooperate in securing its ends with other agencies,
official and unofficial, including the police department, tenement
298 SOCIAL HYGIENE
house department, district attorney, criminal courts, surety companies,
brewers' associations, and many others, all of which have been stimu-
lated and assisted by the Committee to more effective achievement
within the field of its activities.
During the past year the Board of Aldermen under authority con-
ferred by the state legislature, to license massage operators and in-
stitutes, passed such an ordinance which was signed by the Mayor;
places of this character, where during the past few years particularly
vicious conditions have persisted, are now being driven out of business.
The grand jury is criticized for its failure to find indictments in the
cases of keepers of disorderly houses submitted to them and the re-
port recites the effort of the secretaries of the Committee to secure
legislation permitting jury trials in such cases without the interposition
of indictments by the grand jury. Although the attempt was un-
successful in 1916, it will be repeated this year with the hope of better
success.
Cooperation with the brewers has very greatly reduced the num-
ber of disorderly saloons; and practically no "parlor" houses of pros-
titution exist. Prosecutions for tenement-house prostitution have
decreased and street solicitation has decreased to an astonishing
extent.
Social Hygiene
VOL. Ill JULY, 1917 NO. 3
AN ANALYSIS OF RESULTS OBSERVED AT THE NAVAL TRAINING
STATION, NORFOLK, VIRGINIA
CHARLES E. RIGGS, M.D.
Medical Inspector, United States Navy
The prevalence of the venereal diseases is widespread and
there is perhaps no community from which they do not exact a
certain toll of ill health. It is seldom that any community has
reliable statistics concerning the extent of its venereal scourge,
or any accurate information as to the different factors that are
responsible for its continuance. The mere fact of having a
venereal disease, even though innocently acquired, carries with
it a certain stigma. It is not difficult to appraise the cause for
this social stigma ; it is probably due to a knowledge on the part
of the public that these diseases in their origin are nearly always
associated with vice and with the opprobrium which attaches to
indulgence in alcohol, and that, while they permeate all grades of
society, they flourish most among the reckless element where the
sense of personal responsibility is at a minimum.
This social stigma which attaches to those having a venereal
disease has created an overwhelming desire for secrecy that has
effectively concealed from public knowledge most aspects of the
venereal problem. On account of this desire, the venereal dis-
eases are usually not reportable, and thus do not conform with
299
300 SOCIAL HYGIENE
other communicable diseases in regard to the requirements of
boards of public health. Where these diseases have been
made reportable, it is generally admitted that the returns are
incomplete and unreliable for statistical purposes. In order to
make an estimate of the amount of harm done in any community
by the venereal infections existing there, it is necessary to re-
sort to indirect methods, as there is no reliable basis for such
estimates in the actual number of reported cases, as in the case
of other acute infectious diseases.
Accordingly, such general estimates as have been made do
not carry the proper weight and no matter how startling the
conclusions may be, there is an inclination to believe that an
error has been made and that the situation is not as bad as rep-
resented. But on the other hand, it may perhaps be worse than
represented. If it were now possible to speak accurately of
the number of cases of gonorrhea and syphilis in a certain com-
munity, just as it is possible to speak of the number of cases of
measles or typhoid fever, it would without doubt bring about a
more correct appreciation of the immense amount of harm done
by the venereal diseases and result in a marked increase in
activities for their suppression and control.
Before attempting to use means for the suppression and con-
trol of any communicable disease in a given community, it is
necessary to become acquainted with certain facts concerning the
community and the disease. The percentage of the population
involved, the causative agent of the disease, the methods of
transmission, and, in particular, the circumstances surrounding
the individual at the time of exposure and infection, should be
ascertained as fully as possible if we are to expect the campaign
of eradication to be intelligently prosecuted.
Science has successfully answered the question concerning
the causative agents of the three venereal diseases as the germs
of each are now well known. Also, there is no mystery con-
cerning their method of transmission. That is, infection usu-
ally takes place by direct contact, and, as infection by indirect
contact is extremely rare, we are spared uncertainty concerning
the source of infection which is so likely to exist when we have
VENEREAL PROPHYLAXIS IN THE NAVY 301
to do with diseases spread by the indirect method of trans-
mission. But, when we come to look for the other information,
such as the part of the population afflicted or the special cir-
cumstances surrounding the individual at the time of infection,
which the sanitarian will desire to know before beginning the
attack upon the venereal diseases, we find that there is practi-
cally a complete absence of reliable data. The aforesaid desire
for secrecy here interposes an effective concealment and the
investigator must content himself with such indirect answers
as may be given by the records of police courts on the one hand
and of the public hospitals on the other. But there is one
class of observers who have always contributed fairly reliable
health statistics and that is those who are engaged in the mili-
tary services. This is on account of the rule in these services
that every day of a man's time must be accounted for, and, if
loss of time be due to ill health, it must appear accordingly in the
statistical returns. Consequently, these morbidity statistics
give accurate reports of the amount of ill health there is in the
Army and Navy in consequence of each of the various diseases
that are encountered in all parts of the world, and the venereal
diseases are not excepted.
The mere availability of these statistics showing many cases
of venereal diseases in armies and navies has served to give
these services an undeserved and unenviable reputation for
harboring an unusual percentage of these infections. No simi-
lar statistics from civil life have been available for comparison,
but I believe that persons in the military services are freer from
venereal diseases than are those of the corresponding walks in
civil life. A recent analysis of the venereal diseases found among
2607 apprentice seamen who passed through the Norfolk Train-
ing Station during a period of one year seems to indicate this.
During this period, 68 contracted a venereal disease of which
just one-half, or 34, contracted the disease under the influence of
civil life environment and the other half under the influences
of military life. Twenty-five of the former infections were con-
tracted just prior to enlistment, and it is clear that no blame
attaches to the military service in such cases. The facts that
302 SOCIAL HYGIENE
the number of diseases is equally divided, and that the time
passed under civil and under military conditions is about as
one is to five seem to indicate that the relative tendency to
contract venereal disease is much greater under civil environ-
ment than under military environment.
In civil communities, unlike the military services, venereal
diseases are not reportable. Sanitarians very properly com-
plain that they are without adequate information to prosecute
work for the suppression and control of these diseases. However
it is not true that 'investigators do not realize the magnitude
of the venereal scourge for, as one of them states:1 "As a danger
to the public health, as a peril to the family, and as a menace
to the vitality, health, and physical progress of the race, the
venereal diseases are justly regarded as the greatest of modern
plagues, and their prophylaxis is the most pressing problem of
preventive medicine that confronts us at the present day."
It is rather that our information is too general and not definite,
and our sources of information are indirect instead of direct.
Even in the military services there is little else recorded than
the number and kind of diseases and the amount of tune lost on
account of illness due to them. The causes leading up to in-
fection by these diseases are seldom investigated and the source
of infection usually goes undisturbed.
With the view of acquiring definite data concerning conditions
prior to infection and finding out if possible any factor pro-
moting infection, a plan for the investigation of each new venereal
infection was instituted at the Naval Station at Norfolk, Va.,
beginning March 1, 1915. The idea of making this unusual
survey was inspired largely through correspondence with the
American Social Hygiene Association.
At that time, Norfolk was supporting a large number of saloons
as the prohibition law of the state of Virginia did not go into
effect until November 1, 1916. As a further contribution to
vice conditions, it was the policy of the police department of
that city to maintain a so-called segregated and regulated red-
1 Rosenau : Preventive Medicine. New York, Appleton, 1916.
VENEREAL PROPHYLAXIS IN THE NAVY
303
light district in which were located eighty commercialized houses
of prostitution. The police department did not even enforce its
own regulations within this district, and the sale of liquor and
beer was permitted with little restriction. This district was
closed at twelve o'clock Saturday night, June 24, 1916. Ac-
cordingly, during the last five months covered by these statis-
tics, the community was under the influence of state laws sup-
pressing both prostitution and the sale of alcohol. During the
period under consideration, from March 1, 1915 to March 31,
1917, 458 original venereal infections were investigated. The
following table will serve to give an idea of the character of the
data collected: —
TABLE 1
Various circumstances concerning 458 venereal infections
CHANCROID
GONOB-
RHEA
SYPHILIS
Number infected
80
348
30
Contracted prior to enlistment .
9
91
3
Contracted while on furlough
17
102
8
Contracted while on liberty
54
155
19
Contracted from inmates
43
165
14
Contracted from street walkers
29
120
13
Contracted from clandestines
8
63
3
Contracted in Norfolk or vicinity
56
174
14
Not contracted in vicinity of Norfolk
24
174
16
Under the influence of alcohol
20
116
14
Not under the influence of alcohol
60
232
16
Used artificial prophylaxis .
27
89
9
Did not use artificial prophylaxis
53
259
21
It appears, as a result of the investigation of the venereal
situation here, that the different preventive measures can be
conveniently grouped under the following divisions: —
1. Previous unfavorable environment.
2. Educational prophylaxis.
304 SOCIAL HYGIENE
3. Alcohol.
4. Artificial prophylaxis.
5. Therapeutic control and isolation.
Previous Unfavorable Environment. By this is meant the un-
favorable moral environment or the moral delinquencies which
promote and lead up to committing the first sexual offenses.
In the prevention of sex immorality, a great deal has been lost
when the sensibilities have been once blunted by a first offense.
The young men who are received here for training are usually
from eighteen to twenty years of age, and by interrogating those
who became infected it was found that they would nearly
always admit exposures prior to enlistment. Of course the
period prior to enlistment is clearly beyond the reach of any
preventive work done here. It seems probable that most of
those who had been continent until they arrived at the station
remained so, and that, as a rule, only those who had previous
experiences in sex immorality took the risk of exposure to
infection. Opportunity was taken to question 39 individuals
as to what they considered the most important factor in lead-
ing them to commit their first sexual offense. Even at this
early age, the elements of commercialized vice were most
prominent. One-third, or 13, gave visits to parlor houses
inspired by curiosity as the cause of their first experience with
sexual immorality. Four were enticed by street walkers in
their home towns and 7 blamed clandestine prostitution in or
near their home towns. That is, 21, or more than one-half,
attribute their first offense to the activities of commercialized
vice.
Educational Prophylaxis. The circular letter of the Secretary
of the Navy, of February 27, 1915, made instruction in educational
prophylaxis in the Navy mandatory and directs that such in-
struction shall be given so that no man shall be subject to loss
of health through ignorance of the serious results that may come
to those contaminated. There is still a moot question as to
what constitutes proper material to present to boys in a lecture
VENEREAL PROPHYLAXIS IN THE NAVY 305
on sex hygiene. Of course, we believe that the dangerous con-
sequences of venereal infection should be neither minimized
nor exaggerated. We must avoid exciting an unfavorable
curiosity or giving a false sense of security, the latter being a
frequent cause for criticism of instruction in the methods for the
use of artificial prophylaxis.
At the naval station at Norfolk, the lectures are opened
with a talk by the chaplain. His remarks seek to impress
upon the boys the importance of selecting proper associates,
and of not frequenting places where the environment is known
to be questionable or vicious. This is followed by hygienic
instruction by the medical officer, a brief outline of which is as
follows : There is first explained the high authority for giving the
instruction, which is, of course, the circular letter of the Sec-
retary of the Navy above referred to. Certain parts of this
letter are read to the class and emphasis is laid upon the remark-
able prevalence of the venereal diseases both in and out of the
service. The three venereal diseases are then briefly described
and the class is told that these diseases are caused by germs,
and each disease by a different germ; that these germs obey
the same laws of nature as the germs of other diseases; that
there is nothing mysterious about them; and that they will
grow wherever they find a suitable soil. They are told that,
practically all prostitutes are diseased, or have been diseased
and to drive this home that paragraph from Commercialized
Prostitution in New York City which shows that 90 per cent,
of the young girls of a certain reformatory were diseased is read
to the class. It is taught that sexual continence is compatible
with perfect health, and that alcohol and venereal disease are
close allies. Finally, after repeated admonitions to avoid the
dangers of illicit sexual intercourse, the subject of artificial
prophylaxis is introduced. It is emphasized that this method is
not a guarantee against acquiring a venereal infection, but that
it should be resorted to as soon as possible after exposure; that
allowing time to elapse after exposure gives greater oppor-
tunity for the germs of venereal disease to entrench themselves
against antiseptic attack.
306
SOCIAL HYGIENE
In lectures elsewhere, instruction in artificial prophylaxis is
frequently omitted, as it is considered that instruction in this
method of prevention will be regarded as a tacit encourage-
ment to incontinence, thus rendering nugatory a large part of the
educational value of the lecture. Our statistics here do not
support this view but indicate that the effect of the lectures as a
whole is to reduce the number of prophylactic treatments ad-
ministered. The following table, covering a period of thirty
months, shows a marked falling off in the percentage of those
taking prophylaxis coincident with the inauguration of the
hygienic and prophylactic instruction:—
TABLE 2
Number and percentage taking prophylaxis for six periods of five months each,
beginning October 1, 1914 (App. Sea. Branch)
AVERAGE
COMPLEMENT
NUMBER TAK-
ING PROPHY-
LAXIS
PERCENTAGE
First 5 months
794
1006
126.7
Second 5 months .
783
515
65 7
Third 5 months
618
309
50.0
Fourth 5 months .
798
531
66.5
Fifth 5 months
468
458
97 8
S'xth 5 months . .
910
352
38. 6
The lectures began during the second period and this period
shows a reduction from 126.7 per cent, of the previous period
to 65.7 per cent. The fifth period shows an exacerbation and
it is coincident with the closing of the red-light district in Nor-
folk. To explain this exacerbation, it should be stated that it
had been pretty well advertised that the red-light district in
Norfolk would close the last of June and it is probable that many
were enticed there to see what they believed they would never
have another opportunity to see.
Alcohol. There is an intimate and not well understood rela-
tion between alcohol and the venereal diseases. Promoters of
vice, recognizing that alcohol stimulates trade and increases
VENEREAL PROPHYLAXIS IN THE NAVY 307
profits, have combined the sale of liquor with professional pros-
titution to practically a universal extent in this country.2
Estimates vary considerably as to the amount of vene-
real diseases that is contracted while the individual is under
the influence of alcohol. Dr. Douglas White states that 80
per cent, of the men who acquired a venereal disease have told
their physicians that they have done so under the influence of
some kind of alcohol. Notthafft estimates as low as 30 per
cent., and Forel gives 76 as the probable percentage of those
who were drinking at the time infected. Our statistics show
that prior to the time of enforcement of the prohibition law in
the state of Virginia there were 365 infections and 137, or 37.5
per cent., of the infected admit being under the influence of
alcohol at the time the disease was contracted, and 228, or
62.5 per cent., deny alcohol. Since the enforcement of prohibi-
tion there have been 93 infections of which 11, or 11.8 per cent.,
were acquired while under the influence of alcohol, and all but
two of -these were contracted outside the state and in "wet"
territory. Of the 458 infections investigated 148, or 32.3 per
cent., were acquired while under the influence of some kind of
alcohol. Alcohol is still a factor in the venereal problem, but
owing to increasing prohibitory legislation it is a diminishing
factor.
Artificial Prophylaxis. By this is meant those artificial
means that may be used to prevent infection resulting from
exposure. The so-called Army and Navy type of medical
prophylaxis is used at this station, when men who admit ex-
posure return from liberty. A record was taken of 6746 treat-
ments of which 127, or 1.88 per cent., turned out to be ineffectual.
In a record of one regiment on the Mexican border covering a
period of 29 weeks Exner found the failures of the treatments
as used there to amount to 1.4 per cent. This treatment is
remarkably effective and, if used within a short time subsequent
to exposure, it is practically infallible. With a view of deter-
2 George J. Kneeland. Commercialized Prostitution and the Liquor Traffic.
SOCIAL HYGIENE, Vol. II, No. 1, January, 1916.
308
SOCIAL HYGIENE
mining the efficiency of this medical prophylaxis for each hour
elapsing after exposure, every applicant for treatment at the
station was required to state how many hours had passed since
he had been exposed to infection. Considerable care was taken
in recording these figures and there is now available for examina-
tion a history of 5103 treatments concerning which the time of
treatment subsequent to exposure is known. 81, or 1.58 per
cent., were ineffective. The following table gives the number of
treatments during each hour subsequent to exposure and the
number who later developed a disease on account of that
exposure : —
TABLE 3
Number of treatments, failures, and percentages for each hour after exposure
HOURS SUBSEQUENT TO
EXPOSURE
NUMBER OF TREAT-
MENTS
NUMBER OF INFEC-
TIONS
PER CENT. OF INFEC-
TIONS
1
1180
1
0.08
2
1172*
7
0.59
3
4
521
330
4
2
0.77
0.61
5
199
3
1.57
6
321
5
1.58
7
277
6
2.27
8
390
16
4.22
9
283
10
3.62
10
214
11
5.14
More than 10
216
16
7.40
Total
5103
81
1.58
There were 1180 treatments during the first hour which were
followed by a single infection. This infection was carefully
investigated and there is considerable doubt as to whether it
was genuine or not. The disease was diagnosed as chancroid
and was cured in two days.
The above table is a remarkable testimonial as to the efficiency
of medical prophylactic treatment in particular, if administered
within a few hours subsequent to exposure to infection. As
Dr. R. A. Bachmann states: "It is an almost overwhelming
fact. . . . that if every illicit or dangerous intercourse
VENEREAL PROPHYLAXIS IN THE NAVY 309
were followed by a reliable prophylactic, in a few years we should
witness the passing of the scourge as complete as the eradication
of yellow fever, bubonic plague, and malaria."
Some have maintained that this treatment in the end does
more harm than good in that it gives a false sense of security
and thereby the restraining factor of fear of disease is done away
with. I do not believe that there is any truth in this for during
the past two years I have questioned hundreds of individuals
as to why they permitted themselves to be exposed to infection
and I have yet to hear one say, "I didn't think there was any
danger if I took the prophylactic."
Furthermore, I have asked a number of experienced medical
officers if they had ever heard such or a similar reason given as
an excuse for sexual incontinence and all have replied that they
had not. If it is fact that the knowledge of the protective value
of medical prophylaxis does not tend to increase illicit sexual
intercourse, then the argument of those who are against this
form of prevention on the grounds of morality is without support.
Of course it might be held that a venereal infection is the
proper and natural punishment for one who offends sexually, but
this does not seem reasonable. Nor does it seem good morals
to hold that because the individual has already taken one false
step he shall be denied artificial assistance to save him from the
further horrible consequences of a venereal disease. Accordingly,
it appears that if we deliberately neglect to use this valuable
branch of prevention we are actually guilty of encouraging the
spread of venereal disease.
There are no statistics from which we may deduce the normal
percentage of venereal infections that may be expected- to follow
illicit sexual intercourse when prophylactic means are not
employed. In the above table those who took prophylaxis
later than ten hours after exposure give a rate of infection of
7.4 per cent., and applying this percentage to the 6746 recorded
exposures gives an expectancy of 499 venereal infections. As
a matter of fact, there were only 127 subsequent infections, so
it may be assumed that the difference, 372, represents the least
number of venereal infections which were prevented by the
310
SOCIAL HYGIENE
6746 treatments. It is unlikely that the venereal situation in
this community would have been better had the 6746 prophy-
lactic treatments been withheld and these 372 venereal infections
been permitted to take place.
Therapeutic Control and Isolation. By this is meant the care
of infected persons both as regards treatment and isolation so
that the healthy may be protected from dangerous contact with
them. In the military services it is comparatively easy to
enforce proper treatment and effective isolation, and in civil
life we are beginning to discuss means to these ends. The agita-
tion for proper facilities for treating venereal diseases at public
dispensaries and hospitals and for a better control of infected
individuals by making the venereal diseases reportable are
indications that the period subsequent to infection is being
considered of importance from a preventive point of view.
Also the source of infection should be investigated and, if
possible, her activities in the spread of disease suppressed. If
the prostitute is of the commercialized type it is comparatively
easy to enforce a certain amount of isolation and treatment,
but if she is of the clandestine type the situation is surrounded
with many difficulties. Commercialized prostitution was re-
sponsible for 387, or 84.4 per cent., of our infections. The
following table gives the number and kind of diseases contributed
by each class:—
TABLE 4
Number and per cent, of each kind of venereal disease contracted from each class of
prostitute
CONTRACTED FROM
NUMB EH
INFECTED
CHANCROID
GONORRHEA
SYPHILIS
Num-
ber
Per
cent.
Num-
ber
Per
cent.
Num-
ber
Per
cent.
Inmates
223
164
71
44
29
7
19.7
17.6
9.0
165
122
61
73.9
74.3
85.9
14
13
3
6.2
7.9
4.2
Street-walkers
Clandestine
The value of any campaign for the eradication of the venereal
diseases should be measured by the results accomplished in the
community to which it is applied. In order to form an estimate
VENEREAL PROPHYLAXIS IN THE NAVY
311
of the efficiency of our methods here we may examine into the
incidence of gonorrheal infection during the period under
consideration. There were 348 infections, of which 91 took
place prior to enlistment, leaving 257 who were infected in spite
of our prophylactic measures. Dividing the total period into
periods of five months each we have as follows: —
TABLE 5
Showing average complement, number infected, percentage and yearly rate for five
successive periods of five months each
PERIOD
AVERAGE
COMPLE-
MENT
NUMBER
DISEASED
RATE PER
1000
TEARLT
RATE PER
1000
First 5 months
1566
76
42.1
101.0
Second 5 months
1268
47
37.8
88.8
Third 5 months
1863
55
29.4
70.5
Fourth 5 months
1307
40
30 6
73 4
Fifth 5 months
1567
39
20 4
48.9
The number of new infections for the last period of five months
is less by more than 50 per cent, the number for the first five
months. It is not possible to state definitely what part each
of the several factors of the prophylactic work played in bringing
about this excellent result. A portion of the good results ob-
tained was evidently due to improved conditions in Norfolk;
and it is probable that educational prophylaxis was responsible
for most of the remainder, as medical prophylaxis had already
been in use for some time prior to the periods covered by these
statistics.
CONCLUSIONS
1. At this station commercialized vice was responsible for
at least 85 per cent, of the venereal diseases.
2. Educational prophylaxis is the most important branch
of the venereal prophylactic propaganda, and in a sense includes
all other branches.
3. Medical prophylaxis is remarkably efficient, and should
be used when the way has been cleared by educational prophy-
laxis, as it does not then tend to promote incontinence.
312 SOCIAL HYGIENE
4. The teachings concerning the venereal diseases themselves
should be limited, conform strictly to the facts, and seek neither
to minimize nor exaggerate the consequent horrors, nor to excite
undue curiosity.
5. Each new infection should be carefully investigated as to
the vicious factors that instigated it, and the moral, civil, and
military agencies at hand should avail themselves of the knowl-
edge thus acquired to prevent further infections by the same or
similar activities.
6. Once the individual has been infected he should be provided
with proper treatment and effective surveillance to the end that
the healthy do not become 'infected and thereby also become
further sources of infection.
7. From an epidemiological point of view the venereal dis-
eases are in a class by themselves and necessary reports to the
authorities should be fully protected from public inspection.
The infected person should be protected by consistent secrecy
to avoid public scandal and we may then expect his useful co-
operation in preventive work.
WASHINGTON— THE CLEANEST CAPITAL IN THE
WORLD
DAVID LAWRENCE
Washington Correspondent of the New York Evening Post
There is something at once exemplary and instructive in the
study of vice conditions in the capital of the United States today
as compared with four years ago and the long periods prior thereto
when social evils of every kind and description nourished within
shadow of the capitol itself.
To comprehend the change, the abruptness of its coming,
and the unique factors that have operated to make law enforce-
ment a stern reality, it really is necessary to know the picture
of conditions as they existed before the clean-up began. The
District of Columbia, it should be kept in mind, is governed by
Congress through a commission of three members appointed by
the President. With the advent of Mr. Wilson, commissioners
were appointed who took their tasks seriously. They gave the
real estate ring no quarter. They abolished favoritism and
even what has come to be known in some municipalities as
"legitimate" graft. Two newspapermen — Oliver P. Newman
and Louis Brownlow — together with an engineer commissioner
designated by the War Department — Col. Charles W. Kutz,—
have given the city of Washington the best government it ever
has had. Perhaps the most radical of the many radical reforms
instituted was the new police administration. When they chose
Raymond W. Pullman, a young newspaper correspondent, early
in 1915 as head of the police department, some of the old-timers
chuckled. Why — he taught a bible class on Sundays; he was
innocent; and, in the vernacular, would be an easy mark.
But Major Pullman has proved quite the reverse. He has
studied his job with painstaking care and the police force has
learned to pay wholesome respect to the Sunday-school-teacher
police superintendent. His character and personality was the
313
314 SOCIAL HYGIENE
very thing Washington needed to insure an honest administra-
tion of its laws.
First of all, of course, the Congress had to provide rigid laws.
Within the last three years, the segregated district has been ab-
solutely wiped out through the Kenyon Law, fornication and
adultery have been made punishable by long terms of imprison-
ment, and by next November absolute prohibition will take the
place of the partial prohibition which has been strictly enforced
between 1 a.m. and 6 a.m., daily and between midnight Sat-
urday and 6 a.m. Monday. Consider also that the Mann White
Slave Law makes it possible for the government to prosecute
for the transportation of women " within the District of Colum-
bia," which may mean a block or two or any distance in a jour-
ney that has for its object any immoral act, and the power of the
law to strike at vice is obviously supreme and comprehensive.
But the picture four years ago — perhaps the scenes during the
inauguration period of 1913 best illustrate the depths to which
this municipality had sunk. Three or four sections of the city,
not all contiguous, contained scores of houses of prostitution.
Many of these houses were within a block of the Senate and
House. Others were a stone's throw from the Post Office Depart-
ment and other government buildings. Their proximity to gov-
ernment buildings was, of course, accidental and due for the
most part to accessibility from the streets and car lines, but
the shame of such proximity did not a little toward producing the
agitation that exterminated these vice dens for all time. Liquor
was sold at the usual high prices in these houses and some of
the more expensive abodes became renowned institutions in the
life of the capital. The city of Washington each year entertains
thousands of sightseers, thousands of delegates to conventions
and meetings of various kinds. The inauguration always has
brought tens of thousands, many of whom have been attracted
by the hilarious debaucheries of inauguration nights. In what
was known as the " Division," the better part of Washington's
segregated district, men stood in lines awaiting entrance to the
houses of iniquity exactly as people do for tickets to a popular
vaudeville or theatrical attraction. The police were always busy
WASHINGTON — THE CLEANEST CAPITAL 315
protecting the crowds on the main thoroughfares and the Divi-
sion was the least of its worries especially during the earlier hours
of the night. Beer and wines sold for ten and fifteen times their
retail price and the profits of prostitution were so great that some
of the feminine managers of s.uch enterprises have been known
to retire on fortunes of more than $100,000.
Street-walking was, of course, in vogue but not as conspicu-
ously as it used to be in New York or other cities. The presence
of the segregated district made this branch of the trade quite
unnecessary in the main, though in some sections of the city it
was abominably evident.
Some of the so-called institutions in Washington's red-light
district furnished amusements of various kinds. And whenever
baseball or football games brought hundreds of collegians to the
national capital, scenes quite similar to those of inauguration
nights were to be witnessed. Washington has a fairly large
student community for its size and the effect on their lives with
a district of prostitutes always available to them can very well
be imagined. It became the custom for these young men to
saunter down after the theater to the houses along Ohio Avenue,
D Street, and the like, in northwest. Groups dashed boister-
ously thither in automobiles for merry-making into the wee
hours of the morning. The police stood on guard at street-
corners but never were there many prosecutions, except in con-
nection with brawls and disorders, arising out of social crimes.
Indeed, one real estate syndicate is known to have built a
row of houses especially for use in enterprises of prostitution.
A block of large "parlor" houses, modern in construction, and
each with a private dancing hall, were built in a secluded
section of the city just five squares south of the United States
Capitol, and a row of additional houses were planned to occupy
a part of the land which the syndicate had purchased as the
site of a new "tenderloin de luxe," as the project was termed
at that time. Although the location of the "new Division" was
supposed to have the sanction of the authorities, the strictest
secrecy was maintained as to the use to which the houses were
to be put. Raymond Pullman, who was a newspaper man and
316 SOCIAL HYGIENE
not the head of the police department at the time, learned
about the purpose of the enterprise, and assisted by James E.
West, now of New York and then residing in Washington, suc-
ceeded in making the plans of the syndicate public just when
the houses were nearing completion. The publicity killed all
chances of using the row as houses of prostitution, and the syn-
dicate which had figured on making 35 per cent interest on the
investment gave up the project in disgust, and later sold the
property at a loss. The houses were never occupied for the
purposes for which they were built, and they now rent for $25
a month instead of $65 a week or $250 a month in advance,
which is said to have been the amount on which members of
the syndicate figured their original investment and expected
huge profits. The houses are now occupied by respectable fami-
lies, doubtless none of whom knows the original purposes those
dwellings were to subserve.
Conditions in Washington were, to be sure, little different from
those prevailing in other cities before vice crusades were insti-
tuted but with Congress governing the District of Columbia it
was much easier to bring about needed reform. Members of
Congress hesitate to vote with the liquor interests or other de-
fenders of social evils lest they incur the displeasure of the better
class of citizens in their home constituencies. Pressure by the
interests, too, on individual congressmen is of little avail in the
District of Columbia because there are too many congressmen to
be thus influenced and the majority are thoroughly indifferent
to such influences.
When, therefore, the Kenyon Law was proposed abolishing the
red-light district, hardly any dissent was voiced. Three years
ago the bill was approved by the President and its operation has
been singularly successful because it has been enforced not
merely by the police department but by the landlords and real-
estate men who have been mindful of the penalty — a year's
forfeiture of all rents — incurred in harboring prostitutes in their
dwellings. There have been only three or four rooming houses
and hotels thus closed but this small number was sufficient to
make property owners see the point. In the majority of cases
WASHINGTON — THE CLEANEST CAPITAL 317
the police do not need to search for vice. Most of their informa-
tion comes through complaints by residents in apartment houses,
by neighbors or real-estate owners. The law also penalizes the
owner of the building $300 in additional taxes which together
with the loss of a year's rental and the attendant notoriety has
proved a deterrent sufficiently powerful to wipe out almost en-
tirely commercialized vice in hotels and rooming houses hitherto
used for that purpose alone.
Here are, for example, some of the police regulations made
shortly before the last Inauguration by the Commissioners of
the District of Columbia by authority of Congress which for
strictness are perhaps unparalleled.
1. That any person giving information about or directing any other
person or persons to any house or place for immoral purposes, or to
any immoral woman or women, whether the communication be by word
of mouth direct or by telephone or in writing shall be fined not more
than $100 and in default of payment thereof shall be liable to imprison-
ment in the workhouse of the District of Columbia for a period not
longer than sixty days.
2. It shall not be lawful for any person to invite or entice any per-
son or persons upon any avenue, street, road, highway, open space or
public square or enclosure in the District of Columbia, to accompany,
go with or follow him or her to any place for immoral purposes, and
it shall also be unlawful for any person to invite, entice, or address any
person from any door, window, porch or portico of any house or build-
ing, to enter any house or go with, accompany, or follow him or her to
any place whatever for immoral purposes under the penalty of a fine
of not more than $100 and in default of payment thereof to imprison-
ment in the workhouse of the District of Columbia for a period of not
longer than sixty days.
3. No person shall rent a room for the purpose of assignation or any
immoral purpose to any person or persons; nor shall any person permit
the use of any part of premises which he or she may control to be used
for assignation or any immoral purpose; and any person violating this
section of the regulations shall be liable for each such offense to a fine
not to exceed $100, etc.
4. No driver of any public vehicle shall transport a woman, man,
or man and woman for immoral purposes; and any person violating
318
SOCIAL HYGIENE
this section of the regulations shall be liable for each such offense to a
fine not to exceed $100, etc.
5. All persons who let or rent out rooms excepting owners of hotels
of twenty rooms or more keeping name registers shall keep a record
showing the signature (written in ink) and street and home city ad-
dress of each and every person temporarily residing in the building in
which they may rent rooms. Erasures or alterations on this list shall
not be permitted or be made for any purpose and the names and ad-
dresses shall be retained and open for inspection of the police or any
proper officer at any time.
6. All persons renting rooms shall report to the police any suspicious
character who may apply for rooms or report any suspicious acts of
any person to whom rooms may have been rented.
Together with the above, the laws of the District of Columbia
under the Federal Penal Code punish fornication by a fine of
one hundred dollars or imprisonment for not more than six
months while adultery is not punishable by a fine at all but by
imprisonment for not more than three years.
In the two years that the police department has been admin-
istered by Major Pullman, during which period, too, these drastic
laws have been in operation, arrests for both fornication and adul-
tery have been more than doubled. The comparative statistics
for 1913 and 1916 tell the tale.
1£
13
IS
16
Arrests
Held
Arrests
Held
Fornication
260
211
628
565
Adultery
71
49
80
64
Some western newspapers have drawn the erroneous conclu-
sion that these figures indicate a larger percentage of violations
under the present system than before. Quite the contrary is
true because in 1913 when the "Division" and other sections
where houses of prostitution were running full blast, violations
w^re carried on under the very eyes of the police and the city's
population, and the arrests were for the most part outside the
segregated districts. Now, with the whole city under surveillance
WASHINGTON — THE CLEANEST CAPITAL 319
and commercialized vice punishable by severe fines and imprison-
ment, the number of arrests and convictions testifies rather to
the efficiency of the police department than to an increased per-
centage of cases. The violations have relatively decreased, the
deterrent effect of the arrests and prosecutions being incalculable
hi extent.
Law enforcement has been splendidly efficient. Instead of
increasing commercialized vice in sections of the city previously
untouched, the abolition of the restricted district has tended to
diminish vice throughout the whole city. Physicians and clin-
ics have fewer patients. Visitors in the city find it almost im-
possible to locate prostitutes.
The inauguration of 1917 was so different from any of the
preceding inaugural celebrations with respect to vice conditions
that thousands of men who either had heard of Washington's
clean-up or learned of it after their arrival departed soon to Bal-
timore, Philadelphia, and other cities. No crowds lingered after
the parade — and those who did furnished by their futile search a
striking proof of the thoroughness of the anti-vice crusade.
Shopkeepers, cigar store clerks, hotel bellboys, taxi drivers,
cabmen, and pedestrians generally who were asked by visitors
to be directed to houses of prostitution learned with surprising
unanimity of the "tightness" of the city. Many cabbies had
been arrested several weeks before for conducting men to the
rooms of immoral women and none dared take any risks. The
saloons were closed both Sunday and Monday of the inaugura-
tion period which prevented congregation of men and women in
any side-door cafes. Washington has been for the most part
cleaned of these latter institutions and with the ending of the
liquor traffic next November, the police expect even fewer viola-
tions of the fornication and adultery laws than heretofore. Cer-
tainly the closing of saloons at 1 a.m. and the law which pro-
hibits the sale of liquor to unescorted women have done a great
deal in the last two years to rid Washington of the cafe evil and
its attendant crimes. Few dance halls of the variety which are
notorious in the larger cities exist in Washington. In fact, the
police are so alert that these dances all close promptly at one
320 SOCIAL HYGIENE
o'clock. Frequently unmarried girls are rounded up and sent
to houses of detention; others to juvenile court. It is through
persistent enforcement of the letter of the law as well as its spirit
that Washington's police department makes life miserable for
the prostitute and dangerous for those ignorant of the law who
set out on a hunt for immoral companions. Soldiers and sailors
especially have felt the hand of the law in this respect and they
no longer are seen loitering the streets at night.
With very few exceptions, the saloons are clean, and bartend-
ers are scrupulously careful to plead ignorance to the questions
of their customers concerning places of prostitution. That a
few such houses do start and exist for a while is admitted by
the police but none is protected. It is merely a question of time
to get the evidence and make the raid. Two or three are dis-
covered each month. The business of prostitution is however
become a clandestine affair. It is no longer out in the open,
a recognized fact in community life. As soon as the police
encounter it, they are quick to make arrests. Prostitutes have
for the most part left the city. A few move about quietly from
one dwelling to another, carefully covering up their tracks from
month to month but the majority do not long succeed in elud-
ing the police. The dancing and drink evils in connection with
•prostitution are gone. Those few persons who conduct houses
of prostitution on the sly have less than three inmates as a rule
and all are careful to commit no disturbance lest the neighbors
tattle. Thus, not only has the profit been taken out of prostitu-
tion in Washington but such as remains is carried on clandes-
tinely and without the hilarious disorders of yesteryears.
On the whole, the morale of the city has been uplifted. Com-
mercialized vice has been almost entirely eradicated, and within
another year, when the saloons and cafes go, the city of Wash-
ington will outrank any capital in the world in purity and clean-
liness of its life. With the social evil that is not commercial,
the police of course cannot hope for complete elimination but the
extinction of open prostitution has unquestionably affected kin-
dred phases of the problem. The churches and other civic insti-
tutions which are constantly struggling to implant higher moral
WASHINGTON — THE CLEANEST CAPITAL 321
standards in community life find that a gratifying stimulus has
been given their work by the removal of the segregated district.
They reason that the appeal to sex imagination has been appreci-
ably reduced. The police are responsive to the efforts of social
workers to close down amusement places which display suggestive
pictures or countenance practices that tend to weaken the mor-
ality of the city's youth. Police graft has been at a minimum.
Three or four cases, promptly and vigorously prosecuted, have
given the police something to keep in mind and altogether the
administration of the laws governing vice can be said to be at
least ninety per cent efficient. The size of the police force, smallest
of any in the great world capitals — Washington up to recent
weeks has managed to get along with only 715 men — prevents
a perfect administration but if every city in the United States
could boast the splendid conditions that now prevail in Wash-
ington, the nation would have reason for self -congratulation.
And looking abroad, thoughts of vice conditions in Paris, Berlin,
London, Bucharest, Madrid, and elsewhere make Washington
stand out as far and away the cleanest capital in the world.
THE MORAL CAMPAIGN1
It is characteristic of any endeavor to control a virulent evil in the body politic
that the measures first employed are relatively superficial, and attack only the
immediate results of this evil. But as the attack becomes more and more or-
ganized and expert it reaches farther and farther back in the chain of causes
until it finally assails the primal cause. So it has been in the attack upon vene-
real disease. The chief concern was first with the treatment of individual cases,
then with the control of the prostitute and the material measures just mentioned
in reference to the army and navy.
But if we are to make any serious headway we must go even farther back and
attack, not only the prostitute, the material cause of venereal disease, but also
the sexual impulse, the moral cause of venereal disease. It is confessedly a
long call from the present state of society to that in which each one of us shall
have his sexual impulses under perfect control. Indeed so remote does this
possibility seem, and so weak today are many of those religious influences which
might formerly have been invoked in aid of a moral campaign, that society is
quite frankly willing to compromise, for the present at least, on all of the moral
questions involved.
My personal hope of the success of this campaign is far higher than you may
think the facts could warrant. Not only is the direct attack upon sexual license
succeeding beyond what one might have dared to hope a decade ago, but the whole
moral tone of the community is such as to lend itself to this reform now as never
before. The almost universal reprobation of the grosser forms of alcoholism is
a wonderful step in the right direction. The social forces engaged, both in the
diversion and the inspiration of youth, are educating a generation of young
men in whom a serious aspiration to sexual purity would seem almost a natural
condition. To the cynics who forbid us any hope we can only reply that a cen-
tury ago the seduction of innocent young women ceased to be an acknowledged
fashion. Today alcoholic intemperance is ceasing to be an acknowledged fash-
ion. Let us not be too bold in setting a limit to which the future can aspire. Let
us hope, as the purest members of the race have always hoped, for the highest
ideals of sexual purity. For thus only may we hope to put the final crown on our
campaign against the venereal diseases.
EDWARD L. KEYES, JR., M.D.
1 Medical and Social Aspects of the Venereal Disease Problem. Presented
before the New York State Conference of Charities and Correction, Pough-
keepsie, November 14, 1916.
322
INDUSTRIAL SCHOOLS FOR GIRLS AND WOMEN
MARTHA P. FALCONER
Superintendent, Sleighton Farm
Industrial schools for delinquent girls and women can never
be upheld as an effective solution of the entire problem of delin-
quency. To those acquainted with the problem they offer them-
selves as the last resort. Active preventive work, through girls'
clubs, camp fires, supervised dance halls and probation, keeps
many girls out of reform schools in the outside normal world.
To do that is, of course, our ultimate aim, but remarkable as are
the results of the preventive work conducted in some of our large
cities, there is an ever considerable group of women and girls
who do not respond, and who need special training, in a place
especially adapted to their needs, away from the temptations
of the life they were unable to cope with.
In communities where vice conditions have been investigated,
the question is usually asked, "What would become of the girls
and women in the sporting houses? Where would they go?
What is our duty toward them? What provision should we make
for the prostitutes? If we could get our segregated districts
closed, have we a right to do so until some plan is made for the
unfortunate girls and women who have been living in the district?"
If a young woman has been leading a life of prostitution for
a period of two or more years, she is usually in bad physical con-
dition from dissipation, liquor, and drugs. The moral fibre is
so much broken down that if the choice were left to the girl, she
would not care to leave that life, and what has the outside world
to offer to an untrained, irresponsible, diseased, dissipated young
woman? Most of the girls would proabably leave a community
if the people who are managing the business of commercialized
vice felt that the city authorities were in earnest about cleaning
up the conditions and it was going to be more difficult for the
business of prostitution to continue. Many of the girls would
323
324 SOCIAL HYGIENE
probably go to another community, a near-by city, until the so-
called trouble had blown over and it was considered safe for
them to return. Is anything gained by this driving the girls
from one community to another?
If every community would appoint a group of men and women
to look into the vice conditions of their city and to try to get pub-
lic sentiment roused to eliminate vice and to organize preventive
work, much more would be accomplished. For the girls who do
not leave and who may be brought into court, the first thing is
to have hospital accommodations or dispensaries where they can
be treated and helped into a better physical condition.
Probation should be tried for those who are willing to be helped
in this way. It will probably be found some would be willing
to return to parents or relatives in a distant city. Careful in-
vestigations must be made as to home conditions. Will the en-
tire family be willing to receive the girl? Will it be possible for
her to get work? Some person in the town should be found will-
ing to look after the girl, if there is no probation officer to do so.
When the girls are in physical condition to work, employment
must be found for them — not an easy task because of the girls'
lack of industrial training and education; then a home found with
some woman who would be willing to take an interest in the girl
if the home conditions are such that it is not best for the girl
to return to parents.
Very few will go voluntarily to an institution. For this reason
state reformatories for girls or women or a colony in the country
will be needed because the prostitutes are a menace to the com-
munity and should be placed where they can have good care phys-
ically and be taught and trained if they are going to be helped
to earn their living in a decent way.
For such, commitment to a corrective institution for training
is a necessity, if they are to be helped to lead normal lives. The
sort of institution adapted to this need is, we believe, an indus-
trial school located in the country, far enough away from city
and village to give the girls and women freedom for outdoor
work and play.
In developing such an institution it is important first to obtain
INDUSTRIAL SCHOOLS FOR GIRLS AND WOMEN 325
a large tract of land — three or four hundred acres if possible,
suitably located. Difficulties of access, expenses of hauling sup-
plies, etc., are of little import when compared with the desira-
bility of having nervous, sexually immoral girls and women
living out-of-doors. We consider this a vitally important thing.
A reform school for girls or women naturally attracts visitors
from a village or town, and to guard against this is a reason why
the school should be located at a considerable distance from either.
So successful has agricultural work been for girls or women of
this sort, that it is advisable to obtain a tract of land large enough
for gardening, poultry raising, pigs, etc.
Before any definite plans for the school are made the superin-
tendent should be chosen, a woman of intelligence and executive
ability, with a deep sympathy and understanding of work for
neglected girls and women. To be effective she should be allowed
great independence of action. She should have the authority
to select all the members of her staff in order to secure that unity
of spirit and purpose which is so necessary. Her word should
be final in the daily matters of conduct and management.
If there is a habitable building such as an old farmhouse upon
the land, let the superintendent be established there at once,
with a few girls to work up the spirit of the place. Numbers can
be increased as equipment is ready.
There has been a healthy reaction against expensive buildings.
That is encouraging; for it is much more important that the avail-
able money be put into inexpensive, practical buildings and the
salaries of good officers, rather than using the bulk of the money
for material equipment. Enthusiastic, sympathetic women,
many fine young college women, are eager for work in institutions
of this sort, if the life and vision of the place be held to a high
enough standard. If possible the school should have a trained
psychologist to test the girls, and aid practically in planning their
work and placing them. The office of psychologist can some-
times be combined with that of physician. The school should
employ a woman physician, a woman dentist, and a woman
optician from the nearest city to come to the school on certain
days during the week, and a scientifically trained woman farmer
326 SOCIAL HYGIENE
should direct the farm work. The inmates of such a school have
usually seen too much of the wrong sort of men and it is important
that they be brought into contact with the right kind of women.
The fewer men employed in the institution the better.
The institution should be developed on the cottage plan.
Each cottage should be a unit in itself, with its own dining room
and kitchen, and if possible a laundry, accommodating a group of
not more than twenty-five, with a matron and housekeeper
working in each cottage. In this day of recognition of the value
of fresh air, plans for the cottages should include sleeping porches,
as this is especially desirable for nervous, delicate girls. Cot-
tages should not be placed too near together, as intercommunica-
tion should not be made easy.
Of course girls and women should not be sent to the same place.
Young girls learn too much evil from older women. Girls should
be committed for the rest of their minority. Good training
requires residence in the school for at least two years. You can-
not build character or develop effective methods of work quickly.
Women, if possible, should be committed for an indeterminate
sentence. Those in charge of the institution are the ones best
able to determine when a woman is ready to leave. When the
judges are unable to use the indeterminate sentence, commit-
ment should be made for three years at least, making training
in the school and parole work possible. The school must be ever
on the lookout that the training given the women or girls be
worth while. They must be taught the dignity of labor under
the right leadership. As soon as possible industrial and academic
work should be developed in' a well-organized school. Difficul-
ties will be paramount, for the girls and women in reform schools
frequently do not have power of concentration, and often have
the added disadvantage of lack of knowledge of the English
language. But the school must be made to meet their needs,
and must be attractive to them. It frequently is practicable
to give school work for one half of each pupil's time, and indus-
trial or manual work the other half. In the summer time it is
found a good plan to have the girls and women working in the
fields during one half of the day, and in a school conducted some-
INDUSTRIAL SCHOOLS FOR GIRLS AND WOMEN 327
what after the manner of vacation schools, the other half; learn-
ing the simple elements of correct English, arithmetic, handwork,
and music, the attempt being always to coordinate the outdoor
work with that done in the school.
With the modern point of view in which the reformatory ap-
pears as the last resort, it is apparent that many of the girls
and women sent there will be those of low-grade or disturbed
mentality. This makes it necessary that the school offer con-
siderable industrial work, basketry, work with the looms, etc.,
domestic science, dressmaking, and music, rather than a great
deal of academic work. It is always to be remembered that the
institution is built for the girls and women and their needs, and
not for the workers or directors. We feel that the problem of
adolescence is met by constant diversion and employment in
work that offers valuable training. To a very great extent this
holds true of women.
It is not necessary to wait until a gymnasium is built before
securing a well-trained gymnasium teacher. With very simple
and inexpensive equipment she can direct the girls in outdoor
sports and indoor exercises. She should direct the summer
recreation. Girls and women of reformatories respond to the
virility of baseball, races, etc. With the school located in the
country it is possible to take long walks. This the girls and women
need, not only for the physical benefit derived therefrom, but to
have the country interpreted to them.
As funds are available, the part good music plays in the develop-
ment of girls and women in the schools should be emphasized.
Good music should be played and sung, and the girls and women
trained to sing, not only for their religious services but as a means
of entertainment. The teacher must be a woman who is not
only well trained, but who has a great love for music, and belief
in its humanizing and ennobling power.
The training offered in domestic science presents almost in-
finite possibilities. The need for it is great. Many of the girls
and women are of foreign birth, knowing only a low standard of
living and many of them have spent their working lives in the
mills so that they have acquired no knowledge of household
328 SOCIAL HYGIENE
management. Experiment and theory in the school-room
should always be correlated with practical use in the cottages.
In a state institution provision must be made for the religious
training of girls of different sects. A non-sectarian service should
be held to help bring the girls or women together in spirit and pur-
pose, but provision must be made for those of different religious
beliefs.
The success of an institution depends entirely upon the per-
sonnel of the workers. Young women, forceful, enthusiastic,
and sympathetic should be chosen rather than middle-aged,
broken-down women, who consider their work a duty rather
than a joy, and cleanliness and order the sole aim of the insti-
tution. The more we can do with these girls and women, rather
than for them, the better, An industrial training school for
delinquents is no place for nervous, tired women. No woman
should ever be taken on the staff out of sympathy, nor for that
reason kept there after the time she is actually useful to the in-
stitution. It is vitally important that the members of the staff
work together pleasantly. The entire success or failure of the
school depends on the spirit and ability of the workers.
It is desirable for the girls and women always to wear washable
dresses — bloomers of denim or heavy cotton cheviot are very prac-
tical for field work and for much of the heavy indoor work, in
care of the floors, all laundry and kitchen work. The workers
should wear at all times washable cotton dresses. Too often a
worker has been allowed to wear out shabby finery, when on
duty in class room or in the cottage. Let it never be forgotten
by all connected with a reformatory institution that we teach
unconsciously much more than consciously.
Plenty of plain, wholesome food must be provided for inmates
and workers, vegetables raised on the farm and eggs and poultry
make variety possible. Never should it be the custom to have
an elaborate dinner monthly for the directors and visitors only.
Equally good meals should be served continually for all in the
institution. No one is ever helped by being deprived of food as
a punishment. An effective system of discipline can be worked
out by student government among the inmates. This takes
INDUSTRIAL SCHOOLS FOR GIRLS AND WOMEN 329
careful guidance by those who believe in it. College women who
are fresh from this training are very helpful to guide and direct
student government in the cottages. It is one of the best ways
of developing responsibility among the girls and women. A
small council of five or seven selected by the girls in each cottage
group can be made a vital force in all matters of discipline and in
developing a spirit of loyalty to the cottage and school.
When there is a considerable colored population, it is found
successful to have colored women placed in charge of the colored
girls. The experiment was first made at Sleighton Farm, a re-
formatory of about five hundred girls from Eastern Pennsyl-
vania, with about a fourth of the population colored. Colored
girls are more responsive to the supervision of women of their
own race. It is possible to secure colored women of education
who are adaptable to the work.
When the school is financially able, a laboratory for the psy-
chological and eugenic field work should be developed. So large
a proportion of the population of reformatories are girls and
women of low mentality, and so unproved and uncertain is our
knowledge of the treatment of feeble-mindedness that intensive
study of particular cases is of great value to those who are try-
ing to plan for their training and their lives after they leave the
institution.
The importance of the parole department of the institution
cannot be over-estimated. That is where the training the school
offers is put to the test. But girl or woman cannot be expected
to pass safely from such close supervision to entire freedom. The
school must have enough parole officers to keep the girls and
women who are out on parole well in their oversight. It is found
most satisfactory to have Jewish girls handled by Jewish women.
The Council of Jewish Women is always very willing to cooperate.
The ideal board of director sis a small mixed board of from seven
to nine persons, from different parts of the state, who should
be selected carefully with a view to their fitness for and interest
in this work, and who are willing to give time enough to make
themselves acquainted with the problems of the institution.
And not content with the problems of the single institution of
330 SOCIAL HYGIENE
which they are directors, they should be acquainted with the
problem of delinquency as a whole, and they should endeavor
to correlate with other forces of the community to study the
causes of delinquency and to help shut off the sources of supply. It
is important to have the directors visit the institution frequently,
it is not enough to visit at the time of stated meetings only.
The women managers, if they are persons of discretion, can be
of great service to the superintendent by making themselves
familiar with the daily routine of the institution. One of the
best ways for a woman manager to learn about the life of the
institution is frequently to remain over night, mingling with
the girls or women in the evening, also to be present when the
day begins. It is a protection to a good superintendent for the
girls or women to have ample opportunity to make any complaints,
real or imaginary, to a member of the board. It is a woman's
work, for women. Devoted, intelligent women, can be found
who will make the work of the superintendent possible. If the
superintendent selected proves unequal to her work, let the right
kind of a superintendent be found, but let her have full authority
in selecting her workers, and be held responsible for results.
Work with neglected girls and women is always more difficult
and discouraging than work with boys and men. It is a sex
problem. That fact must be understood. For this reason it
is of the greatest importance to have a group of intelligent women
on the board to work with the superintendent.
PUBLIC MORALS AND RECREATION
THE BASIS FOR A COMMUNITY PROGRAM
C. WALKER HAYES
On Sunday afternoon the city pours forth its legions to breathe the fresh
air and enjoy the sunshine of the parks and rural environs. Satirists may
say what they please about the rural enjoyment of a London citizen on
Sunday, but to me there is something delightful in beholding the poor
prisoner of the crowded and dusty city enabled thus to come forth once a
week and throw himself upon the green bosom of nature. He is like a
child restored to his mother's breast, and they who first spread out these
noble parks and magnificent pleasure-grounds which surround this huge
metropolis have done at least as much for its health and morality as if
they had expended the amount of cost in hospitals, prisons, and peni-
tentiaries.— Washington Irving.
Public morality is conformity to the social will, to the domi-
nant edict of society. Society, becoming convinced of what
makes for her welfare, formulates laws intended so to limit and
direct the activity of the component individuals and groups that
the social welfare shall be promoted and not destroyed. The
process of securing conformity to the requirements of public
morality may be spoken of as social control. This implies re-
straint, not of the expression of the impulses and tendencies
which a community deems normal, but of the anti-social or im-
moral tendencies. But it is not enough for society to set such
limitations upon the conduct of individuals. It is equally im-
portant to direct the expression of the powers and passions of
human life into such modes as have been found good in social
experience.
More and more we are writing into our legislation, provisions
for a higher and more wholesome life. Law is constructive as
well as restrictive. This is no less true of ethical ideals, the
stuff out of which laws are made, and of religion, the motive
power of law-making and law-enforcement. Neither are we
working under the assumption that legislation is the sole means
331
332 SOCIAL HYGIENE
for social control, nor do we need to admit that it is the chief
measure. We must rely greatly upon religion and education.
Law formulates the mandates. A community program for the
protection and improvement of public morals must then be in
large measure a legislative program, supported by education and
religion. On the other hand, the extra-legal endeavors of social
groups must be encouraged. A community service can be car-
ried on without legal mandate just as the individual may do a
service to a fellow without the bidding of written law or even of
a moral commandment.
The new social thinking forbids us to estimate progress in
terms of restraint or repression. But it does not follow that
little is to be expected from legislation by way of moral or social
improvement. We need only to include in our attitude toward
legislation the conception of a civilization built upon the free
expression of social surplus, whether it be physical, economic, or
spiritual. Laws are not necessarily restrictive. They may be
directive and promotive.
By omitting from this discussion any treatment of other forms
of endeavor than recreational, the writer does not minimize the
importance of other phases of constructive effort to promote pub-
lic morality or develop the health and character of individuals.
It is not the purpose of this discussion to deal with the educational
process which should spread universally and thoroughly impress
the truth about sex. But be it understood that education must
be promoted as a coordinate part of the endeavor to reduce
prostitution. Neither is it to be understood, by the recognition
of prostitution as in part a recreational problem, that it follows
that the growing recreational movement is dependent upon its
relation to public morals for its incentive. It is perhaps more
usual to think of recreation as an aid to health than as an aid to
morals. But it is well to realize that, because of the intimate
connection between health and morals, that which affects the one,
affects also the other. Moreover, there is no inclination to think
of recreation as justified only by the contribution it makes to
health or morals as though it were not of vast importance in
and of itself, as one of the elemental expressions of the fulness of
PUBLIC MORALS AND RECREATION 333
life. But the joy and gladness of play are quickly and univer-
sally recognized, whereas the ultimate moral effect, is the more
in need of emphasis.
The program of recreational endeavor as a counteractive of
sexual immorality is based, first, upon the fact that it is at play
or in search of amusement that vicious habits are formed; second,
upon the fact that health-building recreation fortifies the body,
thus making for the control of the sex instincts. Recreation
accomplishes far more than these ends but it is because it does
these things that a community program for public morals must
include a division relating to recreation.
Illicit indulgence of the sexual appetite is play gone wrong.
"The brothel is a play center, though a pathological one."
Prostitution can hardly be termed a form of recreation. The
notion violates the fundamental meaning of the word. Never-
theless, it must be admitted that since, for many, vice is amuse-
ment, the logical counteractive is recreation. Professor Patten
has said,' " Amusement is stronger than vice and can stifle the
lust of it." This is true of recreation in the case of a normal
individual at least.
Prostitution is not, as it was formerly thought to be, justified
by sex necessity. The old falsehood which has long been the
mainstay of prostitution, namely, that sexual intercourse is nec-
essary to health, has been correctly appraised, and as the
belief that, outside of the marital relation, continence is the only
course that is hygienically safe becomes increasingly established
in the social consciousness, the only plea which remains for pros-
titution is made in behalf of those who would follow the lure of
lust as a form of amusement, irrespective of the consequences.
Vicious habits are often formed in youth. Admitting that
many of the patrons of prostitution regard their practice in the
light of a necessity rather than as an amusement, this in no way
discounts the fact that the practice of prostitution is often, if
not generally, begun in the quest of amusement both in the case
of patrons and of prostitutes, nor the even more important fact
1 The New Basis of Civilization. Simon N. Patten. New York: Macmillan.
p. 143.
334 SOCIAL HYGIENE
that habits of sexual indulgence when acquired in youth are
generally begun while at play. The basis of the need of directive
measures is defined by Professor Hetherington.2 "The tremen-
dous power of sex-feelings in the life of most youths will make
them a source of playful enjoyment under present social condi-
tions, until adults set up a plan of action and volition which
appeals to and holds the hardy practical sense of youth. . . .
The ideal is so to mould the interests, activities, and organized
volitions of youth, that it will put the brothel out of business
through lack of patronage."
A rather extreme putting of the relationship between prostitu-
tion and public recreation was that made by a city superintend-
ent of parks in a recent conversation with the writer. "Why,
if I were authorized to administer the public parks in this city
on the same proportions as those upon which the fire and police
departments are administered, I would reduce prostitution in
this city 98 per cent." Such a statement no doubt seems ex-
travagant, but very likely it is nearer the truth than many even
of those who are very familiar with the problem of prostitution
have as yet come to realize. The opposite view is illustrated by
the opinion of the prosecuting attorney who, upon being told of
the remark of this gentleman, disclaimed any connection between
prostitution and recreation, saying, "I don't believe it is possible
to connect parks with prostitution." The carefully stated opin-
ion of a prominent physician of the same city will find ready cred-
ence by the average intelligent thinker. "Any normal recrea-
tion which gives a wholesome outlet to natural physiological
emotions will of necessity have a tendency to diminish the de-
mand for prostitutes." Over against the inability to see any
relation between parks and prostitution, we have the statement
of Forel.3 "The best conditions of existence for men are con-
tact with nature, air, and light, sufficient bodily exercise com-
bined with steady work for the brain, which requires exercise
2 Play Leadership in Sex Education. Clark W. Hetherington. Social Hygiene,
Vol. I, No. 1, December, 1914.
3 The Sexual Question. August Forel. New York: Rebman Company, p.
328.
PUBLIC MORALS AND RECREATION 335
as much as the other organs; this is just what is wanting among
the poor in the town and in the factory. Instead of this they
are offered unhealthy nocturnal pleasures and a prostitution
which spreads itself everywhere."
The scientific character of the fact under discussion is more
and more apparent in the light of the testimony of eminent
authorities. Dr. G. Stanley Hall4 refers to gymnastics as "a
safeguard of virtue and temperance;" and play he says "is the
ideal type of exercise for the young, most favorable for growth,
and most self-regulating in kind and amount. For its forms the
pulse of adolescent enthusiasm beats highest. It is uncon-
strained and free to follow any outer or inner impulse. The
zest of it vents and satisfies the strong passion of youth for in-
tense erethic and perhaps orgiastic states, and gives an exaltation
of self-feeling so craved that with no vicarious outlet it often
impels to drink."
The effect upon the youth of a city of the lack of proper rec-
reational life has been shown by investigations into the life and
environment of juvenile delinquents.5 The conviction is well sus-
tained that efficient constructive endeavors to promote whole-
some recreation have most direct effect in the conservation of
public morals. In 1897 a building was presented to the city of
Boston and thrown open to the general public. It was Boston's
first municipal gymnasium.6 "Two days a week the entire build-
ing is reserved for the exclusive use of women and girls. The
first year that it was under the management of the city its gross
attendance during ten months was 65,000, four times the num-
ber that had visited it while it was under private control. As
for the good effect of this institution upon the neighborhood, we
have the statement of the police of East Boston who say that
since the opening of the gymnasium there has been a marked
diminution of lawlessness. The local school principal gives em-
4 Youth: Its Education, Regimen and Hygiene. G. Stanley Hall. New York:
Appleton, 1909. p. 75.
5 Cf. especially, West Side Studies. Russell Sage Foundation. New York:
Survey Associates, Inc., 1914.
* Substitutes for the Saloon. An Investigation made for the Committee of
Fifty. Raymond Calkins.
336 SOCIAL HYGIENE
phatic testimony to its influences upon the children, and the
disappearance of a number of low-toned social clubs suggests its
importance as a rendezvous for young men."
Among the cities of the United States which have thrown
open their schools for public use, is Philadelphia. A section of
the city "had come to be regarded as a breeding place for crimi-
nals, but a subtle change has come over it since the school house
doors have begun to swing open after sundown."7
It is pertinent at this point to observe the extent to which the
demand for recreation as a counteractive of vice has been recog-
nized in reports of vice commissions, as well as to note the sub-
sequent activity in the cities where their reports were made.
Previous to October, 1915, organizations in twenty-four cities
and two states8 had made investigations of vice and definite
recommendations. Nineteen of these reports had definite recom-
mendations in regard to public recreation. To members of the
organizations responsible for these nineteen reports, the writer
directed inquiries concerning the results of these recommenda-
tions. Thirteen of the nineteen inquiries were answered. Rec-
ommendations concerning the policing and supervision of chil-
dren in such places as streets, parks, playgrounds, and commer-
cial amusement places, were made in six different reports. In
one of the cities, Hartford, a law requiring that children under
sixteen years attending motion picture shows should be accom-
panied by an adult, was laxly and spasmodically enforced. The
closing of houses of prostitution in Philadelphia is reported to
have made safer conditions for children in that city. But there
was no report from any of these cities that recommendations of
this nature have been carried out.
7 The Wider Use of the School Plant. Clarence Arthur Perry. New York :
Charities Publication Committee, 1910.
8 A report made after the writer's inquiry was begun, is that of Maryland.
The Maryland State Vice Commission made public its report to Governor Golds-
borough on December 20, 1915 and made recommendations, according to pub-
lished summaries, which included the organization of a permanent morals wel-
fare commission, the supervision of places of amusement and the establishment
of various forms of recreation under municipal auspices. See SOCIAL HYGIENE,
Vol. II, No. 2, April, 1916.
PUBLIC MORALS AND RECREATION 337
The regulation of public dance halls was dealt with in the rec-
ommendations of nine reports, urging that these places be sup-
ervised by women police or matrons and that the sale of liquor
and the granting of pass-out checks be forbidden. The Wis-
consin State Vice Commission endeavored to secure the enact-
ment by the legislature of bills providing for the regulation of
dance halls and the censorship of motion pictures, but these
bills were defeated. The secretary of the Philadelphia Vice
Commission reports that the city has not undertaken the licens-
ing and supervision of amusement places other than by the
police department. After the report in Massachusetts of the
Commission to Investigate the White Slave Traffic, So-called, in
1914, legislation for the regulation of dance halls was proposed
but failed of enactment. From one city the report comes that
"the law failed of passage in the city council. The city govern-
ment shows no sympathy for such legislation and the police pro-
tect the law-breakers."
The motion picture theatre was the subject of recommenda-
tions in six reports, but nothing definite has resulted therefrom.
The Report of the Senate Vice Committee of the State of
Illinois, in 1916, included among its recommendations:9—
"Improvement of conditions of girls in domestic service and of
girls from homes offering inadequate social opportunities, by the
opening of school houses and all other available buildings as
social centers; hours of labor of girls in domestic employment
to be regulated to permit of participation.
"Creation of a state athletic commission for the encourage-
ment of healthy and non-professional sports and pastimes."
The Bridgeport, Connecticut, Vice Commission made a report
in April, 1916, in which they recommended a recreational sur-
vey of the city to be followed by the creation of a permanent
recreation commission to take into its power and authority all
public amusements, shows, and recreation of the city. In the
introduction of the report the following is listed among the
unanimous conclusions arrived at by the national and local vice
9 SOCIAL HYGIENE, Vol. II, No. 3, July, 1916.
338 SOCIAL HYGIENE
investigations: "That the lack of proper recreation is always a
concomitant of vice. Healthy amusements or athletics either
make impossible or drive away the morbid frame of mind or
body which brings passion to the height of unlawful practices.
Hence there is a new conscience in the world with regard to the
meaning of recreation."
In reply to an inquiry by the writer, a member of the Bridge-
port Vice Commission wrote January 16, 1917, as follows: "The
Recreation Commission recommended in our report has been
created. We are having an intensive recreational survey made.
The results already achieved are the opening of six new play-
grounds, the purchase of two new parks, the enlistment of the
manufacturers for welfare work, and the opening of two school
centers. And this is only a start."
It is evident from these reports that the commissions making
them were convinced of the relationship between public morals
and recreation. From the above inquiry, however, it is no less
evident that if the effectiveness of the vice reports were to be
measured by the reforms of a constructive nature that have been
effected subsequent to their publication, most of them would
have to be set down as disappointing failures.
An adequate program for the conservation of public morals
must include a well developed plan for the provision and super-
vision of public recreation. Such a program must include both
repressive and constructive measures. It must unite the en-
forcement of repressive legislation and the program of prevent-
ing immorality by the constructive development of recreational
facilities upon a large scale, kept wholesome by a prudent super-
vision. At the same tune new dignity will become attached to
the old program of enforcing the laws against disorderly houses,
places of assignation, and soliciting for immoral purposes on the
streets and in public places. This repressive part of the program
is now far too feeble or at least intermittent. It is true that
there is something more hopeful and exhilarating, more appealing,
about a constructive campaign than there is about any routine
activity concerned with the enforcement of repressive laws.
Nevertheless, the repressive program must hold its ground. We
PUBLIC MORALS AND RECREATION 339
may hope that as the constructive program builds up the weak
places in the walls of social life, raising the norm of the moral
health of society by whatsoever means, the extent of the need
for the repressive methods will gradually diminish. Yet, until
the educational and public health programs are completed, there
will always be the feeble-minded and morally depraved, whose
activities will have to be repressed. Public servants must de-
termine who are the feeble-minded and who are the morally
depraved and control the forces that are demoralizing. Govern-
ment, which acts for the common welfare in obedience to public
opinion, must constantly be engaged in carrying out the two es-
sential programs of repression and development.
FIELD-MARSHAL THE RIGHT HONORABLE LORD
KITCHENER'S MESSAGE TO THE BRITISH
EXPEDITIONARY FORCE
You are ordered abroad as a soldier of the King to help our
French comrades against the invasion of a common enemy.
You have to perform a task which will need your courage, your
energy, your patience. Remember that the honour of the
British Army depends on your individual conduct. It will be
your duty not only to set an example of discipline and perfect
steadiness under fire but also to maintain the most friendly
relations with those whom you are helping in this struggle.
The operations in which you are engaged will, for the most
part, take place in a friendly country, and you can do your own
country no better service than in showing yourself in France
and Belgium in the true character of a British soldier.
Be invariably courteous, considerate and kind. Never do
anything likely to injure or destroy property, and always look
upon looting as a disgraceful act. You are sure to meet with a
welcome and to be trusted; your conduct must justify that
welcome and that trust. Your duty cannot be done unless your
health is sound. So keep constantly on your guard against any
excesses. In this new experience you may find temptations
both in wine and women. You must entirely resist both temp-
tations, and, while treating all women with perfect courtesy,
you should avoid any intimacy. Do your duty bravely.
Fear God.
Honour the King.
KITCHENER,
Field-Marshal.
240
THE TREATMENT OF VENEREAL DISEASES IN GEN-
ERAL DISPENSARIES OF NEW YORK STATE
OUTSIDE OF NEW YORK CITY
JOSEPH J. WEBER
Executive Secretary of the Committee on Hospitals, New York State Charities Aid
Association
What part general hospitals in New York State, outside of
New York City, are playing in combating venereal disease, was
set forth in the January, 1917, issue of SOCIAL HYGIENE. Since
then the Committee on Hospitals of the State Charities Aid As-
sociation has made a similar study of the treatment of venereal
diseases in the general dispensaries of New York State outside
of New York City.
As in the case of the study of hospital facilities, separate ques-
tionnaires covering syphilis and gonorrhea were carefully pre-
pared, with the assistance of Dr. W. F. Snow, General Secretary
of the American Social Hygiene Association, Dr. Thomas W.
Salmon, Medical Director of the National Committee for Mental
Hygiene, and Mr. F. J. Osborne, Executive Secretary of the
New York Social Hygiene Society. These questionnaires, ac-
companied by a letter, were sent to the 27 general dispensaries
in New York State outside of New York City.
I. CLINICS FOR SYPHILIS
Nineteen of the 27 dispensaries either returned the question-
naire or sent a letter in reply. The remaining 8, we were later
informed by the New York State Board of Charities, have no
clinics for the treatment of syphilis; we received word directly
from 9 dispensaries that they do not maintain clinics for the
treatment of syphilis, — a total of 17 out of 27.
Ten dispensaries, then, maintain clinics for the treatment of
syphilis, and of these 9 filled out our questionnaire more or less
341
342 SOCIAL HYGIENE
fully. What of these 9? Are they adequately equipped? Have
they sufficient and up-to-date facilities for accurate diagnosis
and effective treatment? Do they attempt to educate their
patients in the methods of preventing the spread of these dis-
eases? Do they keep adequate and satisfactory records? Are
their records studied often enough?
There is, unfortunately, no authoritative standard to which
we can refer as a norm in answering these questions. It is gen-
erally conceded, however, by those familiar with the dispensary
treatment of syphilis and gonorrhea that the dispensary of the
Brooklyn Hospital maintains one of the best services for venereal
diseases in New York State. We may, therefore, properly use
this dispensary as a sort of norm for purposes of comparative
analysis and criticism.
EQUIPMENT
SEPARATE DEPARTMENTS
Brooklyn Hospital Dispensary, At this dispensary syphilitic patients are
treated in a separate department; three rooms are devoted to men, and four to
women and children.
Nine Up-State Dispensaries. Two of the dispensaries treat their patients in
a separate department. Of these two, one has one room; the other, two rooms.
DIAGNOSIS AND TREATMENT
REFERENCE OF PATIENTS TO CLINIC
Like the Brooklyn Hospital Dispensary, 8 of the 9 up-state dispensaries are
connected with hospitals, from which in two instances syphilitic patients having
other complications are invariably referred to the syphilitic clinic, and in one
instance sometimes.
Three of the dispensaries are also connected with medical colleges.
VENEREAL DISEASES IN GENERAL DISPENSARIES
343
WASSERMANN TESTS
The Brooklyn Hospital Dispensary gives Wassermann tests on all cases.
Five of the up-state dispensaries studied give this test on all cases; three on
some cases; one failed to indicate whether or not it gives this test.
DISPENSARY
NUMBER OF TESTS
REMARKS
Brooklyn Hospital
About 30 a
Majority done by Depart-
Dispensary A
week. About
1560 a year.
150
ment of Health; Brooklyn
Hospital as a check
Tests made during last dis-
Dispensary B
3
pensary year, but these
bloods are sent to Bender
or State Laboratory
During last dispensary year
Dispensary C
21
During last dispensary year
Dispensary D
7
During last dispensary year
Dispensary E
18
During 5 months, — time clinic
Dispensary F
24
has been in existence
During last dispensary year
Dispensary G
271
During last dispensary year
Dispensary H
Many
Dispensary I
(No answer)
EXAMINATION FOR TREPONEMA OF INITIAL LESIONS
Brooklyn Hospital Dispensary. The Brooklyn Hospital Dispensary has no
facilities for making this examination, but whenever necessary the examination
is made by individual members of the staff of the dispensary at their own offices.
This is done be cause the Department of Health has no facilities for making these
examinations.
Nine Up-State Dispensaries. Five Dispensaries make this examination. One
during its last year, examined 50 patients; another examined 33 patients; two ex-
amined 3 patients each.
USE OF SALVARSAN
Brooklyn Hospital Dispensary. In the medical treatment of syphilis, this dis-
pensary uses salvarsan, salvarsan substitutes, mercury by injection, and other
medication, such as tonics and potassium iodid.
Nine Up-State Dispensaries. Eight dispensaries use salvarsan; six use salvar-
san substitutes; all nine use mercury by injection or rubs, and eight use other
medication.
PAYMENT FOR SALVARSAN, ETC.
Brooklyn Hospital Dispensary. This dispensary furnishes these drugs at cost.
Nine Up-State Dispensaries. Five of the dispensaries furnish salvarsai at
cost to patients when they do not themselves purchase it or the more expensive
344 SOCIAL HYGIENE
mercury compounds. If a cheap type of mercury is used, it is often furnished by
one of the dispensaries. One makes a nominal charge; one furnishes it free to
those unable to pay; one refers cases to the hospital with which it is connected;
and one to the Municipal Hospital.
PHYSICIANS
Brooklyn Hospital Dispensary. There are eight physicians in attendance at
this dispensary, five of whom are paid.
Nine Up-State Dispensaries. Five of these dispensaries have two physicians
each in attendance; four have one each. None of these physicians is paid for his
services.
PAYMENT FOR TREATMENT
Brooklyn Hospital Dispensary. At the morning clinics there is an admission
fee of ten cents and a nominal charge for medicine. At the evening clinics, a
charge of one dollar is made, covering both treatment and medicine, except sal-
varsan, which is sold at cost.
Nine Up-State Dispensaries. A routine dispensary charge is made at two of
the dispensaries; at the other seven no charge is made except, as already indi-
cated, for salvarsan.
SOCIAL SERVICE AND FOLLOW-UP
Brooklyn Hospital Dispensary. Personal visitation in venereal work has not
been found practical unless under the direction of unusually qualified and tactful
persons; consequently, it mails a card in a sealed envelope at the end of one week
after a patient's failure to appear at the clinic. At least three cards are sent
before removing the case history from the active list. The interval between cards
depends upon various factors. A primary or an active secondary syphilis, a
refractory patient, and other similar points determine the number and frequency
of the cards.1 The cases of women and children are cared for, when necessary,
by the social service department of the general dispensary.
Nine Up-State Dispensaries. Three dispensaries endeavor to persuade the
patient to continue treatment; one advises him to continue; and one endeavors
to reach the patient through the medium of the Board of Health. Two dispen-
saries refer their cases to the social service worker of the hospital with which
they are connected; one to the social service worker connected directly with the
dispensary; and one to the Visiting Nurse Association and the Associated
Charities.
DISCHARGE OF PATIENTS
Brooklyn Hospital Dispensary. This dispensary requires a negative Wasser-
mann every ten weeks for six months while under treatment ; negative Wasser-
mann every three months for the next six months without treatment; provoca-
tive salvarsan and negative Wassermann for the next year, as follows : end of
three months; end of six months; end of year.
1 Attacking the Venereal Peril, Alec Nicol Thomson, M.D., February 14,
1916. Long Island Medical Journal, April, 1916.
VENEREAL DISEASES IN GENERAL DISPENSARIES 345
Nine Up-State Dispensaries. Six of these dispensaries require, by specific
regulations, healed contagious lesions; five require entire disappearance of symp-
toms three require negative Wassermanns ; while one occasionally uses the Hecht-
Weinberg test, and two the Luetin test.
EDUCATION
LITERATURE OR INSTRUCTIONS
Brooklyn Hospital Dispensary. Each patient when admitted to the dispensary
receives a ten-page pamphlet on venereal diseases. During the course of a pa-
tient's treatment, the Department of Health card on syphilis is given the patient.
Bulletin boards with health maxims are arranged about the walls of the
dispensary.
Nine Up-State Dispensaries. Eight of these dispensaries give their patients
either printed or oral instructions as to how to avoid spreading infection.
RECORDS
A. IN GENERAL
Previous Treatment ,
Brooklyn Hospital Dispensary. Careful records are kept of previous treat-
ment received by the patient at this clinic or elsewhere.
Nine Up-State Dispensaries. All these dispensaries follow the practice of the
Brooklyn Hospital Dispensary.
Source of Infection
Brooklyn Hospital Dispensary. This dispensary keeps a careful record of the
source of infection of each case treated.
Nine Up-State Dispensaries. Six of these dispensaries make a record of the
source of infection, if possible; one, "only as history indicates."
How Patient is Referred
Brooklyn Hospital Dispensary. This dispensary keeps a record of the sources
from which patients are referred.
Nine Up-State Dispensaries. Six of these dispensaries keep such a record.
Method of Keeping Histories
Brooklyn Hospital Dispensary. Histories are kept so that they can be readily
studied. Each one hundred records of closed cases are bound and digested.
Nine Up-State Dispensaries. Eight of these dispensaries keep records that
can be easily studied. Three summarize and digest their records once a year;
one, semi-annually; and one, quarterly.
B. ADMISSION, ATTENDANCE, AND DISCHARGE OF PATIENTS
Questions regarding the admission, attendance, and discharge of patients
were included in the questionnaire, but the answers were so incomplete and con-
flicting that they are of little value and are therefore omitted.
346 SOCIAL HYGIENE
II. CLINICS FOR GONORRHEA
Of the 27 dispensaries to which our questionnaire was sent,
18 do not maintain clinics for the treatment of gonorrhea. Of
the 9 that do, 8 rilled out our questionnaire more or less fully.
EQUIPMENT
SEPARATE DEPARTMENTS
Brooklyn Hospital Dispensary. At the Brooklyn Hospital Dispensary, male
patients having gonorrhea are treated in a separate department with six rooms;
women are treated in the gynecological clinic.
Eight Up-State Dispensaries. Three dispensaries treat gonorrheal patients in
a separate department, and of these, two devote two rooms to this purpose, and the
other, one room.
DIAGNOSIS AND TREATMENT
REFERENCE OF PATIENTS TO CLINIC
Like the Brooklyn Hospital Dispensary, all but one of the up- state dispen-
saries are connected with hospitals, from which patients having other complica-
tions are referred to the genito-urinary clinic.
EQUIPMENT FOR TREATMENT
Brooklyn Hospital Dispensary. This dispensary has complete equipment for
the diagnosis and treatment of gonorrhea, including microscope, sterilizer, sounds,
dilators, irrigators, and a laboratory.
Eight Up-State Dispensaries. Five of the dispensaries have the same variety
of equipment for diagnosis and treatment that the Brooklyn Hospital Dispensary
has; one is equipped with microscope, sterilizer, sounds, and a laboratory; one
with microscope, sterilizer, sounds, irrigators, and a laboratory; and one with
microscope, sterilizer, and a laboratory.
ENDOSCOPY AND CYSTOSCOPY
Brooklyn Hospital Dispensary. The Brooklyn Hospital Dispensary has com-
plete facilities for endoscopy and cystoscopy.
Eight Up-State Dispensaries. Four of the up-state dispensaries have complete
facilities for endoscopy, cystoscopy, and complement fixation test; one has fa-
cilities for cystoscopy, and complement fixation test; one for cystoscopy; one re-
fers serum elsewhere, and in one case the attending physician uses his own
facilities.
METHOD OF TREATMENT
Brooklyn Hospital Dispensary. In its treatment, the Brooklyn Hospital Dis-
pensary uses massage, dilatations, irrigations, hand injections with silver salts
and astringents, and mouth medication.
VENEREAL DISEASES IN GENERAL DISPENSARIES 347
Eight Up-State Dispensaries. One dispensary responded that it uses all types
of treatment as cases require; one, several types; one that it uses irrigation and
medication; one, medication; and one, "local treatment."
PHYSICIANS
Brooklyn Hospital Dispensary. There are ten physicians in attendance at
the genito-urinary clinics. None of these are paid for attendance at the free
clinics held during the day.
Eight Up-State Dispensaries. Five of these dispensaries have two physicians
in attendance; one has four physicians; and two have one physician. None of
them are paid for their services.
PAYMENT FOR TREATMENT
Brooklyn Hospital Dispensary. At the free clinic, an admission fee of ten cents
is charged. At the evening clinic, a charge of $1.00 per visit is made which
covers medicine and treatment.
Eight Up-State Dispensaries. In three of the dispensaries, a routine dispen-
sary charge is made. In five, no charge is made except for vaccines, etc.
SOCIAL SERVICE AND FOLLOW-UP
Brooklyn Hospital Dispensary. The same system of sending out card notices
to patients who fail to continue treatment is used as described above for syphilis
patients.
Eight Up-State Dispensaries. Only three of the dispensaries definitely state
that they make an effort to persuade their patients to continue treatment. The
others apparently make no attempt whatever along this line.
The Brooklyn Hospital Dispensary has no social service worker connected
with it. Three of the up-state dispensaries use social service workers of the hos-
pitals with which they are connected, and one, students from the medical college.
DISCHARGE OF PATIENTS
Brooklyn Hospital Dispensary. At this dispensary the patient's history must
show three monthly negative prostatic smears, a negative complement fixation
test, a clinical cure, and a final examination of the urethra.
Eight Up-State Dispensaries. Four of these dispensaries require negative
prostatic massage; four require negative cervical smear; and one requires nega-
tive complement fixation test.
EDUCATION
LITERATURE AND INSTRUCTIONS
Brooklyn Hospital Dispensary. This dispensary follows the same method of
giving patients pamphlets and printed instructions as in its syphilis clinic.
Eight Up-State Dispensaries. Seven of the dispensaries give patients litera-
ture or oral instructions as to how to avoid spreading the disease.
348 SOCIAL HYGIENE
RECORDS
A. IN GENERAL
Previous Treatment
Brooklyn Hospital Dispensary. The Brooklyn Hospital Dispensary keeps a
record of previous treatment, of the sources of infection, and of the sources
from which the patient was referred.
Eight Up-State Dispensaries. All of these dispensaries make a record of pre-
vious treatment received by the patient at its clinic or elsewhere. Six record the
source of infection, and four make a record of how the patient was referred to the
clinic.
Method of Keeping Histories
Like the Brooklyn Hospital Dispensary, all eight up-state dispensaries keep
their histories so that they can be easily studied.
As with syphilitic cases, the Brooklyn Hospital Dispensary binds and digests
the records of each one hundred closed cases.
Of the eight up-state dispensaries, three summarize and digest their histories
yearly.
B. ADMISSION, ATTENDANCE AND DISCHARGE OF PATIENTS
Questions regarding the admission, attendance, and discharge of patients
were also included in the questionnaire on gonorrhea, but here, too, the replies
were so incomplete and conflicting that they are of little value and are therefore
omitted.
From the foregoing it will be seen that the dispensaries through-
out New York State have made a beginning, small though it is,
in providing facilities for the diagnosis and treatment of these
diseases. One-third of the dispensaries now maintain clinics
both for syphilis and gonorrhea. Their facilities and staff, to
be sure, are often inadequate, but these it may be expected will
be improved with time and the growing realization of the im-
portance of this problem. Moreover, in view of the growing
willingness on the part of dispensary authorities to meet this
problem, we may shortly expect to see clinics for the treatment
of syphilis and gonorrhea established in many more of the dis-
pensaries of the state.
It is particularly important at the present moment for all hos-
pitals and dispensaries to give serious consideration to the sub-
ject. Venereal diseases are not likely to decrease during the next
few years and not only must attention be paid to them as a
VENEREAL DISEASES IN GENERAL DISPENSARIES 349
military problem but the civil population must be cared for.
Every focus of infection, possible of location, must be found.
Facilities must be increased to meet the existing demand and
should be developed with due regard to the future needs of the
state.
LIBERTY AND DISCIPLINE1
Now the test of a civilization based on liberty is the use men
make of the liberty they enjoy, and it is a failure not only if
men use it to do wrong, but also if they use it to do nothing, or
as little as is possible -to maintain themselves in personal com-
fort. This is true of our institutions as a whole and of the Amer-
ican college in particular. A student who has no sustaining
faith in the education he can get there; who will not practice
the self-discipline needed to obtain it; who uses his liberty to
put forth not his utmost, but the least possible effort ; who uses
it not to acquire, but to evade, a thorough education, fails to
that extent in his duty to himself, to his college, to his country,
and to the civilization he inherits.
Never have I been able to understand — and even less than
ever in these terrible days, when young men, on whom the future
shone bright with hope, sacrifice from a sense of duty their lives,
the welfare of those dearest to them, and everything they care
for — less than ever can I understand how any man can stand
in safety on a hillside and watch the struggle of life in the plain
below without longing to take part therein; how he can see the
world pass by without a craving to make his mark, however
small, on his day and generation. Many a man who would be
eager to join a deadly charge if his country were at war, lacks
the insight or imagination to perceive that the warfare of civi-
lization is waged not more upon the battlefield than in the work-
shop, at the desk, in the laboratory, and the library. We have
learned in this stress of nations that men cannot fight without
ammunition well made in abundance; but we do not see that
the crucial matter in civilization is the preparedness of young
men for the work of the world; not only an ample supply of the
best material, but a product moulded on the best pattern, tem-
pered and finished to the highest point of perfection. Is this the
ideal of a dreamer that cannot be realized; or is it a vision which
young men will see and turn to a virile faith?
A. LAWRENCE LOWELL,
President of Harvard University.
1 Liberty and Discipline, a Talk to Freshmen. An address delivered to the
freshmen class of Yale College, October 15, 1915. Yale University Press, New
Haven, 1916.
350
WHAT IS CHICAGO DOING FOR THE VENEREALLY
DISEASED?
A SYMPOSIUM BY DR. WILLIAM T. BELFIELD, DR. WILLIAM
ALLEN PUSEY, DR. F. O. TONNEY, DR. OLIVER S. ORMSBY,
DR. B. NEWTON NOVY, DR. ANNA E. BLOUNT, DR. RACHELLE
S. YARROS, DR. LEWIS W. BREMERMAN, AND OTHERS.
The meeting before which the following papers were presented
was held at the Chicago City Club on December 14, 1916, in
connection with a dinner which was attended by physicians,
nurses, social workers, and others interested generally in social
hygiene work. The lively interest of certain members of the
Chicago Woman's Club, the Woman's City Club of Chicago,
and the Chicago City Club, particularly in the public health
aspects of social hygiene, led to their sharing with the American
Social Hygiene Association the auspices of the meeting. Dr.
William T. Belfield, professor of genito-urinary surgery, Rush
Medical College, secretary and one of the founders of the Chicago
Society of Social Hygiene, presided. In his opening remarks, Dr.
Belfield said : —
Fifty years ago personal liberty, as then interpreted, assured to
every resident of Chicago the right to acquire scarlet fever or diph-
theria, and to scatter it among his friends and schoolmates without
hindrance by the law. The city did, however, recognize one duty in
the premises, namely, to see that the remains .were decently interred.
Today, personal liberty assures to every resident of Chicago the
right to acquire syphilis or gonorrhea, and to communicate this to his
intimates, to his bride, even to his unborn children, without hin-
drance by the law. The state does, however, recognize one duty in the
premises, namely, to see that the remains are decently interred in
asylums for the insane, for the feeble-minded, for the blind, in peni-
tentiaries and poorhouses, all of which owe a large part of their rapidly
increasing population to the venereal diseases. Illinois spends mil-
351
352 SOCIAL HYGIENE
lions every year in mopping up the floor, but neglects to turn off the
faucet.
Since the disasters wrought by syphilis — civic, economic, vital — are
incomparably greater than are those entailed by scarlet fever, the
necessity for protecting the community against syphilis is obviously the
more imperative; yet for reasons evident and cogent, the public re-
fuses to adopt against syphilis those protective measures which have
long been used against scarlet fever, including compulsory notification
and quarantine. A proposed ordinance now in the hands of the Health
Committee of the Chicago Common Council carefully excludes these
two features.
A decade ago, the education of the public concerning the disas-
ters entailed by the venereal diseases was begun by societies organ-
ized for that purpose in New York, Philadelphia, and Chicago, and
subsequently in a score of other cities. My acquaintance with this
movement has been rather intimate, because of my association, since
its inception ten years ago, with the Chicago Society of Social Hy-
giene— which society, by the way, coined the phrase "Social Hygiene"
to designate this movement; a coin that has since secured general
circulation in this sense.
While not a visionary optimist, I am convinced that the social
hygiene campaign in this country has been worth while. For it is
now generally conceded to be not a new phase of religious mania, but
the earnest effort of intelligent people to check the tide of physical
and mental degeneracy, already painfully apparent in our population.
Several states now require a certificate of freedom from venereal dis-
ease from all male applicants for a marriage license; in other states,
innumerable fathers now privately demand similar assurance before
giving their daughters in marriage. A dean of a large university has
publicly stated that of their five thousand students, the number
contracting venereal disease has in five years dropped from eighteen
to one per cent.
Even the enemies of the movement have given convincing testi-
mony to its value. Thus nine years ago certain magnates of the Chi-
cago red-light district — then ablaze with glory and electricity — in-
stigated the police to exclude from that district certain leaflets published
by the Chicago Society of Social Hygiene, on the ground that said
leaflets were shockingly "immoral." So strong was their pull with
police officials, that we referred the matter to the then Corporation
Counsel, Mr. Brundage. After reading the leaflets, including the
WHAT IS CHICAGO DOING? 353
names of the officers responsible for them, Mr. Brundage officially
decided that the social and moral tone of the red-light district would
not be seriously impaired by this literature.
No man imagines that a knowledge of the venereal diseases
alone will restrain all young men from contracting them; but some of
us do believe that this knowledge will reduce — indeed has already
reduced — the contamination of wives and children with these diseases.
This, I take it, should be the prime effort of the social hygiene
movement — to keep these infections out of the family, out of the
stock; and this is not only the most important effort, but also the
most feasible, because its wisdom and justice are heartily conceded by
all, even by those already infected.
A few physicians have acquired a profound knowledge of syphilis,
both as a disease and as a public health problem. One of these —
perhaps the best qualified — will discuss for us "What Chicago Should
Do for the Venereally Diseased."
Dr. Belfield then introduced Dr. William Allen Pusey, profes-
sor of dermatology at the University of Illinois College of
Medicine and author of Syphilis as a Modern Problem. Dr. Pusey
spoke as follows: —
Gonorrhea is probably the commonest of important specific infec-
tious diseases, and syphilis is only less common than gonorrhea. I
can not give the exact figures of the prevalence of either of these dis-
eases. It is well within the facts to say that five per cent, of the adult
population of the United States has had syphilis. I am not so familiar
with statistics as to gonorrhea. They vary widely, but I have no
doubt that it is an under-estimate to say that twenty per cent, of the
adult population has had gonorrhea, and of those who have had either
of these diseases a great many continue to have them. The problem of
these diseases, therefore, is exceedingly important, and it is a" very
vital question what a city the size of Chicago should do for the vene-
really infected.
The indirect methods of attack upon the venereal diseases, by in-
culcating the advantages of clean living, of sexual restraint, of high
moral standards, by the regulation or repression of prostitution, and
by the control of the liquor traffic, are all of more or less value. Quar-
antine or isolation of the venereally infected is impractical because of
the long duration of the diseases and the enormous number of cases.
354 SOCIAL HYGIENE
Education as to the dangers of the venereal diseases acts as a deter-
rent only to the intelligent and the cautious. Education as to meas-
ures for preventing infection upon contact with venereal infections can
be only slow, presents difficult questions, and for a long time, if not
always, can reach only the intelligent or special classes in the com-
munity. I believe we can not hope to see any radical effect produced
upon the extent of the venereal diseases through these methods of
attack.
We have, however, one method of attack upon the venereal dis-
eases which is definite, positive, and capable of wide application; and
that is the suppression of the infectiousness of the venereal diseases by
intelligent treatment. If syphilis and gonorrhea are taken early and
treated intelligently their infectiousness can be promptly suppressed
almost to the vanishing point, instead of lingering as it does for months
and years when prompt and proper treatment is not instituted. Every
case of venereal disease promptly treated means the destruction of a
focus of danger to the community, and it is this fact which justifies the
insistence on the importance of means for the treatment of the vene-
real diseases purely as a matter of sanitary business. The subject is
so important to the people as a whole that it could well be urged that
the state should, as a matter of public policy, provide adequate means
for the treatment of all who are venereally infected. But the time is
not ripe when we can hope for so radical a social measure.
The best that can be done now is to urge that a proper start be
made in this direction. The question will arise in some minds: "Have
we not a very large start already made in our present hospitals and
dispensaries? Are they not already doing this work, and providing
an object lesson?" They are not, and there are many reasons for this.
In hospitals and dispensaries it has been the custom to look on the
venereal diseases as step-children — not to say bastards — among dis-
eases. Charity hospitals will not provide for them, and dispensaries
are ill-equipped to take care of them. These institutions have not
awakened to the duty they have to the community in treating these
patients, not only for the patients themselves, but for the protection
of others. Some start is being made in the right direction, but so far
it is a very small start. The attitude of most hospitals and dispen-
saries towards the matter is still one of Pharisaical intolerance or of
ignorant inappreciation of their duties.
What should be done? Perhaps the best way to indicate this would
be to sketch in briefest outline the best measures that could be estab-
lished.
WHAT IS CHICAGO DOING? 355
The best condition would be to have provided universal opportunity
for proper treatment of those venereally diseased, and in Utopia this
would certainly mean compulsory treatment. At the present time
efforts should be limited to the provision in dispensaries, and to some
extent in hospitals, for the proper treatment of these cases. The
chief essentials of a proper venereal department of a dispensary are:
First, that it be well manned. Second, that it be properly equipped
for diagnosis and treatment. Third, that it should have a social ser-
vice including a follow-up system. Fourth, that it should be free,
easy of access, and without difficult or embarrassing conditions.
Competent physicians and a well-manned service are the first essen-
tial. The diagnosis and treatment of venereal diseases at the present
time is highly specialized work, and it requires men trained for it. In
fairness, in order to command a sufficient amount of the men's time
and for the sake of discipline, the attending physicians should have
salaries, not necessarily large, but enough to justify the exacting of
efficient work. Adequate provisions for diagnosis and treatment are
also necessary. Here is one point where dispensaries now are weak.
Such provisions are not very elaborate nor very expensive, but an
adequate equipment is essential to good work. The furnishing of
diagnosis in these cases, as is done by health departments frequently,
while useful in a way, can not be regarded as any adequate substitute
for proper dispensaries. The diagnoses are needed only because they
are a prerequisite to treatment. Treatment is the essential thing.
The social service is needed to instruct the patients; to encourage
them in what to many of them is one of the depressing experiences of
life; to look after social conditions; and to carry out a follow-up system
which is necessary in order to hold the 'patients under treatment.
This social service, by men for men, and by women for women, is an
essential part of a successful scheme of this kind.
Opportunities for treatment must be accessible, free, and devoid of
embarrassing conditions. Convenient hours for consultations are neces-
sary; and that means evening dispensaries, in order that patients may
attend without sacrificing time from their work. Treatment should
be free to the poor, but in any extensive scheme of this sort oppor-
tunity should be provided for patients able to pay small fees. In or-
der that patients may readily seek treatment, embarrassing conditions
concerning treatment should be avoided as far as possible. For this
reason these venereal services should as far as possible be departments
of general dispensaries. In the same reason lies the objection to the
356
notification of venereal diseases. It deters the patient from seeking
treatment in a dispensary, as elsewhere, where he thinks his secrets
may be disclosed.
'To apply this scheme specifically to Chicago, the first thing that
should be done would be to bring our present dispensary and hospital
wards for venereal diseases up to modern standards of efficiency.
These departments should be well supported, and their workers should
be imbued with the fact that in treating these patients they are deal-
ing with a sanitary problem of prime importance. I believe it would
be a good plan to have an institution started downtown in Chicago
along these lines with a medical staff of well-trained men. They
could nearly all be young men, but they should have an older direc-
tor who should be in charge of the service, and who should not only
have competent training, but should be free from political entangle-
ments and independent in the appointment of his staff of physicians
and other assistants. Such an institution would be valuable not
only for taking care of the venereally diseased, but especially as an
object lesson.
It may be objected that a few such institutions would only scratch
the surface of the problem of venereal diseases. That is true, but the
thing that encourages one to urge a crusade of this sort is that it does
not have to be carried out in full in order to perform a public service;
for every patient freed from the infectious dangers of gonorrhea or
syphilis means the removal of a danger to the public. Every pros-
titute with syphilis or gonorrhea so cared for prevents scores of cases
of venereal disease; thus one well-equipped dispensary service or in-
stitution for treating venereal diseases does a service to the public
far in excess of its cost, justifies its existence even alone, and is a step
in the direction in which lies the only practical solution of the control
of the venereal diseases.
The next speaker was Dr. F. 0. Tonney, director of the Chi-
cago Health Department laboratories. Dr. Tonney's paper, pre-
pared in collaboration with Mr. L. K. Torbet, secretary of the
Chicago Morals Commission, was entitled "What the City of
Chicago is Doing for the Venereally Diseased," and is presented
in a somewhat abridged form.
In the year 1910 a venereal clinic was established in the Iroquois
Hospital, and shortly subsequent thereto the health department
WHAT IS CHICAGO DOING? 357
laboratory began in a small way to accept blood specimens for Wasser-
mann tests and smears for diagnosis of gonorrhea. Wassermann
tests were necessarily limited to specimens collected from charity pa-
tients. Since that time several efforts have been made to secure the
passage of an ordinance requiring the reporting of venereal diseases
to the health department. These efforts have not been successful.
At the present time no venereal clinics are being operated by the
health department, although specimens of blood for laboratory tests
are being collected daily at the Iroquois Hospital.
In presenting the subject-matter under consideration, we purpose
to follow in outline the recommendations of the American Public
Health Association, originally published in 19 131 and to show wherein
the existing facilities correspond with or fall short of fulfilment of
those recommendations. The recommendations, addressed to the
state, provincial, and municipal governments, are: —
1. To insure a system of confidential notification of those diseases to a sani-
tary authority;
2. To conduct a systematic educational campaign for the limitation of the
spread of these diseases; and
3. To make proper provision for the diagnosis and treatment of all cases
of syphilis and gonococcus infection not otherwise provided for.
(1) At the present time, as stated above, venereal diseases are not
required by ordinance to be reported to the Department of Health.
A considerable number of confidential reports of venereal cases, how-
ever, are now being received by the health department in connection
with laboratory specimens. The number during the year 1915 was
1951, of which 1604 were received in connection with Wassermann
tests, and 347 with gonorrheal specimens.
(2) While the health department has always endeavored to do some
educational work in regard to the prevention of venereal disease, the
Morals Commission, which is intimately connected with the health
department through budget provision and otherwise, constitutes the
chief agency through which publicity relative to the fundamental con-
ditions underlying the spread of venereal disease has been secured.
This commission, which was established by ordinance of November
30, 1914, has been the means of collecting and disseminating through
its published reports and recommendations to the mayor and city
council much valuable fundamental data.
(3) On May 27, 1911, the health department laboratory first began
to accept specimens for Wassermann test. For various reasons it has
1 American Journal of Public Health, vol. 3, No. 10.
358 SOCIAL HYGIENE
been necessary to confine such work strictly to the service of charity
patients. This branch of the service has grown materially. During
the year 1915, among a total of 221,433 various examinations, the
laboratory made 1604 Wassermann tests, 3 gonorrheal complement
fixation tests, and 347 examinations of pus for gonorrhea. Experi-
ence has shown, however, that although the laboratory possesses suit-
able space and equipment for such work, it must materially increase
its force of bacteriologists and assistants before unlimited free sero-
logical service can be offered.
For the treatment of venereal cases not otherwise able to secure
treatment, there are no clinic facilities owned and operated by the
municipality. Such facilities, however, are provided by the general
clinics of the various medical schools in Chicago, a discussion of which
is included in the program of the evening.
The chairman of the meeting next presented Dr. Oliver S.
Ormsby, professor of dermatology at Rush Medical College. Dr.
Ormsby spoke as follows, regarding "The Treatment of Syphilis
in the Dermatological Department of the Central Free Dis-
pensary," which dispensary is affiliated with Rush Medical
College :—
The older methods employed made the treatment of syphilis a com-
paratively simple matter. In most clinics, hospitals, and dispensaries,
mercury was the drug chiefly employed, and this was administered by
mouth, by inunction, or by injection. When either of the first two
methods was used, the patient could carry out the treatment unaided.
Injections, however, had to be administered at the clinic and required
some additional time of the physician. The other agents, chief of
which was potassium iodid, were also taken by the patient, and there-
fore required no special effort on the part of the attending physician.
Now the matter is different. It has recently been found that by the
older methods of treatment a large number of patients never recover,
and that the treatment therefore is far from efficient. The treatment
now being employed by most European clinics, hospitals, and physi-
cians, and by most physicians in this country and a few clinics, requires
much more equipment, more time, more workers, and much more
money, but its efficiency seems to warrant the extra effort.
At the dispensary, the dermatological department has fitted up a
room for administering salvarsan and equipped it with the necessary
WHAT IS CHICAGO DOING? 359
apparatus for the work, together with apparatus for the demonstration
of spirocheta pallida, the causative organism of syphilis ; and has also
equipped a laboratory for making Wassermann tests. It has employed
a special worker to make these tests and assist in administering sal-
varsan. In a disease having latent periods, such as are presented in
syphilis, treatment is necessarily controlled to some extent by blood
and spinal-fluid tests. It is therefore necessary for successful work to
have facilities for making these tests.
The department has in the past had some service from the social
service department, and, beginning January 1, 1917, will have a
social service worker devoting her entire time to this work.
From April until December 12, 1916, 823 salvarsan and 635 mer-
curial injections were given to 182 patients suffering from syphilis,
and 1213 Wassermann tests were made. The treatment is given in
courses, five salvarsan injections and from twelve to twenty mercurial
injections constituting a course, with the entire work controlled by
Wassermann tests. The amount of treatment and the technique in
each case depend upon whether the case is abortive, early active, late,
latent, or nervous.
By this method, the patients are kept under better control than
formerly, are given a much better chance to recover, and their
relatives and associates are better protected from accidental infection.
The patients at the dispensary get practically the same treatment as
private patients do who are able to pay and do pay large fees for the
work. From the standpoint of public health, something is being ac-
complished by clearing up the infectious cases soon, thus preventing
the spread of the disease. By having a social service worker keep in
touch with the families in which a case exists, the patient is less likely
to neglect treatment, and other members of the family are protected
through proper instruction, and associated cases are urged to take
treatment. As a further aid, the social service worker ascertains
whether the people are entitled to dispensary treatment. Not infre-
quently a child is brought in who has been accidentally infected, and
on investigation other members of the family are found to be suffering
with the disorder and are instructed to take proper treatment.
It is a well-known fact that patients of the dispensary class are apt
to neglect treatment as soon as symptoms have disappeared, and in
these cases serious consequences may follow. When treatment is
carried out as outlined in this paper, most patients recognize its im-
portance and lend their cooperation.
360 SOCIAL HYGIENE
Dr. B. Newton Novy, of the genito-urinary department of
Northwestern University Medical School, made the following
statement regarding the "Free Dispensaries and Clinics in
Chicago:" —
We have in Chicago free dispensaries and clinics in connection with
six colleges, three post-graduate schools, and one marine hospital.
There is also one free private dispensary. All but one (and that has
very little genito-urinary work) are supported by the schools and
students and are run for the benefit of the students. There is no mu-
nicipal dispensary. At these various dispensaries were treated during
1916, approximately 8000 cases of gonorrhea and syphilis, old and
new. All the dispensaries have morning or afternoon hours. We
have no night dispensaries. All are situated in the school and hos-
pital districts on the west side and south side. There are no dispen-
saries on the north side, northwest side, nor southwest side. At least
four of the dispensaries have laboratories, where diagnostic and Was-
sermann work is done free.
Most of the dispensaries are fairly well equipped with instruments
and material, but we can only do so much and no more, in the first
place on account of the character of the patients. The chronic cases
or the chronic disease carriers come to the dispensary when they have
an acute attack, with pain or discomfort or with an acute exacerbation
of a chronic attack. They stay with us until the acute or painful
stage passes and then voluntarily leave, uncured. The unemployed
come to the dispensaries because they are out of work and have no
money. They stay with us one to three weeks, or until they get em-
ployment, and then, on account of working all day, they are unable
to return for treatment and they remain uncured. So that I can
truthfully say that not more than ten to fifteen per cent of the cases
treated by us are discharged cured. Secondly, we have no social service,
no follow-up system, and no hospitals connected with the dispensaries,
so that no matter how hard we work, no matter how great the doctors,
we are limited.
There is only one hospital in Chicago that receives these cases,
and this one will not take them in free. They charge about $10 a
week for a room, and as most of the patients can not pay that much,
they must go without hospital treatment, mingle with others, spread-
ing disease until they become grave surgical cases or develop some form
of insanity, and then become public charges.
WHAT IS CHICAGO DOING? 361
In the open discussion following the formal addresses, a num-
ber of physicians, nurses, and social workers participated. A
few of the points made by these speakers may be profitably
quoted here.
"I have seen in one dispensary," said Dr. Lewis W. Bremerman, "an
absolute inadequacy of equipment to such an extent that patients would
not return for further treatment. They knew that they were not re-
ceiving proper treatment in their cases. If this is the case in one, is it
not likely that other dispensaries are run in the same manner?"
"In the treatment of these diseases, the great disadvantage is that
we have not cured the patients who have come to us for treatment,"
said Mr. John E. Ransom, superintendent of the Central Free Dispen-
sary. "I have gone over the records of our institution for 1914-15,
with reference to cases of syphilis and gonorrhea. The number of
patients who made visits enough to be cured was very small indeed.
Keep them under treatment until treatment is completed — that is
the problem of the medical institution. It may not be the doctors'
problem in such an institution, but it is the problem of the adminis-
tration; and in so far as it fails to keep its patients under treatment
until treatment is completed, it is failing as a medical institution."
Dr. Anna E. Blount said: "We never accomplished anything
in the tuberculosis campaign until we finally found that the cause of
tuberculosis was the intrenched ignorance of mankind. We have
the same lesson to learn about venereal diseases."
"One of the things that has been suggested, and which seems to
be an excellent idea, is to make a survey as to what is really being
done for the venereally diseased," said Dr. Rachelle S. Yarros. "When
we realize the large number of cases of venereal diseases in Chicago,
we will see how little is being done for our venereally diseased. If we
are going to treat these cases, we ought to have proper provision for
treatment. As an illustration is the splendid work done at the Brook-
lyn Hospital Dispensary. I think all other cities ought to copy this
institution. We all agree that venereal clinics ought to be first-class
clinics, because these people need first-class treatment."
Mr. Samuel P. Thrasher, in speaking of the work of the Committee
of Fifteen, pressed much into the following sentence: "If for no other
reason than that of public health, prostitution should be suppressed."
362 SOCIAL HYGIENE
Dr. Arthur William Stillians, associate professor of dermatology
and syphilis, Chicago College of Medicine and Surgery, de-
scribed the work of the evening pay clinic of the Lincoln Dispen-
sary : —
In attempting to follow up and help the patients discharged from
the women's ward of the skin and venereal service of Cook County
Hospital, Mrs. E. S. Rydstrom, our excellent social worker, soon felt
that her efforts to keep these unfortunates under treatment after she
had found positions for them were balked by the lack of opportunity
to obtain treatment in the evening. To fill this need our clinic was
organized, at the request of Mrs. Ira Couch Wood, president of the
Illinois Training School for Nurses, under whose direction the social
service at the Cook County Hospital is maintained.
We have attempted to follow along the lines of the evening clinics
conducted by the Boston Dispensary2 and the Brooklyn Hospital
Dispensary,3 and are indebted to Mr. Davis and Dr. Thomson not only
for the valuable instruction obtained from their writings, but for very
cordial letters of encouragement. Our clinic began June 29, 1916, and
for the first three months was held only once a week. Since October
it has been open twice a week, on Tuesday and Thursday evenings from
seven to nine o'clock. During our first six months we have treated in
the dermatological clinic 54 cases, making 279 visits, an average of 7.6
per evening, and have administered 91 doses of neosalvarsan, salvar-
san, arseno-benzol, or diarsenol. Of our first 25 cases, 17 have been
regular in attendance and have had negative Wassermann reactions
for some time.
The genito-urinary clinic has been in operation since October 4,
under Dr. G. A. Remington, and has treated 13 cases, who have
made 48 visits. Owing to the fact that our progress, so far, has been
largely in the line of organization, and that we have done no adver-
tising, these figures, which seem pitifully small compared to the great
field of usefulness which we believe to be open to such undertakings,
are not very impressive. But we have aimed at thoroughness rather
than a large clientele, and have found that the number of patients
that we are able to treat well in an evening is not very large.
2 Davis, Michael M., Evening clinics for venereal disease. SOCIAL HYGIENE,
1915, vol. i, No. 3.
3 Thomson, Alec Nicol, The genito-urinary department of the Brooklyn
Hospital Dispensary. Ibid., vol. ii, No. 1.
WHAT IS CHICAGO DOING? 363
At the beginning a charge of $1 was made for consultation and
medicine, but we have concluded that a fee of 50 cents for consultation
and an extra charge for medicine is fairer to the patient and to the
clinic. The Wassermann reaction costs $1. Most of the other lab-
oratory work is free. Medicines cost a little more than the wholesale
cost of the drugs, and for injections of salvarsan we charge $1 more
than the wholesale cost of the drug. Thus the whole expense to the
patient is seldom more, often less, than the cost of his medicine at
retail, as Davis4 has pointed out.
We expect to do a little charity. At first we did much more than
necessary, owing to a poor system of collecting. The real need for
charity among patients who can not attend the day clinics is, of course,
small.
Financially we have come out about even, paying our expenses ex-
cept the rent, light, and heat, and the salaries of nurse, druggist, and,
clerk, all paid by the Lincoln Dispensary in connection with its other
clinics. At first the attending physicians made no charge, until things
were under way. Since October they have been paid a small fee for
their services. So far we have been under no expense for social work.
Mrs. Rydstrom has donated her services for the benefit of her patients,
and too much can not be said in praise of her tactful management of
what is probably the most difficult of all classes to handle. We gladly
take this opportunity to thank her for her untiring efforts in behalf
of the clinic.
Advertising we have attempted only recently by posting cards an-
nouncing an "Evening Clinic for People of Moderate Means," in work-
rooms, restaurants, and other places frequented by the poorly paid
workers. We have not had time to see any results as yet.
Attempts to teach the patients how to live and care for themselves
as well as how to protect others from infection have been made by
means of the printed Rules of Conduct for Syphilitics, and by personal
instruction by the doctors, nurse, and social worker.
Medical teaching has been limited, owing to the character of the
work. Few patients object to the presence of a few undergraduate or
postgraduate students. There is an opportunity in such a clinic for
very valuable teaching, especially along the line of therapy.
"I believe that the establishment of more and more dispensaries
will do comparatively little to rid us of gonorrhea," said Dr. Bertha
4 Davis, Michael M. Loc. cit.
364 SOCIAL HYGIENE
Van Hoosen. "I believe that the best way would be to tell our pa-
tients with gonorrhea, that they have gonorrhea and that it is a men-
ace to their health, and that they should go to the hospital and be
treated in a very conscientious way. We have had uniform success
when we have taken the matter seriously."
Dr. Charles S. Bacon asked the question which was undoubt-
edly uppermost in the minds of the people present :—
I would like to ask Dr. Pusey to tell us whether he thinks the
agencies now existing, the dispensaries now handling this work, are
sufficient to meet the situation satisfactorily, or would it be desirable
for the municipality or the county to undertake to establish dispen-
saries and institutions for the handling of this work, just as they have
for the handling of the tuberculosis work?
Dr. Pusey concluded the discussion with the following vigor-
ous remarks: —
In answer to Dr. Bacon: I do think that the present hospital and
dispensary facilities are not nearly sufficient to handle this problem
completely. I do think the first step which should be taken is to
improve our present facilities.
In regard to Dr. Van Hoosen's remarks: I do not believe that any
of the men and women who have talked tonight take the venereal dis-
eases any less seriously than she does. I deny her statement that it is
necessary to put these patients in a hospital. They can for the most
part be taken care of on their feet, and we can handle the problem
practically by providing care for ambulant cases.
I always have a feeling of regret when the moral issues are raised
in these discussions on the medical aspects of the venereal diseases.
I believe in discussing the moral side of this subject, but there is also a
medical side — a sanitary side — which is worthy of discussion, and the
invariable injection of the moral questions into every discussion of the
sanitary and the medical aspects simply confuses the discussion. We
medical men understand — a fact which we apparently often are not
given credit for — that there is a moral side to the venereal diseases,
but we also understand that the subject is one which is capable of dis-
cussion as a medical and sanitary problem alone. The venereal dis-
eases are diseases. They can be handled as diseases, and unless they
are so handled we will never, in my opinion, get anywhere with them.
We can not overcome the dominating influence of the sexual appetite
WHAT IS CHICAGO DOING? 365
as a factor in this subject. Education, religion, conscience, honor,
fear, will influence a part of the community, but they will not hold the
submerged tenth, to say nothing of their slight restraining influence
upon a large part of the other nine-tenths. If I am convinced of any-
thing, it is that to handle the venereal problem we must tackle it as a
physical problem. I am ready to support all measures for the better-
ment of mankind, and for the improvement of his moral status, but I
am not willing to lose sight of the fact that the venereal diseases are
diseases and that, to control them, they must be handled as such.
AN APPEAL TO PHYSICIANS
In the glitter and enthusiasm, of military activity, in the gath-
ering together of young men to make an army, in the conce tra-
tion of recruits and training camps, one is apt to forget an in-
tensely human side, the purely animal nature of which is the
main deterrent from its public discussion. In all that we hear
from the battlefield, in all that we read of wounds and death,
of victory and defeat, nothing appears in the public press about
the venereal hospitals. In all the newspaper and magazine
reports which told us what a splendid sample of an army we had
sent to Mexico, not one word was said of the number of cases
of venereal infection which, in spite of all reasonable precau-
tions, ran well up into the thousands upon thousands and were
brought back from the Mexican Border to be multiplied broad-
cast throughout the land; and when this hideous fact was pre-
sented before a medical gathering in a Texas city, it was made
a subject for jest among the physicians of the audience.
Let this appeal directly to you, Doctor. Perhaps your son
will be drafted; with your knowledge of what syphilis usually,
and gonorrhea often leaves in its wake, can you laugh if your
son gets infected? Can you remain indifferent if some one
else's son infects your daughter? These are bald, crude, unvar-
nished thoughts. Have you done your part to prevent the
venereal peril in our own armies — are you cooperating in any
way with the efforts of the Council for National Defense to
prevent a great wave of venereal disease sweeping across the
country and adding its millions to the millions already diseased?
Use your influence in the community and explain to your boy
and others what paresis, locomotor ataxia, pelvic abscess,
ophthalmia, and a few dozen other trifling consequences of youth-
ful indiscretions mean. It is part of " doing your bit."
HENRY GOODWIN WEBSTER, M.D.
Long Island Medical Journal, June, 1917.
366
HOW SHALL WE TEACH
THE NORMAL SCHOOLS AND COLLEGES AND THE PROBLEM OF
SEX EDUCATION
BERTHA CHAPMAN CADY
Field Secretary for Education, The American Social Hygiene Association
Sex, with all its impulses, the desires, and aspirations which cluster
about it, is coming more and more to be recognized as one of the most
potent factors in human life. Today few question the statement
that in the life of the great majority of the people sex plays a part of
no small proportion. Charged as it is with fateful power, sex may either
broaden life, amplify thought, elevate or re-create the conduct of an
individual, or it may, if misdirected, disintegrate and destroy him.
Recognizing, then, the power for good or for evil in this natural sex
instinct, how are we preparing to direct and control it? After all, the
real question resolves itself into a matter of control and direction.
The Teacher and the Sex Problem. Every honest teacher knows
that sex morality and conduct are among the most important problems
of the school room. Practically and ideally, therefore, an education
which aims to consider every factor which has a determinative influence
upon the success with which life is or may be lived is bound to take this
vital element of sex into serious consideration. We have no hesitation
in saying we have failed thus far to do so.
The Evils Resulting from the Neglect of Sex Instruction. All our
experiences and the results of careful investigation go far to ward con-
vincing us of the evils resulting from neglect to meet the natural curi-
osity of our boys and girls in regard to their sex natures. Nor can we
longer console ourselves with the delusion that it is possible to keep
our children ignorant of sex by remaining silent ourselves. We too well
know the many vulgar sources of information open to young minds
eager to receive anything which seemingly explains the mystery which
clouds everything pertaining to sex and reproduction.
We Know the Need for This Instruction; Now Tell Us How to Impart
It. Little time need now be wasted in most communities in proving
the need for sex instruction. This is generally granted at once and the
367
368 SOCIAL HYGIENE
call is for an education which shall meet the needs — an education which
in the largest sense shall include "all scientific, ethical, social, and re-
ligious instruction and influence which directly and indirectly may help
young people prepare to solve for themselves the problems of sex that
inevitably come in some form into the life of every normal human
individual."
Who, then, shall meet such responsibility and of what shall the in-
struction consist? These are our present problems.
Who Shall the Teachers Bel Naturally, with the general confusion
both as to the method and the matter no single group of workers
has volunteered eagerly to serve. The very intimate nature of the
subject makes in itself a matter peculiarly fitted for maturity of mind,
clarity of thinking, and well-wishing — for a sympathetic personality
with tact and charm; therefore, not a subject which can ever be handled
well by everyone. Yet the acuteness of the situation makes it imper-
ative that something be done.
The Parents Not Prepared. Every one will grant immediately that
the parents are rightfully the responsible ones. It should, therefore,
be their duty and their privilege to undertake this delicate instruction.
Thus say the teacher, the doctor, the minister, the social director
delighted so easily to escape a responsibility they know not how to meet.
But this is indeed no solution at all.
No matter how great the duty of the parents may be in this matter,
it is impossible that they should alone meet the whole responsibility
and, moreover, one must admit that there is today no possible hope that
the parents as a whole can be expected to deal with the problem. They
are not prepared to handle it. nor can we reach them in any adequate
way immediately to prepare them.
The Schools Hindered by Prejudice. Turning from the parents, we
instinctively look to the great body of trained men and women in the
schools, the teachers who have in so many ways met the requirements
of a developing society for which parents are unequal.
Here again we find them unprepared. Teachers are not ready;
school administrators are not ready; and an almost insurmountable
wall of prejudice on the part of parents and the community makes it
difficult for any one to undertake the task. "Everybody admits some-
body should do something but nobody is willing that anybody should."
This is the way one leader expressed the deadlock.
The Physician too Ready to Emphasize the Pathological Side. With-
out the aid of the schools and the homes we look farther afield and we
HOW SHALL WE TEACH? 369
find the physician, who has much to contribute through his splendid
experience and his scientific training. Yet he cannot do all. Fre-
quently, too, he but makes matters worse. He has long faced the facts
of sex irregularities and disease and forgets that his hearers are less
familiar with life. In his zeal to prevent further miseries, he pictures
vividly the pathological side of the subject and terrifies unduly. This
will not do, as our healthy, happy youth do not need this abnormal
approach so much as the interpretation of the normal, natural expres-
sions of sex.
The Church Unprepared. In despair, we appeal to the church. Here
at least we should find a class of men and women accustomed to impart
great living truths, to interpret life through high ethical ideals, and to
inspire youth to nobility of body and mind and spirit. What do we
find? In most cases, the same feeling of unpreparedness for the great
task has kept the churchman silent.
The "Teachers" of the Street Corner Alone are Ready. Meanwhile
our youth are growing into maturity without any help from us in inter-
preting the real meaning of sex in their own lives or in the world about
them, while the old familiar channels of vulgarity and filth remain wide
open.
The corrupt "teachers" of the street corner and the alley feel no hes-
itancy in imparting unclean, false information, while we stand silent
and abashed in the presence of the noblest, the purest universal instinct
of sex, the impulse which has given us our deepest joys, our love for one
another, our devotion to our children, our homes and all that goes out
from them.
With these facts burning in our conscience it is impossible to refuse
to face the problem and to find some solution.
The old-time method of silence has failed dismally and we know it.
Now let us find a better way and go about it.
No One Group but All Working Together. Again turning to our in-
terpretation of what we now mean by the larger sex education, it is
readily seen that no one group of society can or should be expected to
assume full responsibility for giving instruction that covers so wide a
field. It is plainly a matter for cooperation and coordination. Sex
is not a thing apart from life, something to be dealt with by and for itself.
It is rather of and included in all that makes lif e worth while and there-
fore must be treated as an integral part of existence. Neither is there
any one period of our development when we can give all the sex infor-
mation that shall ever be needed. This education is a gradual growth
370 SOCIAL HYGIENE
«t
from the earliest years of childhood to old age. We can no more get
through with our sex education than we can any other kind of education.
They go on both together to the end, and all members of a community
must take a share in the training.
The Teacher's Part. Certain elements, certain basic truths can be
systematically, scientifically taught in the schools. This phase of the
subject will satisfy and answer the demands of the school leaders who
insist that all its material shall be standardized and become a part of
a more or less fixed "course of study." The atmosphere of the school
in general is agreeable to this kind of information which naturally fits
in with various well-established " courses" already available.
The Parents' Part. The more intimate and therefore the more effec-
tive part of the teaching rightfully belongs to the parent if that parent
be in any way qualified to interpret sex and exact the necessary disci-
pline. The community should be satisfied if with more or less informal
talks the parent gains the child's complete confidence and through this
frankness and intimacy gives the youth a grasp of the meaning of sex
and a determination not to be found wanting in the conduct of life.
Naturally where parents are unequal to this task, it must always
be assumed by a personal advisor provided by the school or the com-
munity.
The Minister's Part. For the great ethical and religious interpreta-
tion and inspiration, we have the right to turn to the church for help.
So it is with all our scientific, our social or special groups — each has a
part to play either as an individual or as a community unit and each
is ready to undertake that part when shown how best it can be done.
This is the pressing need today — a concrete, well-defined program.
The Need of a Critical Examination of the Possibilities of Sex In-
struction. Nothing should be done, however, toward formulating a
definite, concrete program of work until a careful study of the various
experiments throughout our schools has been made.
Individual Teachers Have Met with Success in Giving Sex Instruction.
The truth is that there has not been a recent critical examination of
the possibilities of sex instruction in our schools or in other organized
groups. We do not know, except by assumption, what the schools, for
example, as a whole can and what they cannot do. There have been
here and there notable achievements with good and far-reaching re-
sults. But for the most part these successes are unknown to the great
body of teachers, for their success depends very largely on this method
of avoiding notoriety. Wherever the work becomes known two in-
HOW SHALL WE TEACH? 371
ferences are generally drawn from the results. They are regarded as
models to be followed, achievements to be emulated, or they are re-
garded as impractical because they are exceptional. It is assumed
that because they are conspicuously the product of especially interested
and qualified persons, it would be hopeless to expect that such per-
sons would be elsewhere available as needed. The general conclusion,
therefore, is one of discouragement and a sense of inability to deal with
the situtation.
It would seem that what is now most needed is an intensive, compara-
tive study of the sex education going on in the country, attempting to
discover of what it consists, how it is offered, what are its tendencies
and results.
With this plan in mind, the American Social Hygiene Association
has undertaken to make a preliminary study of the actual work being
done in the normal schools and colleges of the country, giving special
attention to those institutions which have achieved at least some measure
of success.
What the Normal Schools and Colleges are Doing. The normal schools
have been chosen as the natural sources of our future teachers who shall
deal with the problem in the schoolroom. Bringing together such avail-
able data is bound to be helpful to all those teachers and leaders who
realizing the need for the instruction yet hesitate to undertake it without
more adequate information as to matter and methods. In the hope
of testing the conditions prevailing in these institutions throughout the
country, such questions as the following have been submitted : —
Are you giving any sex instruction in your normal school or college?
If so, are you introducing it through a special course in "sex instruction"
or are you coordinating it with biology, physiology and hygiene, physi-
cal education, history and community civics, home economics, ethics,
morals, literature, psychology, etc., using your own faculty and the
regular well-established courses? Or are you using special lectures
provided by the Young Women's Christian Association or the Young
Men's Christian Association, members of the medical profession, or
especially fitted members of your own staff?
Where an institution is not giving the subject any attention, an effort
is made to discover what is the reason for the neglect. Is it because
there is a general feeling on the part of the president of the institution
that the subject is unsuited to the school course, or is there a general
unwillingness to undertake it on the part of the faculty, the students,
the members of the community or the parents?
372 SOCIAL HYGIENE
It will be of distinct value can we know what is coming to be regarded
as a satisfactory body of instruction; not however, with the expectation
of reducing it to systematic form, but rather as desirable objects of
achievement or ends to be realized wherever possible.
Having Discovered What is Being Done We Can Form a Program for
the Future. Out of this body of information, we should perhaps come
to know the possibilities of adapting it to the local school system, the
community environment, the teaching subject about which or in con-
nection with which the instruction is to be given, the temperament and
predilections of the leader, the age, sex and type of pupil best handled
by any one method. We should perhaps come to know what can and
what cannot be done through class instruction and when and how the
personal work, if any, is to be given. Also it should give us an under-
standing of what can be done through the cooperation of parents and
teachers.
With such a fund of information once in our hands, it should be easy,
with the aid of experienced teachers, to take a first step at least in pro-
viding a more or less concrete program for sex education in the primary,
secondary, and high schools, and the colleges.
THE RESPONSIBILITY OF THE DEAN OF WOMEN FOR SEX
INSTRUCTION
LOUISE FARGO BROWN
Dean of Women, University of Nevada
What should be the attitude of the dean of women toward sex edu-
cation? Dean Lois K. Mathews, in her handbook1 wherein is pic-
tured the ideal dean of women, is dumb on this important subject.
Nor has it, so far as I know, figured on the programs of those confer-
ences of deans of women the results of which Dean Mathews so admir-
ably summarizes. And yet is it a subject that the dean of women has
any more right to neglect than the subject of vocational guidance,
living conditions, or social relations? Doubtless no deans of women do
neglect it; certainly, however, there is a great diversity in their solu-
tion of its problems, and some consideration of these problems may be
not untimely.
The dean of women, if she is qualified for her position, has a wide and
intimate knowledge of girls. She knows how the present generation of
1 The Dean of Women. Lois K. Mathews. Boston : Houghton Mifflin Co., 1915.
HOW SHALL WE TEACH? 373
young women, with few exceptions, grew up; that as children they
early discovered that on the subject of the origins of life, interesting
in connection with a new family of kittens or puppies, the mother,
elsewhere so dependable, was not to be relied upon. She knows that
they early came to realize that this was a subject somehow taboo with
all except their playmates, who knew as little as themselves, or older
girls, who secretly and mysteriously imparted bits of information.
She knows that this information was incomplete and usually incorrect,
and often so slimed over with nastiness that some of these girls will
all their lives be unable to regard as clean and wholesome the funda-
mental biological facts of human existence. She knows that by the
time they entered college most of them had probably acquired, in-
directly and furtively, and with an expenditure of time and energy
that might have been much better directed, some knowledge of the
facts of reproduction. She knows that it would be impossible that
curiosity should not have been awakened, in a day when the picture
show, the theater, the books and magazines on the family table, are
frankly bringing to her attention subjects which for the young girl's
benefit were carefully excluded from print in English-speaking coun-
tries until the past few years. She knows that they spend a great
deal of time discussing these topics, with eager interest and curiosity
that is for the most part not in the least unclean or morbid, but is too
intent because of their ignorance and because, through always having
been associated with an atmosphere of mystery, the subject has been
given undue importance.
Perhaps the reading room in the hall of residence is supplied with one
of those well-meaning little books which have recently been produced
in such numbers, that permit the conscientious elder to salve her
conscience and yet avoid embarrassment by giving the girl in print
the information that she ought to have. In that case the dean of
women, entering unexpectedly, has probably seen a student hurriedly
conceal the book, or slip it back on the shelves, ashamed of having been
discovered showing curiosity that she has been brought up to believe
is unbecoming. In a college where every freshman girl was required
to read one of these books and hand in an account of her impressions,
very interesting results were obtained. It was evident from these
accounts that many of these young women had gained information
that was entirely new, many said that incorrect ideas had been cor-
rected, and that if they had obtained information on matters of sex
earlier and in a similar way they would have been spared a great deal
374 SOCIAL HYGIENE
of perplexity and unhappiness. When we consider that there is a
tendency among young women to pretend to greater knowledge in this
regard than they actually possess, it is safe to assume that the number
of girls to whom the book brought enlightenment was even greater
than their papers indicated.
What are our colleges and normal schools doing to dispel this ig-
norance, before they send girls out to become wives and mothers or
to have in their charge class-rooms full of children? Or have they
any responsibility in the matter? One thing that strongly differen-
tiates discussions of sex education today from discussions of the same
subject ten years ago is the decided strengthening of the opinion that
the teaching of sex hygiene as a separate subject either in schools or
colleges is at best a pis otter; that the different aspects of the subject
should be treated fully and clearly in courses in biology, ethics, psy-
chology, and sociology, and that it is above all desirable that the
foundations of knowledge should be laid in early youth. This last
position is largely due, undoubtedly, to the researches of psychiatrists
and psychologists, who are showing the tremendous importance for
later life of childish impressions and of habits formed in early years.
The doubts of people who have feared that, because of the great im-
pressionability of childhood, information on matters of sex might make
the child morbid, ought to be dispelled by a realization of the fact
that it is only when curiosity is not satisfied that any subject which
comes into the child's mind is brooded over; that the child's curiosity
as to where the kittens come from is casual, and that the subject loses
interest if his mother gives him an answer which is reasonable and not
open to challenge by another child. It is at a much later period that
the child's questions become more searching, and if the mother has
not lost his confidence by answering him with lies or evasions, he turns
to her then with his questions about paternity. It is surely desirable
that it be to his mother or father, and not to some other boy, that
he turns. But whence is to come the generation of parents enlight-
ened enough to perceive the obligation to answer the child's questions
truthfully; well-informed and wise enough to answer them in the best
way? Today we have thousands of educated mothers and fathers
struggling conscientiously with this problem and solving it with vary-
ing degrees of success, and hundreds of thousands, educated and un-
educated, telling the old lies, either upon the old grounds, or because
they do not feel competent to select the best method of approach.
And in the schools we have teachers who must deal with the results of
HOW SHALL WE TEACH? 375
parents' reticence, and who will have this problem for an indeterminate
time, as it will be slow work making way against the ignorance, preju-
dice, and inhibitions of parents. Whether in cities or in rural com-
munities, whether in expensive private schools or in the public school '
of the tenements, whether in primary schools or in high schools, the
teacher has the problems of smuttiness, of masturbation, of perversion
in her classroom. If she is ignorant, habits are being formed before
her very eyes which will vitally affect the lives of her students; if she
is half-informed, by some magazine article or other on the prevalence
of vice among school children and its symptoms, she is unduly suspi-
cious, and her Well-meaning efforts perhaps do more harm than good.
If she has been wisely taught, she may be able, especially if she be a
primary teacher, to check bad habits in their inception, and do more
for the abolition of the social evil by helping in the formation of a
generation of clean-minded and clean-living men and women, than any
amount of publicity given to the prevalence of venereal disease can
ever hope to do.
What is the present policy in colleges and normal schools in this re-
gard? Although in a surprisingly large number the conspiracy of
silence still reigns, many have adopted a definite policy. The path
of least resistance is the one already referred to: the use of books or
pamphlets, with or without attention to their being read. The state-
ments of students provide the criticism of this method. A very large
number showed that the girl had been shocked, or that a disagreeable
impression had been produced which made the whole subject un-
pleasant. Although many of the books and pamphlets dealing with
the subject are admirable, and may with the utmost profit be read by
parents and teachers as suggestions for method, it is to be doubted
whether any book is satisfactory to put into the hands of young people,
simply for the reason that where the information is given orally the
speaker can gauge the mood of his hearers, and adapt his tone to it,
seeing, as it were, the approach of the unpleasant impression and dis-
pelling it before it is fairly established, while the tone of the book
is the same to all and unalterable, and upon a reader whose inhibitions
are especially strong, or whose associations with sex matters are already
unpleasant, it is likely to leave an unpleasant impression.
The idea of one college president was that the dean of women
should talk with each girl individually at the time when she needed
the information. The practical difficulties here are so obvious that
discussion is unnecessary. It is worth noting, however, that the
376 SOCIAL HYGIENE
conclusions of this college president were based upon the undesirable
reaction produced in the college by a series of talks by a well-known
lecturer on sex hygiene. This seemed to him to prove that such lec-
tures to a group of young people, far from being desirable, were actually
mischievous.
This brings us to the most general method of sex education in col-
leges: the lecture. Such lectures are usually given as a part of a
course of lectures on personal hygiene, by the physical director, the
college physician, the dean of women, or some speaker brought from
outside the college. Attendance is sometimes voluntary, some-
times required of all students, sometimes expressly limited to upper-
classmen or to seniors. Should it not be the freshmen rather than
the seniors? A study of the effects produced leads to the conclusion,
fairly obvious in any case, that the usefulness of such lectures depends
entirely upon the personality and equipment of the lecturer. There
are lecturers on sex hygiene who speak with a sort of unction which
makes their lectures actually harmful. There are the lecturers who
by sentimentality, or by the curious juxtaposition of sex and religion,
produce inevitably a sense of distaste in the healthy minds of young
people, which they cannot analyze, but which to them makes the
subject unpleasant, when the trouble is with its presentation. Re-
flections on the shortcomings of the majority of lecturers result in defi-
nite conclusions. To be absolutely successful, a lecturer on sex hy-
giene should be either a trained biologist or a physiciaa, so that she
can speak authoritatively and at the same time be as free from self-
consciousness as if she were describing the alimentary canal. It is
very desirable that she be a married woman, who has borne children,
though it would be a mistake to state this as an essential qualifica-
tion. But above all things she must be a woman of absolutely nor-
mal, vigorous, and confidence-inspiring personality.
There is one woman who combines these qualities, and who has
worked out what the writer believes to be the ideal method of sex
education : a method which gives sex its proper place in the life of the
individual and of society. The young women who have listened to
her lectures have been shown the absolute Tightness of sex, its tre-
mendous powers for good when understood, its tremendous powers for
evil when abused.2
Yet even when ideally conducted, the lecture method is open to the
2 Dr. Mabel Ulrich.
HOW SHALL WE TEACH? 377
criticism that it gives the subject undue prominence by segregating it;
that for a week or a month the mind of the college community is fixed
on a topic which ought to be an integral part qf the subject-matter
of courses in half a dozen departments. In many colleges the depart-
ment of biology sees to it that the biological facts of reproduction are
well understood by the students. By the department of sociology em-
phasis is laid upon the family, and upon the great social problems of
today. The department of philosophy considers ethical problems. The
department of psychology considers phases of normal and abnormal
psychology which involve the psychology of sex. Few students take all
of these courses; seldom is there an attempt to correlate the instruc-
tion given in the different departments. Could there be a more in-
teresting or worth-while problem for a dean of women than to awaken
interest among the different members of her faculty and work out
with them a system of cooperation which would produce an ideal method
of sex education?
The writer, whose experience in the field is limited, is doubtless by
this query showing unpardonable ignorance of what has been done and
is being done by deans of women along these lines; she writes these
words in the hope that they may evoke publicity for any scheme that
has been already evolved and practiced with success.
BOOK REVIEWS
PHYSIOLOGY, FIRST AID AND NAVAL HYGIENE. A text book for the
Department of Naval Hygiene and Physiology at the U. S. Naval
Academy, Annapolis, Maryland. By Dr. R. G. Heiner, U. S. Navy.
Annapolis: U. S. Naval Institute, 1916. 139 p. $1.00:
This textbook is designed for use in the United States Naval Acad-
emy. Its general scope is indicated by the author's prefatory state-
ment:—
. . . . "A knowledge of the rudiments of hygiene, physiology
and first-aid is necessary to every naval officer. Sooner or later each
one of them is likely to find himself in charge of a small detachment of
men at some isolated station where there is no doctor, and it will de-
volve upon him to make the necessary arrangements for the preserva-
tion of the health of his men, to treat their injuries and diseases, and
see that their efficiency is not undermined by sickness. In order that
he may do this intelligently it is necessary for him to know something
about the structure and workings of the human body." ....
Its interest for the social hygiene worker lies in the chapter on
venereal diseases which presents the subject so effectively that it is
quoted in full.
"Venereal diseases are diseases that are transmitted during sexual
contact.
"It is possible to contract them under other conditions, but not
probable.
"Their spread is caused by promiscuous sexual intercourse, and with-
out this they would die out and disappear. If all the people of this
earth were to remain virtuous for one or two generations it is probable
that venereal diseases would be stamped out for good. The germ would
die, and it would take more than a thousand years of filthy and immoral
living to develop a new species.
"Venereal diseases are a legacy handed down by our forefathers, and
have probably taken many centuries to develop to their present state
of virulency, centuries of immoral living, due, perhaps, to ignorance;
let us hope so at any rate, and that we of this enlightened age will,
378
BOOK REVIEWS 379
knowing the cause and the method of prevention, stamp out this great-
est of all plagues.
"Just what are venereal diseases? There are three of them, each
due to its specific germ. These germs, or microbes, or bugs as they are
commonly called, are like the germs of diphtheria or smallpox. They
are living organisms, which multiply as a flea on a dog or a cow, al-
ways producing their own species; in other words, if you come in con-
tact with one of the three of these venereal diseases you will contract
that particular one, and it will be the one you will transmit to another
person should that person be so unfortunate as to come in close contact
with you.
"These diseases through ignorance, not so much ignorance of their
presence as ignorance of their terrible effects, have been transmitted
from person to person until there is probably not a spot on the earth
where large numbers of human beings live that they do not exist.
"It is impossible for you to go anywhere and pick out a woman
who will have illegitimate intercourse and not run a great risk of be-
coming infected. No matter how angelic she may appear, she is a
dangerous proposition if she will let you have sexual intercourse with-
out marriage.
"Prostitutes are women who practice illegitimate intercourse as a
means of livelihood. They often have themselves examined by a doc-
tor, who gives them a certificate stating that they are free from venereal
contagion. Few reputable physicians will give this certificate, as it is
almost impossible to be sure that a woman of this kind is free from dis-
ease. This even after a most thorough examination, and it is possible
for a woman to become infected a few hours afterwards. Prophylac-
tic treatment taken after intercourse has saved many a man from a
life of misery, but it can not be relied on as a sure method. There is no
sure method.
"Is sexual intercourse necessary for health and for proper manly de-
velopment? Positively no. Improper sexual intercouse gains nothing
for those who participate and causes loss of self-respect.
"If a man with malice aforethought, or while under the influence of
liquor, enters a disreputable place and comes in close contact with its
inmates or surroundings, he will come away with many misgivings;
for he realizes that there are numerous chances against him. If he es-
capes contracting one of the three venereal diseases, there are still the
dozen and one infections of ordinary diseases, which are most likely
to lurk in filthy places of this kind, to say nothing of bedbugs and
certain kinds of body lice which he may carry home.
380 SOCIAL HYGIENE
"The sexual organs come under the class of those organs which func-
tionate periodically and have a certain time in life for functionating:
as, for instance, the thymus gland, which is active in children and dis-
appears before puberty. The secretions of the sexual organs, when not
expelled, are absorbed back into the system, and are supposed to accen-
tuate the distinctive qualities of the male sex.
"A knowledge of the three forms of sexual diseases further than
before stated may be of help to impress their danger upon you. Their
names are: Syphilis, Gonorrhoea, and Chancroid. All other names
you have heard are complications of these three, as bubo, etc.
"Syphilis. The most damaging of the venereal diseases is caused
by the spirocheta pallida, which first attacks the skin in the region
where it comes in contact with it and causes a local sore. From this
the germ enters the blood and is carried all over the body. The blood
and discharges from sores, mouth, nose, and all parts of the body are
infectious in a person who has syphilis, and they may remain so for
many years.
" '606', a new remedy, has made some wonderful cures, but it is by
no means effective in all cases. Mercury is still used for its treatment.
The usual curative process requires a few painful injections of '606,'
followed by a course of more painful injections of some salt of mercury
covering a period of three years. An old saying is, 'One night with
Venus and three years with Mercury.'
"Gonorrhoea, caused by the gonococcus of Neisser, is a filthy disease
with its profuse discharge of pus from the urethra. It is primarily
local, but may spread by the blood and cause infection of various joints,
and even of the lining membrane of the heart, which latter is quite a
serious affection. It may be carried to the eyes, by carelessness, or
failing to destroy all dressings; wiping parts with a face towel and
using the same afterwards for face, or allowing it to lie around where
someone else may use it; failing to wash and disinfect the hands after
dressing diseased member. Gonorrheal ophthalmia has caused many
cases of total blindness.
"Chancroid is a local disease. It appears in the form of a dirty
ulcer and may cause extensive destruction of parts.
"Syphilis and gonorrhoea are not easily cured; both may leave a
man damaged, and both may break out again after being apparently
cured. Both may infect an innocent wife, and both may produce
damaging effects in the offspring. Many a woman has suffered from
the miseries of syphilis, through no fault of her own, and many a woman
BOOK REVIEWS 381
has gone to the operating table to have her sexual organs removed on
account of the ravages of a gonorrheal infection. Syphilis in a parent
often results in deformity and idiocy in the child.
"In the navy, on account of the menace a man with venereal disease
is to his shipmates, it is necessary for the medical officers to know about
and control all venereal cases. Therefore severe punishment is meted
out to those who attempt to conceal a venereal case.
"The cultivation of pure thoughts and avoidance of temptation, cold
baths, simple non-stimulating diet, vigorous physical exercise, and al-
coholic abstinence will prove efficacious in overcoming desire."
(NOTE. — This article is an exact reproduction of Chapter V. of Physiology,
First Aid and Naval Hygiene, by Dr. R. G. Heiner, U. S. Navy, published and
copyrighted by the United States Naval Institute, Annapolis, Maryland.)
DOWNWARD PATHS: AN INQUIRY INTO THE CAUSES WHICH CONTRIBUTE
TO THE MAKING OF THE PROSTITUTE, with a Foreword by A.
Maude Royden. London: G. Bell & Sons, 1916. 200 p. 50
cents.
This book was written by a group of women who desire that their
knowledge of why girls sell their sex function should precede any course
of public action regarding the consequences of such bargaining. The
nformation is set forth in nine brief chapters, the first of which ex-
plains how the data were gathered from rescue homes, from reports
upon feeble-minded girls, and from the stories of women in the West
End resorts of London. The reader is warned that these 830 cases do
not adequately cover all types of immoral women, but they indicate
why many become prostitutes.
Bad home conditions were found in a large proportion of the cases.
In some instances indecent overcrowding and immoral example re-
sulted in precocious sex experience. Desire for amusement, dress, or
social position, stimulated by bad associates, lures many girls to seek
gratification in the easiest way. The aberration of others is explained
by lack of home ties, dreary lodgings, and sheer loneliness.
Seduction may result in professional immorality when the woman's
character is shaken by the emotional shock, or when men seek to prey
upon her frailty. Compulsion and exploitation by force seem to be
less important than is generally believed, because weakness and stu-
pidity frequently make the girl a willing though misguided victim.
Lack of companionship and economic stress are important reasons for
the lapses of married women and widows.
382 SOCIAL HYGIENE
Feeble-minded girls readily become prostitutes because of their un-
governed impulses and stupid docility. Since they are poor workers,
they readily fall into the ways of the street. There is a large percent-
age of such low-grade women in institutions, but it must not therefore
be assumed that the proportion of mental deficiency is so great among
their more clever sisters.
The effects of general economic conditions are emphasized in the last
chapter. We are told that a girl's wage may not measure the depth
of her poverty, nor her occupation indicate the difficulties of decent
living. Irregular employment in seasonal trades, improper quarters
among servants, and loose associates among actresses, are examples of
working conditions that weaken a girl's moral fibre.
In conclusion, the authors state that many of the factors that go to
make the prostitute are definitely remediable. They therefore urge
reforms in housing, education, industry, recreation, and political life,
that women may emerge from the conditions that suppress them and
lead to commercialized vice with its train of misery and disease.
H. B. W.
SELF MEASUREMENT. By William DeWitt Hyde. New York:
Huebsch, 1912. 74 p. $.50.
MARRIAGE AND DIVORCE. By John Haynes Holmes. New York:
Huebsch, 1913. 63 p. $.50.
FRIENDSHIP, LOVE AND MARRIAGE. By Edward Howard Griggs.
New York: Huebsch, 1915. 74 p. $.50.
In his introduction to the Art of Life Series, to which these three
little books belong, the editor says, "The aim of this series of brief
books is to illuminate the never-to-be finished art of living." And
that we may decide how we are progressing in this "art," we find in
Self-Measurement a scale by which we may measure ourselves in the
various relations of life and so determine whether our lives have posi-
tive or negative value.
"The little world of personal relationship," says Edward H. Griggs
in Friendship, Love and Marriage, "is always the heart and soul of the
larger world of action," and though the phases of personal relationship
are many — from that of slight acquaintanceship to those that reach into
the deepest intimacies of the spirit — the same laws govern them all,
BOOK REVIEWS 383
and only as these laws are obeyed do we find true friendship and happy
marriage.
Marriage, however, differs from friendship in that it has a biologi-
cal foundation as well as a spiritual one, and too often where this fact
has been overlooked unhappiness, broken homes, and divorce are the
result. The solution of the divorce question lies then, not so much
in increasing the divorce laws as in raising the standards of marriage,
and this will result from the regulation of personal conduct by making
the act of love the ruling passion.
That the question of divorce is a most serious one in our day can
not be denied when we realize that in this country the number of di-
vorces is seven times as great as it was forty years ago. "It is doubt-
ful," says John Haynes Holmes, "if it was ever before so thoroughly
'live' a question as it is at the present moment." He then proceeds to
study in Marriage and Divorce the various solutions that have been
offered by recent writers.
These writers he divides into Sacramentarians and Libertarians or
Individualists. The first see in marriage an indissoluble tie and
would grant divorce only in extreme cases. The Libertarians on the
other hand, looking at marriage as the union of two individuals for
their pleasure, maintain that when the relationship ceases to bring hap-
piness and joy to either it should be dissolved. With neither class
has Mr. Holmes any sympathy, for while marriage should not disregard
the rights of the individual, it is above all a social institution, and
as such must be regulated by the state.
Lik6 Mr. Griggs, he believes first of all in raising the standards of
marriage. "I hope," says he, "that some day the time will come when
a marriage license will give the same guarantee as to the fitness of the
recipients to exercise its privileges as the licenses which are now given
for the practice of medicine and law." Marriage founded on true
love and safeguarded by knowledge and training will almost invari-
ably be successful and thus the divorce problem will largely solve
itself. If, however, love and respect do not survive and the married
persons wish a divorce, the state, after giving every opportunity for
reconsideration, must grant it — but the process should be as solemn
and as dignified as the original marriage service. And no one need
fear that granting divorces under these conditions will menace the sta-
bility of the family or tend to undermine the state, for the final re-
source is love, and that "will never wholly fail."
384 SOCIAL HYGIENE
THE ADOLESCENT PERIOD; ITS FEATURES AND MANAGEMENT. By
Louis Starr. Philadelphia : P. Blakiston's Son & Co., 1915. 192 p.
$1.00.
The purpose of this book, says the author in his preface, is to furnish
an outline of the physical and psychical changes of adolescence in sim-
ple terms for the ordinary reader. The aim is a worthy one, for we
still need books that parents and teachers will read, books that will
arouse them to an intelligent study and a sympathetic understanding
of the problems of boys and girls in this critical period of life. Since
G. Stanley Hall gave us his Adolescence in 1904, teachers and parents
have been giving more attention to this subject; but their understand-
ing has not kept pace with the increasing dangers of growing boys and
girls.
Dr. Starr presents a concise, well-balanced discussion of his subject,
but it is too abstract, and lacks concrete illustration. The author
has not succeeded in avoiding technicalities as he says he has tried to
do. Such terms as "cardiac strain," " hypertrophied tonsil," "periph-
eral sexual organs," "divided personality," and "psycho-analysis,"
however common they may be to students of psychology and biology,
will tend to discourage the ordinary reader who is not familiar with
these sciences.
Some statements in the book seem dogmatic. It is interesting, for
example, to read that barometric variations or excessive wind move-
ments have a marked influence upon truancy, but nowhere does the
author refer to authority for his statement nor to investigations or
observations of his own to support it. Probably he has the evidence.
The mistake, if mistake it is, has been in withholding it. The addition
of footnote references would have increased the value of the book.
The chapters on "Menstruation" and "Sexual Enlightenment,"
comprising about one-fourth of the book, are well written. The dis-
cussion of the pathological aspects of sex shows evidence of a wide
knowledge of the subject combined with a wholesome attitude and good
common sense. The author seems not to be familiar with the exten-
sive study of Dr. M. J. Exner showing that most parents fail to instruct
their boys and that most boys acquire distorted and crude information
much earlier than their elders seem to think. It is very well to urge
upon parents their responsibility in the matter and to say to them that
"most of sexual education should be done at home." But the respon-
sibility of the school to those children whose parents are utterly unfitted
for this education should not be ignored.
BOOK REVIEWS 385
Taken as a whole, however, these chapters contain much sound and
valuable information which is much needed, and which is not found in
most books on sex education written for parents and teachers.
H. H. M.
BOY LIFE AND SELF GOVERNMENT. By George Walter Fiske. New
York: Association Press, 1916. 310 p. $1.00.
BOYOLOGY. By H. W. Gibson. New York: Association Press, 1916.
194 p. $1.00.
These two books on boy life may properly be considered together, as
in a measure they supplement each other, and seem to represent at
its highest expression the determination of the Association Press ta
provide for the growing number of students of these problems the best
kind of subject material. Their value in leaders' -classes or for parents
or teachers has already been thoroughly proven. On the other hand,
and of course their authors do not so presume, they are by no means
final or comprehensive. Each author makes frequent references to other
treatments of the theme, and Gibson's book, Boyology, offers as an ap-
pendix an extensive bibliography very important in itself.
One serious omission for a time when the Boy Scout movement is
enjoying well-deserved popularity is that these author-; have little or
nothing to say regarding it. Fiske wrote before it appeared and Gib-
son, while evidently favoring its activities, does not give it special con-
sideration. It is interesting to note however that in the Boy Scouts of
America many of the principles of self-government and development
are strongly emphasized along the very lines laid down by these writers.
In a directly constructive way Fiske defends and enlarges the theory
of the culture epochs in boy life. Announcing fundamental principles
and by-laws, he follows the boy through the successive stages which,
in the individual parallel the upward climbing progress of the race.
The boy and his instincts, the struggle for manliness, the boy's religion,
and the boy's home are fascinating chapters.
Gibson's book grows out of his personal vital relations to boys as a
big brother beloved. It is based on painstaking questionnaires and wide
experience in club room and camp. It provides a wealth of suggestive
studies of the real boy and offers to all who find him at the same time
delight and problem a multitude of hints for wise influence and help.
Of particular interest to teachers and parents are the chapters entitled
the "Language of the Fence" and "Parental Delinquency."
386 SOCIAL HYGIENE
In the first of these the author makes a plea for sex instruction in
the home as the greatest safeguard to clean thinking and clean speech
among boys. With a view to getting at the facts Mr. Gibson inter-
viewed -288 boys over fifteen years of age in forty different cities and
towns, asking them the following questions: "How old were you when
you were first told by anyone about sex matters?" "From whom did
you first receive such information?" "What was the character of the
information, pure or impure?"
As in the similar study made by Dr. Exner among college men, the
results indicate that where the parents were the teachers, the informa-
tion, incomplete and meager as it may have been, was pure and helpful,
but where "other boys" were the guides in these matters, as happened
in the great majority of cases, the information given was generally
wrong and unwholesome.
This teaching will be more effective if given in the home than in the
school because of the relation of confidence and comradeship between
parents and children that it will encourage. And the lack of this rela-
tion is the real cause of parental delinquency, the cure for which is to
be found in " a return to a normal home life. . . . where parental
honor and respect is paid by children and the rights of children are
honored and respected by parents."
Any one knowing the work and interests of these authors finds as
he expects the heartiest apology for adult companionship and brotherly
leadership, and the religious note struck clear and strong. The lan-
guage in each book is clear and direct, the classifications, tables, charts,
and indexes orderly and complete, and the typing and book work up
to the well known standard of the Association Press.
F. D. E.
THE HIGH SCHOOL AGE. By Irving King. Indianapolis: Bobbs
Merrill Company, 1914. 233 p. $1.00.
In this book Irving King has done a great service both to the high
school teacher and to the parents of high school boys and girls. The
author's purpose is well expressed in one of his opening phrases: "Ed-
ucation of boys and girls in their teens will be effective only in propor-
tion to our accurate understanding of their characteristics and their
needs." The book aims to further this understanding by arousing a
spirit of research toward the problems of youthful characteristics and
needs and, in the matter it cites, to suggest investigations rather than
BOOK REVIEWS 387
to supply exhaustive data. The investigations cited are valuable but
my own impression on reading the book was to question how I could
extend such studies to a complete knowledge of the product I teach and,
if I do not mistake the author's desires, it is precisely this attitude he
aims to stimulate.
How many high school teachers if they were required to qualify for
higher salaries by replies to a catechism of this sort would pass the
test? "What do you know about the physiological age of the pupils
in your classes? How do they spend their time on leaving school?
What do they eat? What ideals of conduct have they? What do
they wish to do in life and what is the basis of their choice?" Every
one admits, if he stops to think things through, that these were vital
matters in his own youth but how often mass instruction crowds their
consideration from the teacher's mind. Mr. King has presented the
importance of such subjects and others equally vital in a way to make
us pause and in calling attention to their consideration has produced a
book that well deserves perusal by anyone who has the problems of
youth to meet.
W. H. E.
THE HEALTHY GIRL. By Mrs. Joseph Cunning and A. Campbell.
London: Frowde, 1916. 191 p. SI. 75.
Among the many books now being published pertaining to sex ques-
tions, it is with pleasure that one comes across a volume that not only
accomplishes the task it sets out to achieve but does so in a clean, in-
teresting, and wholesome manner. The simplicity of expression, concise-
ness of thought, and a delicacy of feeling for the tender and emotional
blossom, the healthy girl, contribute largely to the value of this book.
It acquaints the budding girl with her own body and the purposes and
functions of the various organs in an instructive and pleasing manner.
Especially commendable is the opening statement of the authors that
no two girls are alike and that the same treatment may be productive
of different results in different girls. This is not a new idea, of course,
but it is one that needs to be emphasized for, in these days, the tend-
ency, unfortunately, is to make a rule because it happens to fit one
case, regardless of the fact that each person is an individual and there-
fore each case differs from every other. The chapter on menstruation
is excellent and well suited to the needs both of girls and their mothers.
E. R. E.
388 SOCIAL HYGIENE
THE DECLINING BIRTH RATE. ITS CAUSES AND EFFECTS. Being the
report of and the chief evidence taken by the National Birth-Rate
Commission. London: Chapman and Hall Ltd., 1916. 450 p.
$2.80.
The British National Birth-Rate Commission, a volunteer body ap-
pointed by the National Council of Public Morals to make a careful
study of the birth rate in the United Kingdom, heard many witnesses
and had submitted to it thorough statistical studies. On the basis of
the facts developed, it submitted the report which comprises about one-
fifth of the present volume. The subject-matter is dealt with under
the headings: Statistical Evidence; Economic and Social Aspects; The
Housing Question; Medical Aspects; Moral and Religious Aspects.
An addition to the report considers the questions: Is the present de-
cline of the birth rate regrettable? If it is regrettable, is it preventable?
The conclusions may be readily summarized. There has been a
decline of about one-third in the birth rate of the United Kingdom within
the last thirty-five years. This cannot be traced to any marked change
in the constitution of the population. It has been general but not
evenly distributed over all sections. On the whole the decline has
been more marked among the more prosperous classes. Conscious
limitation of fertility is widely practiced especially among these classes.
Various detailed analyses of other causes are presented but the question
of venereal disease in relation to birth rate is not treated at length be-
cause of the work of the Royal Commission on the subject.
The regret expressed in relation to the lowered birth rate is that the
increase is at present coming from those groups in the community least
able to provide the best possible environment for the child's develop-
ment. Education on the importance of family life and proper care of
the mother are among the suggestions presented as remedies. A help-
ful bibliography is appended.
The evidence, representing as it does, widely divergent views, is in-
teresting. The report as a whole is worthy of careful study by all who
are interested in this fundamental question.
A. F.
POPULATION: A STUDY IN MALTHUSIANISM, By Warren S. Thompson,
Ph.D. New York: Longmans, 1915. 216 p. $1.75. (Columbia
University Studies in Political Science, v. 63, no. 3.)
The author has undertaken a statistical study in order to determine
whether the experience of a hundred years has proved the soundness
BOOK REVIEWS 389
of the original contentions expressed by Malthus. His conclusions are :
(1) Malthus was essentially right. For the great majority of people in
the eastern world, the pressure upon the means of subsistence is the
determining factor in the size of the family. (2) Malthus' contention
that much misery is due to overcrowding and that as a consequence a
large number of persons are always in want is certainly true today.
(3) The population will be more and more subjected to actual want
if the present rate of increase continues and the present trend of distri-
bution of labor between agricultural and non-agricultural industries
continues. The writer suggests that a further study based on this
conclusion might consider the questions arising from the present meth-
ods of selection, the problems of the unfit, and the survival of the better
stocks.
The present study is interesting; the facts presented are valuable;
the conclusions suggestive.
A. F.
THE SINS OF THE CHILDREN. By Cosmo Hamilton. Boston: Little,
Brown and Company, 1916. 352 p. $1.40.
We find here presented the story of a father and mother who are
blind to the opportunities of being real comrades and teachers of their
children. The children, unprepared by any knowledge of the vital
facts of life, left without advice, guidance, or understanding, blunder
into mistakes and narrowly escape tragedies, not because of any delib-
erate badness or desire for wrongdoing but merely because they have
been left unprotected and ignorant of the complexities and dangers of
life.
The hero, who is a Rhodes scholar at Oxford and a thoroughly fine
fellow, has kept himself pure in body and soul for the woman whom he
has chosen to be the mother of his children as well as his comrade and
helpmate through life. Because of misplaced friendship in the villain
of the story, a parasitic dandy who lives off his friends, the hero awakens
one morning to find that he has been drugged and carried off to the
home of a woman of the streets. His illness appeals to the best in her
and she nurses him until he is able to return home. Fearing he is no
longer fit to marry his fiancee he is on the point of committing suicide
when his father entering the room at the crucial moment, learns the
facts, averts the tragedy, and finally brings the young people together.
There is so much that is sound in the underlying philosophy of the
book that it is a pity that it is written in such a melodramatic manner.
390 SOCIAL HYGIENE
The characters are overdrawn and the situations extreme. The book
is therefore not convincing and cannot be recommended for young
people.
A. E. W.
THE MARRIAGE REVOLT. A STUDY OF MARRIAGE AND DIVORCE. By
William E. Carson. New York: Hearst, 1915. 481 p. $2.00.
The title of this book suggests a radical presentation of the "spec-
tacular" changes which are transforming domestic life, yet it is en-
couraging to see how impartial its author is and how helpful a mass
of facts, opinions, and side lights he has been able to bring together for
the student. In his own words his "object, in the first place, is to pre-
sent the facts and opinions that have led to what appears to be a wide-
spread revolt against conventional marriage and an equally widespread
increase of divorce; next, to discover to what extent any definite new
conceptions, emerging from this conflict, are finding acceptance; and,
lastly, from an examination and analysis of causes and effects to obtain
a forecast of probable future results."
The chapter on Woman's Emancipation summarizes some of the
best thought of the courageous pioneers in their study of "the advanced
American woman." "The progress of American women, socially, in-
dustrially, and politically, means, therefore, far more than women's
rights and women's votes. Not only is it having a profound influence
on family life, but it is also having its effect on the whole sphere of
matrimony. As women, to an increasing extent, are becoming self-
supporting and independent, they refuse to be governed by old tradi-
tions of woman's domain and woman's duties — chiefly imposed by men
— and with each advance to greater freedom they have become less
tolerant of evils, in and out of marriage, which were once patiently
borne. The emancipation of women, in short, has given rise to new
ideals of marriage which form a striking contrast to those of the past.
. . . This generation of American women, in short, is the first in
the world who were not compelled to depend on matrimony for their
support."
The chapter on the New Morality reviews .the special contributions
to this problem of such men and women as Heinrick Ibsen, Gustav
Hauptmann, Ellen Key, Bernard Shaw, and Tolstoi, but carries the
conviction that out of present confusion a new home life is to be built
upon a basis of higher morality and larger spirituality.
BOOK REVIEWS 391
The chapter on Easy Divorce shows that social changes are also tak-
ing place in other countries; this unrest is not local, but world-wide.
Various remedies are proposed and the facts are summed up as well
perhaps as is possible at this time of experimentation and with what
data are available.
Naturally many readers will cry out against such a frank statement
of opposition to existing marriage conventions, denouncing the freedom
of such radicals as are here quoted in all seriousness. Changes do take
place and it is only fair that all sides be heard. Though this study
may seem to have little upon which one can depend yet it does give
a glimpse of the time too valuable to be neglected and the author has
made a valuable contribution in bringing this material together.
B. C. C.
SOCIAL RULE. A STUDY OF THE WILL TO POWER. By Elsie Clews
Parsons. New York: G. P. Putnam's Sons, 1916. 185 p. $1.25.
Whatever Mrs. Parsons writes is worth reading, not only because she
puts things radically and forcibly, but because the reader is sure to
get a new point of view. In her new book, Social Rule, Mrs. Parsons
proposes to supply a scientific basis for Nietzsche's will to power.
Everyman's struggle to dominate men, women, nature, animals, etc.,
is a demonstration of the contention of the philosopher whom the
world vies in denouncing and acclaiming. While Nietzsche's ideal finds
its justification in pure dominion and the sense of control, Mrs. Parsons
sees not the overlordship as an end in itself, but a struggle of the per-
sonality to free itself from others' will to power expressed as conven-
tion, status, classification, or any means used by the strong, or by so-
ciety itself, to regulate and control the weak. Nevertheless the desire
to control is the prime motive of life, but it need not take the form of
injustice and injury of others. Mrs. Parsons couples her Nietzscheism
with non-resistant pacificism.
Social problems are largely created by the animal impulse to domi-
nate and exploit others. The treatment of juniors, women, slaves and
servants, wage-earners, "backward" peoples, delinquents and de-
fectives, the lower animals (each class has its chapter in the book)
furnishes examples of a blind desire to utilize others through the main-
tenance of class distinctions. The double standard of morals is a case
very much to the point. As long as the class "prostitute" can be main-
tained with all of the social repudiation that goes with it, its members
392 SOCIAL HYGIENE
can be used as may suit the pleasure of those who make the class their
prey.
On the other hand Mrs. Parsons has a hard word for the social re-
formers, the "improvers," the eugenists for example, holding that if
they had their way the weak would suffer from a new form of tyranny
more pitiless than any exercised heretofore. She concludes that the
proper objects against which we should direct our impulse to dominate
are the "self," science, art, the environment, etc.; that there should be
a "concentration of our energy upon bettering nature rather than upon
bettering man, or shall we say, in bettering human beings through bet-
tering the conditions they live under. . . . "
Mrs. Parsons presents much that is true, but it does not always fol-
low that a principle the value of which can be illustrated in many ways,
will be equally promising when we attempt to apply it to the concrete
situation.
V. M. C.
\
THE MOTHERCRAFT MANUAL. By* Mary L. Read. Boston: Little,
Brown and Company, 1916. 440 p. $1.25.
The sin of America today is extravagance of living, wrong values,
absence of high ideals. As President Wilson said recently, "This is
the time for America to correct her unpardonable fault of wastefulness
and extravagance. Let every man and woman assume the duty of
careful, provident use and expenditure as a public duty, as a dictate of
patriotism which no one can now expect ever to be excused or forgiven
for ignoring." The remedy for these conditions is clearly set forth in
Miss Read's book where she says, "The first step is to appreciate the
relative values of life, of genuine simplicity and vulgar show; of educat-
ing the children to share, to carry responsibility, to be self-reliant, or
to be selfish, dependent, luxury-loving." The plea set forth in every
chapter is for simplicity of home furnishings, and elimination of waste
in time, materials, and energy. "Do not mistake the means for the
end," she says. "Orderliness, immaculate linen, garnished rooms are
means. Good cheer, patience, kindliness, reserve force, poise are vastly
greater values. Often it is necessary to choose between the two."
Conservation of the most precious thing upon earth, human life from
its earliest beginnings, is the key-note of this book, the purpose of which
is set forth in the preface as follows: "To bring directly to those who
have opportunity to use it — the home-makers, present and prospective
393
— some of the wealth of present knowledge in biology, dietetics, hy-
giene, domestic efficiency, child psychology, education, that is stored
in the laboratories, research reports, medical records, technical jour-
nals, and educational classics, translating these from the obscure tongue
of technical language into the clear speech of daily life." It is very
evident to one who spends but a few moments upon the index that the
married women who live at home and take care of their children may
no longer be classified by the United States Census takers as "women
without occupation." One has the feeling, also, when reading the
introductory chapters that marriage, with its natural outcome, parent-
hood, is no longer a refuge for the incompetent, a haven for women who
have failed at all other occupations, nor child-care a task which re-
quires no preparation for its accomplishment.
A rational approach is made to the details of child-care by a discus-
sion of the origin of the present institution of marriage and some of
the causes of disagreement in marriage resulting in divorce. Among
the chapters of especial value are those which deal with the teaching
of the eugenic ideal. The necessity for early instruction in inhibitions
before the period of adolescence is emphasized. Twenty pages are
devoted to an outline for the exhaustive study of the child, providing
for physical, psychological and social analyses. There are chapters on
nature-study and the out-of-doors life which gladden the heart of the
nature lover and corroborate his belief that fife need not be dull if chil-
dren were but given their birth-right to be born and live for ten years
in a rural community where there are no signs "Keep off the Grass"
and where there is room for pets. Probably very few grown-ups real-
ize the important part which toys may play in the development of the
child, and an entire chapter on this subject keeps the reader's interest
to the end. An extensive bibliography completes the book.
Throughout the work there is a spirit of quiet poise, cheerfulness,
and optimism. Miss Read takes time to say, "The preparation of
the baby's clothes should be a joy and not a worry or a burden," and
one feels that she looks upon motherhood as a sacred rite, from which
the mother should experience supreme satisfaction.
E. W. Y.
OBSCENE LITERATURE AND CONSTITUTIONAL LAW. By Theodore
Schroeder. New York: Privately printed, 1911. 440 p.
This is a collection of essays defending the freedom of the press.
The thesis is that no restrictions whatever should be placed upon any
394 SOCIAL HYGIENE
publication. The author believes that if the sources of the law relating
to this subject were impartially examined, many of the present legisla-
tive restrictions surrounding publications would be held unconstitutional.
T. N. P.
RELATIVE VALUES IN PUBLIC HEALTH WORK. By Franz Schneider,
Jr. New York: Russell Sage Foundation, 1916. 10 p. 10 cents.'
Not how many dollars to spend but how to spend them for public
health activities is the subject of this pamphlet.
Given some 1,400,000 deaths annually in continental United States,
of which one in four or even one in three are from preventable causes,
the health officials "must decide what parts of the losses are preventa-
ble, and must determine how the greatest return in prevention can be
obtained with the money available. This is the problem of relative
values in public health work."
The actual situation confronting American health officers is that "with
the scanty funds now at their disposal, and the great variation in ef-
fectiveness of different activities, the most careful discrimination must
be exercised in making up the department's program. A bad dis-
tribution of funds means lives lost, and the responsibility, a heavy one,
falls on the administrative official."
Social workers as well as heavy taxpayers and all other citizens
will be aided by this pamphlet in studying local health expenditures.
CRIMINALITY AND ECONOMIC CONDITIONS. By William Adrian Bonger.
Boston: Little Brown & Co., 1916. 706 p. $5.50.
Criminality and Economic Conditions by William Adrian Bonger is
the eighth number of the Modern Criminal Science Series published
under the auspices of the American Institute of Criminal Law and
Criminology. The fact of its being translated and printed as one of
this series is sufficient reason for its careful consideration by all who
are interested in the causes and eradication of crime.
The plan of the volume is as follows: Part I relates to a "Critical
Exposition of the Literature Dealing with the Relation between Crimi-
nality and Economic Conditions." In this part the writings of "The
Precursors" — those "who treated the subject before the birth of mod-
ern criminal science;" "The Statisticians;" "The Italian School;"
"The French School;" "The Bio-Socialists;" "The Spiritualists;"
"The Third School and the Socialists" are discussed and criticized.
The exposition is clear and forceful, but the question of the adequacy
BOOK REVIEWS 395
of the resume1 of each writer is constantly raised in the reviewer's mind.
Not infrequently the impression is conveyed that the thesis of the com-
plete dependency of criminality on economic conditions so overshad-
ows all other things that the analysis is largely directed toward elimi-
nating from the discussion all matters not bearing upon this side of
the question and unduly emphasizing the evidence which immediately
or remotely supports the writer's contention.
Part II is divided into Book I on "The Present Economic System and
its Consequences" and Book II on "Criminality." The former covers
in five chapters the topics: "The Present Economic System," "Social
Conditions of the Different Classes," "The Relation of the Sexes and
of the Family," "Alcoholism," and "Militarism." Book II covers,
among other things, in seven chapters, "Economic Crimes," "Sexual
Crimes," "Crimes from Vengeance and other Motives," "Political
Crimes," and "Pathological Crimes."
Part II constitutes the constructive part of the treatise and the por-
tion which is most open to criticism as a study in induction. The re-
viewer is frankly in doubt as to its scientific value, not so much because
of its summary and analysis of classified crimes — of this he is unable to
judge without a prohibitive amount of study — but rather because of
the implication which runs through it and the thesis which it is made to
support. The book vigorously attacks the present and past economic
orders and imputes to them the etiology of crime in all its manifesta-
tions. The indictment of competition, private property, the present
distribution of wealth, monopoly, etc. is drawn on almost pure Marxian
lines. The analysis represents nothing of the more temperate view of
Bernstein and the German Social Democrats but rather proceeds along
the rigid, fatalistic lines of so-called "scientific" socialism. The re-
viewer's objection is not so much to the indictment nor to the manner
in which it is drawn as to the part it plays in the constructive part of
the treatise. The present economic system is bad, its product is crime.
Cause and effect are clear to the writer ; but the causal connection might
have been found to be different had he not proceeded on this assump-
tion and chosen his evidence with this in mind.
The supporting data are almost wholly statistical. No country of
importance which has collected even the most rudimentary statistics
of crime has been omitted in the search for evidence of the relation-
ship of crime to economic conditions. It is in the analysis of these data
that the author seems most open to criticism. At times the limita-
tions both of the statistics collected and presented and of statistical
396 SOCIAL HYGIENE
method in the analysis of such a problem as crime are carefully indi-
cated, but far too often, in the reviewer's judgment, is a causal con-
nection between crime and economic conditions supported by inade-
quate and questionable statistical evidence. Statistics and statistical
method undoubtedly have a place in the study of the phenomena of
crime, but the establishment, solely by statistical means, of cause and
effect relations between economic conditions, not too definitely defined
nor too clearly marked, and crime, often measured by faulty and non-
comparable data, is a questionable and dangerous procedure.
Crimes, undoubtedly, are intimately associated with "economic con-
ditions," and the writer has done a useful service unmistakably to call
attention to this fact. The scientific method, however, requires the
causes of crimes to be sought in "the man's heredity, the man's physi-
cal and moral make-up, his emotional temperament, the surroundings
of his youth, his present home, and other conditions — all the influenc-
ing circumstances."1 That they are all mediate, the ultimate causes
being found in such an indefinite thing as "economic conditions," few
I feel would care to hold with Mr. Bonger.
Having found the etiology of crime in economic conditions, the
author seems obliged to outline other economic conditions in which
crime would not exist. Although he gives it only as his personal opin-
ion that the solution is to be found in the common ownership of the
means of production, he traces the likely consequences of such a change
and finds that "in such a society there can be no question of crime
properly so-called."2 Two problems are involved in his forecast.
First, the possible structure of such a society, and second, the proba-
bility of crimes being committed in it. Both are matters of opinion
and the writer, of course, is at liberty to believe as he will. The elimi-
nation of other causes helps to make his forecast likely but not inevit-
able. The inclusion of other causes leaves the question still open.
The value of the book is increased by a comprehensive bibliography.
H. S.
STUDY OF ANIMAL FAMILIES IN SCHOOLS. By LAURA B. GARRETT.
New York, Bureau of Educational Experiments, 1917. (Bulletin
no. 2.) 19 p. $.10.
The remarkable success of Miss Garrett in making groups of children
familiar with facts of sex through the care of animal pets gives added
1 General Introduction to the Modern Criminal Science Series, pp. xii, xiii.
*P. 671.
BOOK REVIEWS 397
importance to this recently published brochure pointing out the prac-
tical educational value of animal families in the school room.
"No child should be allowed to grow up," says Miss Garrett, "with-
out having the training which the care of pets gives him. The values
of animal friends to children are so many that it is difficult to think
of them all. The most important is the joy of the child as he plays with
his friends. He learns at the same time respect for life, and incidentally
gains an understanding of reproduction, as he sees his pets bearing young
and is automatically instilled with the appreciation of parenthood,
and the cleanness of the sex instinct. . . .
"The knowledge that the child gets about animal life should be ac-
curate and scientific. If the 'life history' of an animal is presented
to a child — as it ordinarily is — with reproduction entirely omitted
it is not only a lost opportunity to give the child in a natural way
the information which he may otherwise acquire in a twisted way,
but is an actual distortion of fact. It is essentially an unscientific
point of view to expurgate your material for ulterior purposes. This
does not mean that reproduction should be stressed. It should not.
It should merely be treated honestly as a part of the situation when
it really is a part. It thereby becomes related to something under-
standable and ceases to have the glamor of mystery. The children's own
questions and attitudes are the best guide in this matter. This teach-
ing when young, prepares the children for a better understanding and
respect for the great surge of the creative instinct which comes to them
later."
R. W. C.
NOTE AND COMMENT
A City Government Survey in Columbus, Ohio. At the invitation of
the Columbus, Ohio, Civic League, the Bureau of Muncipal Research
of New York City has made a survey of the government of that city,
the report of which has just been published.
"While no moral survey of the city was conducted, an ordinary
tour of observation and conversation and interviews with interested
persons in the city showed" that the policy of the present administra-
tion in Columbus is to maintain a so-called "segregated" district, the
houses used for immoral purposes being distributed between two sec-
tions of the city. The police regulations with regard to the houses of
prostitution and assignation require that "no liquor shall be sold with-
in them, that minors shall not be admitted, and that music and danc-
ing shall cease at midnight," and these regulations seem to be enforced.
"No medical inspection of the inmates of these houses is provided by
the city, nor are they registered with the police although from time to
time a census is taken of them." The number of prostitutes solicit-
ing upon the streets is far in excess of other cities of similar size. The
state law makes it a crime for any person knowingly to rent his property
for use as a disorderly resort and places upon the city officials the duty
of suppressing commercialized vice.
The investigators, therefore, make the following recommendations : —
That the city administration adopt a policy of suppression of vice, and order
the division of public safety to suppress all places operating in the city as houses
of assignation or prostitution.
That a definite procedure be adopted for the investigation of complaints and
the enforcement of the vice laws, which will provide for the proper control over
the officers assigned to this work and the recording of complete information con-
cerning the vice conditions of the city.
That the members of the uniformed force and detective bureau be relieved of
all duties with respect to the enforcement of the laws against vice except that
they be required to report faithfully and diligently all premises suspected of
being maintained for immoral purposes.
That the chief be authorized by the director of public safety to detail plain
clothes policemen to conduct a campaign against prostitutes soliciting at night.
That an ordinance be adopted requiring all rooming houses to obtain a license
and to be subject to police inspection and supervision.
398
NOTE AND COMMENT 399
"The declaration of the policy of suppression followed by a vigorous
prosecution of one or two of the more prominent owners of houses of
assignation would automatically result in the closing of many of the
premises the owners of which are now aware of the policy of toleration
in effect. It has proved that commercialized prostitution nourishes
where vice is protected or permitted, and decreases where authorities
express and prove a determination to rid a city of it. Judging from
observations made during the survey, Columbus is greatly in need of
such a campaign."
In studying the work of the health board of the city, the chief crit-
icism seems to be that not enough emphasis has been laid upon the
question of preventive medicine. For example, with regard to ve-
nereal diseases which "are the most constantly prevalent of communi-
cable diseases little attempt has as yet been made by the health depart-
ment to provide any of the recognized means for the prevention of
these diseases." The report therefore, recommends: —
That immediate steps be taken to encourage the reporting by physicians of
cases of venereal disease.
That the health department establish a confidential clinic at the health de-
partment offices, to which persons suffering with venereal disease may go for
consultation and advice.
That the health department inaugurate an educational campaign against the
use of patent medicine and the operation of quack specialists in the city of Co-
lumbus, and the cooperation of the Academy of Medicine and the public press
be sought to these ends.
That provision be made by the health department for increasing the labora-
tory service to physicians by making Wassermann tests (blood examinations
for the diagnosis of syphilis) for physicians free of charge.
One other phase of the survey is of interest to social hygiene workers
and that is the section dealing with recreation. In examining the
commercial amusements, the investigators found that the city em-
ployed an inspector for dance halls, but that other forms of commercial
recreation such as roller skating rinks, moving picture shows, wine
rooms and cabaret shows, were not adequately supervised. They,
therefore, recommend: —
That the ordinance be amended so as to provide for changing the title "in-
spector of dance halls" to "inspector of amusements," and that this officer be
required to inspect and supervise all places of amusement to which women or
children are admitted, including wine rooms and carbaret shows.
That "robber" and "moonlight" dances be prohibited in public dance halls,
and that the halls be required to be well lighted at all times when open to the
public.
400 SOCIAL HYGIENE
That the Department of Public Welfare assume the important function of
current inspection and supervision of all forms of commercialized recreation with
a view to constructive development rather than to repression and prosecution.
The Public Dance Halls of Chicago.1 Since 1910 the Juvenile Protec-
tive Association of Chicago has been continually watching, and from
time to time intensively investigating the public dance halls of that
city. A recent report supplies the following facts. In 1910-11 agents
of the Association visited 328 public dance halls, and 213 were similarly
visited in 1916-17. The reports of these visits indicate that about
half of the dance halls investigated are poorly ventilated, more than
half permit immoral dancing, liquor is sold in about two-thirds, and
only about one in ten have proper facilities for drinking water. Con-
ditions have remained substantially unchanged during the period of
observation.
The majority of Chicago's public dance halls are controlled by the
liquor interests and are frequently conducted solely for the purpose of
stimulating the sale of alcoholic drinks. Intoxication, absence of re-
straint in dancing, and the presence and activities of prostitutes and
their panders provide a very dangerous combination of circumstances
tending to the demoralization of the young people who attend public
dances. "The conditions existing in the dance halls and in the ad-
joining saloons transform innocent dancing and social enjoyment into
drunkenness, vice and debauchery. Saloon-keepers and prostitutes are
in many cases the only chaperones, and in many of the halls even
young girls and boys fresh from school are plied with alcohol, and
with the suggestion of vice, until dancing ceases to be recreation and
becomes flagrant immorality."
Not only is the moral atmosphere of public dance halls generally
bad, but the physical conditions are damaging to health. As indicated
above, ventilation is generally poor, the floors are often dusty, and in
a large number of cases drinking water is not conveniently provided.
At times the crowd of dancers in such halls becomes so great that
proper dancing becomes practically impossible. Under such conditions,
and particularly when the sale of liquor is interfered with, the police
have great difficulty in controlling the gangs of reckless young people.
In one instance a police officer lost his life while attempting to enforce
the law regarding the sale of liquor. Brawls and fights are frequent
occurrences.
1 The Public Dance Halls of Chicago. A report by the Juvenile Protective
Association of Chicago, 1917.
NOTE AND COMMENT 401
Not only are the city ordinances and state laws regulating the actual
conduct of dances not enforced, but the ordinances and laws regulating
special licenses are not enforced in a regular and systematic fashion.
The Juvenile Protective Association, with the assistance of the Com-
mittee of Fifteen of Chicago and other Illinois organizations, is urging
the present Illinois legislature to pass a law forbidding "the sale, gift
and use of intoxicating liquors in any place while it is used for a public
dancing or skating entertainment and in rooms and places practically
accessible from such place."
A Study of One Hundred and Ninety-six Girls under Supervision1 has
been made by the Boston Society for the Care of Girls, with the purpose
of ascertaining whether the supervision of the Society had fostered
within the child "qualities which would enable her successfully to adapt
herself to community life" after being discharged from the Society's
care. These girls were under the supervision of the Society during the
years 1908 to 1914 and for periods of not less than six months hi each
case. They were of various ages up to twenty-one, the largest number
being between seven and fourteen. The following causes are men-
tioned as being the principal reasons why the girls dealt with came un-
der the supervision of a child-helping society: temporary dependence;
lack of parental responsibility; immorality of the girl herself; wayward-
ness. "The chief reason for the admission of the largest number was
because of temporary dependence. This is a broad classification, but
does not show that a large number of cases are apparently temporary
at the outset. The immorality group (34) is strikingly small, but it
must be noted that many girls in the other groups had been immoral,
but this was not the prime factor in the problem."
The report summarizes the conditions of the girls at the time of the
study as follows: 26 of the 196 were "not seen" and exact information
regarding them could not be secured; 35 were married; 13 were at home;
1 was in college; 7 were in high school; 40 were in grammar school; and
2 were receiving special training; 11 were earning between $15 and $20
per week; 9 were earning $10 to $15 per week; 17 were earning $5 to
$10 per week; 3 were reported out of work; 4 were found to be "shift-
less;" 1 was in a sanitarium; 4 were in hospitals for the insane; 1 was
at Welcome House; 5 at Sherborn Reformatory; 11 in state institu-
tions for the feeble-minded; and 6 were dead. Of the 196 girls, there
1 The Boston Society for the Care of Girls. Annual Report, 1916.
402 SOCIAL HYGIENE
were 128 who were considered to be living "satisfactorily" at the time
of the investigation.
The report concludes that the greatest needs of a child under super-
vision are a thorough study of the social history including family his-
tory, and competent preliminary and follow-up mental tests by a psy-
chologist, and that prevention must be largely through educational
work with parents, the girls themselves, and the communities in which
they live. "In the light of all these facts we hope to supply a three-
fold need; an awakening of mothers and fathers to the knowledge
that if they are careless, over strict, drunken or immoral, they are to
blame; an awakening of girls to their responsibilities, by laying upon
them the burden, and developing within them the power to help, and
finally an awakening of communities to share in building up their bul-
warks."
The "Block System'1 of the Juvenile Protective Association of Chicago.
This does not refer to the signal system of a railroad nor to a plan for
prison buildings, but is the scheme suggested by Mrs. Louise deKoven
Bowen, President of the Juvenile Protective Association, to the local
leagues associated with this organization for keeping the interest of their
members by giving them something to do. The plan is to assign a city
block to each member who will volunteer for the work and ask him to
be responsible for its welfare.
The first thing for the investigator to do would be to make a survey
to find out how many vacant lots, saloons, pool-rooms, dance halls,
houses, churches, etc., the block contained. Having done this, he would
be expected to visit his block frequently and report to the Juvenile
Protective Association upon the conditions, particularly noting those
that should be remedied.
The sort of investigation that could be carried on is indicated by the
following questions: "Are there dance halls in the block? By whom
are they owned? What is the character of the patrons? Are there
any theatres? What is the character of the entertainment offered?
Does the audience consist largely of children? Are there any disrep-
utable houses in the block? Are the keepers of these houses men or
women? What is the name of the owner of the property? Are there
any vacant buildings in which boys and girls congregate after dark?
How often does a policeman visit the block? Does he pay attention
to violations of the ordinances made by the Health Department?"
NOTE AND COMMENT 403
Besides looking for violations of the law and reporting them to the
central office of the Juvenile Protective Association, the visitor would
probably find opportunity to do a good deal of constructive work, for
instance, if there is a vacant lot in the block he might get permission
to turn it into a garden or playground. If there is a church there that
is used only on Sundays, he should try to interest the pastor in opening
at least a part of it during the week for a reading room or meeting place.
In conclusion, Mrs. Bowen says, "It is thought that if every local
league and association would undertake to survey four of five of its
blocks in the manner I have described, and if they could be reported
on at the quarterly meetings of the Juvenile Protective Association,
a very valuable contribution would have been made to the civic work
of the community."
Vice Conditions and Reform in New Orleans. In an article in the
Congregationalist for March 8, Mr. Rolfe Cobleigh writes of the moral
conditions in New Orleans and describes the efforts that have been
made to change them.
Two institutions which have been driven out of almost every other
city in America still flourish in New Orleans: the race track where
gambling is carried on as a legitimate part of the sport and the red-light
district where commercialized vice in its worst form is practically leg-
alized. These offenses against morality which in other states are out-
lawed have not been even considered misdemeanors in Louisiana.
Realizing the necessity of passing laws to deal with these evils a few
public minded citizens succeeded in securing the passage of laws which
limit, though only in a very small degree, race-track gambling and
commercialized vice. But even these laws have been ignored and con-
ditions remained unchanged. Then the Citizens' League of Louisiana
was organized with a committee of one hundred for law enforcement.
Suit was brought against the race-trace company only to have the
case ruled out of court by Judge Skinner. An appeal to the state
supreme court was sustained and a second attempt made to have the
case tried — with the same result as before. This has happened two or
three times and so far the case remains untried.
The next step was to investigate and secure evidence of the violation
of the liquor laws in New Orleans. This the league proceeded to do
and succeeded in piling up a mass of evidence. And then help came
from an unexpected quarter. Mr. Curley Brown, the owner of a
race track in Havana, tried to secure a franchise for a second one in New
404 SOCIAL HYGIENE
Orleans. The mayor and his associates, apparently not wishing to
have any competitors in this field, refused to grant it. Angered by
this, Mr. Brown bought a daily paper and as the surest way of taking
revenge upon the administration proceeded to back up the reformers in
their efforts to drive out the vice district.
As a result of the scathing newspaper editorials the city officials
felt that something had to be done and the police were sent into Storey-
ville, as the segregated district is called, to enforce the law. Some of
the worst cabarets and saloons were closed, but only a few of them,
and the two most infamous places, which are owned by the "Mayor of
Storeyville," a member of the legislature, were left unmolested.
The lowest and vilest streets of this district are filled with "cribs,"
so-called, where the women of the underworld ply their trade in the
most shameless fashion. Here they were violating the law against
street solicitation in a most flagrant manner. These "cribs" were
closed by the police and with only a few hours' notice seven hundred
women were turned out into the street.
Following these raids, a grand jury, forced into action, was kept busy
receiving evidence of violations of the law and as a result indictments
have been brought against practically all the leading hotels and
large numbers of resort-keepers. Many laughed at these efforts and
seemed to think that the changed conditions would last only until the
storm had passed. And unfortunately for New Orleans the latest re-
ports seem to indicate that this is the case. The "cribs" are already
open again and many resorts outside of the segregated district are also
resuming business. Mr. Brown's newspaper is bankrupt and has dis-
continued publication. However the fight is not over and New Or-
leans may yet win in driving out these evils as she did the yellow
fever and bubonic plague.
Mothers' Confidential Registry Letters. The Division of Child Hy-
giene of the Kansas State Board of Health is carrying on an interesting
work with mothers in its campaign for better babies by sending a series
of personal letters written by Dr. Lydia A. De Vilbiss, director of the di-
vision, to every prospective mother who registers with the bureau. The
first letter explains the purpose: "Like every prospective mother, you
want your baby to have the best you are able to give him and it is our
purpose to help you to attain your every desire. To this end I am go-
ing to send you a letter each month which I hope will bring both help
and cheer to you."
NOTE AND COMMENT 405
In this simple, personal way, the letters give directions for the proper
care of the mother during this period, the necessary preparations for
the coming of the baby, and in the final one several suggestions are
made as to the care of the baby during its first year.
The Massachusetts State Department of Health in the first annual
report of the reorganized Department,1 Commissioner McLaughlin
says that syphilis has been neglected in the past, although as a problem
of preventable contagious disease, and in opportunity for life saving,
prevention of blindness, insanity and pauperism, it is second only to
tuberculosis.
What is its relative importance as a public health problem? It is responsible
for more deaths than diphtheria, typhoid fever, scarlet fever, measles, whooping
cough and influenza combined, and it is probably responsible for from two thou-
sand to three thousand deaths each year in Massachusetts. Syphilis seldom ap-
pears on a death certificate. Hidden away under a dozen technical titles are thou-
sands of deaths really due to syphilis. The economic loss due to syphilis is
appalling. It increases enormously our expenses for the blind, pauper and insane.
. . . . At least 10 per cent, of insanity is due to syphilis, a preventable and
curable disease, so that the state of Massachusetts expends at least $450,000 an-
nually for syphilitic insane. Under these circumstances it would seem sound
business policy for the state to expend some money in the prevention of syphilis.
We have in salvarsan a specific remedy, which, if used in the early stages of
syphilis, not only cures the individual but prevents him from infecting others.
With our exact knowledge of the cause of the disease and possession of a specific
remedy why do we not eradicate it? Three reasons may be cited which in them-
selves are sufficient to explain our failure to even reduce the ravages of syphilis : —
1. The prohibitive price of (and since the war, inability to obtain) salvarsan;
2. The natural desire for concealment and secrecy of the individual infected
with a venereal disease which is looked upon as a social disgrace; and
3. Lack of knowledge of the prevalence of the disease, and exact methods of
diagnosis.
Salvarsan is made in Germany and patented in the United States. Its price
before the war was from $3 to $4.50 per dose. At present, owing to the war, it
cannot be obtained from Germany. I believe that United States patents were
never intended to deprive the people of any state of a substance which is nec-
essary for their health and welfare. I further believe that the state of Massa-
chusetts would be within its rights in manufacturing or in some other way pro-
curing salvarsan for free distribution to residents of Massachusetts, in view of
the fact that it cannot be obtained from Germany. Salvarsan can be made by
our chemists I believe it is the plain duty of the state government
to solve this problem, and that an act should be passed providing for free salvar-
1 First Annual Report of the State Department oj Health of Massachusetts.
Boston, 1916.
406 SOCIAL HYGIENE
san for residents of Massachusetts I believe that whenever a physi-
cian reports the data of a case of syphilis, omitting the name and address, and
submits a specimen of blood which is found positive in our laboratory, the state
should send him the salvarsan free with which to treat the case
I realize that syphilis is not a word to conjure with, but I do believe that in view
of its great importance in loss of life, production of blindness and insanity, and
enormous economic loss, Legislatures should pursue a liberal policy and spend
considerable money in combating this great plague.
Some of our larger hospitals and dispensaries are doing splendid work in de-
stroying the infection in the carrier of syphilis. Many other hospitals and dis-
pensaries should pursue a more liberal policy. These other hospitals now refuse
to admit syphilis in the early stages .... As a compensation salvarsan
should be furnished free to hospitals and dispensaries. The time to eradicate
the infection of syphilis is in the early stage. The general public must be edu-
cated in the appalling results of neglected syphilis, and dispensaries, hospitals
and private physicians should be encouraged and assisted in treating the early
cases, without allowing them to become cases of locomotor ataxia, general paral-
ysis, heart disease or apoplexy.
It is said that to advertise the marvelous effect of salvarsan, and to place
it within the reach of the poor, is to put a premium upon vice and to absolve the
syphilitic from the just punishment of his sins. As health officers let us be prac-
tical and consider syphilis as a public health problem, leaving the academic
discussion of its moral and social aspects to others. We may relieve the unfortu-
nate sufferer from the punishment of his own misdeeds, but we are also preventing
this punishment from falling upon women, children and other innocent victims.
Thousands of cases are acquired innocently from syphilitics, and our plain duty
is to prevent these infections by eliminating the carriers of the disease without
regard to their social or moral status.
Thousands of prisoners and inmates of federal, state and municipal institutions
are discharged each year, and these are turned loose without much regard to their
being carriers of disease. In Massachusetts I believe that every inmate of a
public institution should be tested for syphilis, and not discharged from that
institution until he or she has been properly treated and shown to be no longer
capable of infecting others.
As a sanitarian and practitioner of preventive medicine I desire to accentuate
especially the necessity of early treatment in syphilis. The cardinal principle
of our .preventive campaign must be proper treatment in the early stages. In the
first and second stages of syphilis the spirochaetes are more easily reached and
destroyed by salvarsan, hence the chances of complete cure are vastly better than
if treatment is delayed. The important point in early treatment, from the health
officer's view, is that the infection is destroyed, and open sores and lesions, which
are practically certain to cause other cases, are prevented.
The following table presents a resumg of the 4218 Wassermann ex-
aminations at the State Laboratory during 1915 upon various institu-
tional groups: —
NOTE AND COMMENT
407
CLASSIFICATION OF PATIENTS EXAMINED
PATIENTS
EXAMINED
SYPHILITIC PATIENTS
Number
Per cent.
Psychopathic patients
1,997
679
185
432
21
172
136
419
177
298
61
74
39
1
8
24
68
48
14.8
9.0
40.0
9.0
4.8*
4.7
18.5
16.2
26.1
Feeble-minded and delinquent subjects —
Criminal subjects
Tuberculosis subjects
Cancer group
Pregnant women
Infants and children
Acute general hospital group
Patients suffering from chronic disease
Total
4,218
621
15.0
*Patient had syphilis of liver and not cancer.
What Great Britain is Accomplishing. Following the recommenda-
tions of the Royal Commission on Venereal Diseases1 the British Local
Government Board issued regulations requiring the establishment by
County Councils of diagnostic and treatment facilities, empowering
the councils to undertake educational activities and announcing that
the Local Government Board would repay 75 per cent, of the expendi-
tures incurred under approved schemes.
The Board has recently published the needed forms and leaflets for
use in connection with schemes for the prevention and treatment of
venereal diseases: —
(i) Application for pathological outfit, (ii) Application for supply
of approved substitute for salvarsan. (iii) Warning to be given to
patient after administration of approved substitute for salvarsan.
(iv) Particulars to be supplied with each specimen sent to the labora-
tory, (v) Report of pathologist, (vi) Instructions to patients suffer-
ing from syphilis, (vii) Instructions to patients suffering from gonor-
rhea, (viii) Information on the dangers of venereal diseases and on
facilities for treatment, (ix) Notice for public advertisement announc-
ing facilities for treatment, (x) Suggestions for circular from the
medical officer of health to medical practitioners practising within the
area of the council.
1 The British Royal Commission on Venereal Diseases, SOCIAL HYGIENE, July,
!QlG;Venereal Disease Regulations of the British Local Government Board, SOCIAL
HYGIENE, October, 1916; The British National Council for Combating Venereal
Diseases, SOCIAL HYGIENE, January, 1917; What England is Doing for the Ve-
nereally Diseased, SOCIAL HYGIENE, April, 1917.
408 SOCIAL HYGIENE
SUGGESTIONS FOR A PUBLIC NOTICE (e.g. in the Press).
VENEREAL DISEASES.
Although these diseases occur as the result of immoral conduct, they may be
spread in other >vays.
THE EFFECTS OF THESE DISEASES
.upon the -individual and upon the race, are
GRAVE AND FAR REACHING.
It has been demonstrated tliat
PROMPT RECOGNITION AND SYSTEMATIC TREATMENT
of these diseases wilt enable the patient to avoid these grave
after- consequences.
Arrangements have been made for
FREE TREATMENT FOR ALL.
Persons suffering from these diseases- can have treatment
UNDER CONDITIONS OF SECRECY.
Treatment Centres have been provided AT GENERAL HOSPITALS, at which
many other diseases are also treated.
The following Treatment Centres are available for this district: —
Further information as to these facilities, and copies of a special leaflet;
on the dangers of Venereal Diseases, can be obtained from the
MEDICAL OFFICER OF HEALTH,
PUBLIC HEALTH OFFICES.
FORM IX, "NOTICE FOR PUBLIC ADVERTISEMENT ANNOUNCING
FACILITIES FOR TREATMENT" CONSIDERABLY
REDUCED IN SIZE
NOTE AND COMMENT 409
In March 1917 the Local Government Board presented to Parlia-
ment a report which says in part: —
1. Considerable progress has already been made with the organization of
measures for the provision of free diagnosis and treatment for persons suffering
from or suspected to be suffering from, venereal disease. The Local Govern-
ment Board have information that between 130 and 140 hospitals in England
and Wales have expressed their willingness to participate in the schemes of local
authorities, and although in a few instances the authorities of important hos-
pitals have been reluctant to inaugurate during the War any fresh arrangements
for the treatment of these diseases, this hesitation has already been overcome in
some cases. The shortage of medical staff and the pressure on the accommoda-
tion at most hospitals at the present time have presented obstacles in many
instances, but the former difficulty has been met to some extent by the Army
Council arranging that certain officers of the R. A. M. C., who are specially
skilled in the treatment of venereal diseases, should devote part of their time to
the work of the clinics provided at general hospitals for the treatment of these
diseases.
2. Schemes for the diagnosis and treatment of these diseases have now been
submitted to the Local Government Board by 86 out of the 145 councils which
are charged with the execution of the regulations. The total population of the
areas of these councils is about 23,500,000. Forty-five schemes, serving a popu-
lation of over 16,000,000, have been approved and the work has already started
at 30 hospitals. It is estimated that the facilities provided at these hospitals
will serve a population of at least 12,000,000.
3. A comprehensive scheme for London and the home counties embracing 22
of the hospitals in London was inaugurated on the 1st January last. These
hospitals serve a very wide area.
4. The arrangements at the hospitals in London include, in addition to the
provision of out-patient and in-patient treatment, the following facilities : —
(i) Arrangements whereby any medical practitioner, practising in the areas
of the ten councils included in the scheme, can obtain a scientific report on any
pathological material submitted from a patient suspected to be suffering from
venereal disease.
(ii) The supply, free of cost, of salvarsan substitutes which are approved by
the Local Government Board for the treatment of syphilis, to medical practi-
tioners who are qualified to administer these drugs.
(iii) The provision at the hospitals, free of charge, of facilities for the in-
struction of medical practitioners and students in the modern methods of diag-
nosis and treatment.
(iv) The provision of facilities for competent medical practitioners to act as
clinical assistants at the clinics held at the hospitals for the treatment of these
diseases.
5. A scheme of diagnosis and treatment for the whole of the counties of Dur-
ham and Northumberland is already in partial operation. The whole of the
pathological work for this large area will be performed at the Durham Univer-
sity College of Medicine, and treatment centres for venereal diseases have been
410 SOCIAL HYGIENE
opened at the Royal Victoria Infirmary, Newcastle-on-Tyne, and the Sunder-
land Royal Infirmary. Clinics are held at the former institution on each week-
day, and at the latter on two days in each week. Treatment will shortly be
commenced also at the Durham County Hospital and the Darlington Hospital,
and negotiations are in progress for the establishment of further treatment
centres at Gateshead, Hartlepool and South Shields.
6. The scheme of the Portsmouth Town Council came into operation on the
20th February last and the necessary facilities for pathological diagnosis and
for treatment are provided at the Royal Portsmouth, Portsea and Gosport Hos-
pital. Clinics are held on three days in each week, and the area conveniently
served by this institution includes, in addition to the county borough of Ports-
mouth, parts of the counties of Hampshire and West Sussex, and the Isle of
Wight.
7. The Leicester Royal Infirmary, which serves the county of Leicestershire
and the county borough of Leicester, started operations on the 2nd instant.
Clinics are held on two days in each week, and the necessary laboratory facili-
ties for practitioners practising in the county and county borough are also pro-
vided at the hospital.
8. It is anticipated that treatment centres will be opened on the 1st April
at the Norfolk and Norwich Hospital, and the Hereford General Hospital. In
each case special clinics will be held on two days in each week.
9. Arrangements are far advanced for the commencement of work in other
areas.
A summary of the principal points in the scheme worked out by
the medical officer of health at Portsmouth is: —
(1) Treatment of venereal disease will be carried out at the Royal Hospital
under the direction of a specially trained medical officer. He will, at the com-
mencement, attend at the clinic for three days a week; should this prove insuf-
ficient, more extended attendance will be arranged. Different times will be
arranged for male and female patients, and there will be provided two beds for
each sex. The treatment provided will be free to every person who applies,
without distinction. The medical officer and staff will be appointed by the
Royal Hospital Committee of Management, and the appointments will be sub-
ject to the approval of the Local Goverment Board, who will periodically in-
spect the work carried on.
(2) Laboratory facilities in connection with the treatment and prevention
of venereal disease will be provided at the Royal Hospital by the Committee of
Management. These will be available for the medical officer in charge of the
treatment centre, poor law medical officers, medical officers of other institutions,
and medical practitioners generally.
(3) Salvarsan, or its approved substitutes, will be issued to medical practi-
tioners free of charge by the medical officer of the treatment centre and by the
medical officer of Health.
(4) Apparatus for collecting material for examination from suspected pa-
tients will be obtainable by medical practitioners on application either to the
medical officer of health at the town hall, or to the medical officer in charge of
the treatment centre, at the Royal Hospital.
NOTE AND COMMENT 411
(5) A committee shall be formed, including representatives of various public
bodies and voluntary agencies, for the purpose of advising the council in regard
to general measures which may be adopted for disseminating information as to
the scheme and generally to advance measures taken in the borough for the con-
trol of venereal disease.
The Council of the County of London will enter into agreements
with twenty-two hospitals for the following: —
(a) Enabling any medical practitioner practising in the county to obtain,
at the cost of the council, a scientific report on any material which such practi-
tioner may submit from a patient suspected to be suffering from venereal dis-
ease for the purpose of establishing the diagnosis of venereal disease.
(b) The treatment at and in the hospitals of any person of either sex suffering
from venereal disease.
(c) The supply, free of cost, to medical practitioners practising in the
country, of salvarsan or its substitutes for the treatment and prevention of the
spread of venereal disease. A list will be supplied to the hospital of all practi-
tioners in the county who satisfy the conditions specified in the Local Govern-
ment Board's circular of 29th August, 1916.
The governing body of each hospital concerned shall make arrange-
ments for: —
(a) The appointment of a committee of the hospital staff (1) to draft a scheme
for carrying out the special work at the hospital relating to the diagnosis and
treatment of venereal diseases, and (2) to organize and superintend the arrange-
ments within the hospital when such scheme has been approved by the council
and the local government board.
(b) The appointment of a competent staff, under the supervision of the head
of the hospital department concerned, for the purpose mentioned in the fore-
going paragraph (a).
(c) The provision of beds for the treatment of patients.
(d) The treatment of out-patients at evening sessions and at other suitable
times.
(e) The supply, free of cost, to approved medical practitioners, practising
in the county, of salvarsan or its substitutes.
(f) The supply, upon application, to medical practitioners practising in the
county, of apparatus for taking samples of blood, etc., and the supply of the
necessary reports to such practitioners.
(g) The examination of specimens sent by medical practitioners practising
in the county.
(h) The supply of the council each quarter of statistical information as to
work done by the hospitals.
(i) The provision, free of charge, of facilities for instruction of medical prac-
titioners and students.
412 SOCIAL HYGIENE
(j) The provision of facilities for competent medical practitioners to act as
clinical assistants at rates of remuneration approved by the committee of man-
agers of the hospital.
(k) The employment of some women doctors in clinics for women.
(1) The provision and issue of printed instructions for the guidance of (1)
patients, and (2) general practitioners in connection with the taking of samples
of blood, etc.
(m) Enabling the council's medical officer of health or his representative, to
visit the hospital at any time for the purpose of conferring with the staff carry-
ing out the scheme and of periodically examining records.
(n) Referring patients, if they are willing, to their own doctors for continued
treatment, and if the patients have no doctors, advising them to obtain the serv-
ices of doctors, if they are willing and in a position to do so.
The Local Government Board for Scotland and Ireland have issued
similar regulations to the British Local Government Board and in a
circular issued March 30, 1917, to the local authorities announcing
that "schemes for the diagnosis, treatment and prevention of venereal
diseases are in preparation and some are actually providing treatment
at present, the Board deem it advisable to authorize, as they hereby
do, all local authorities within the meaning of the Public Health
(Scotland) Act, 1897, to purchase and distribute any drug, medicine,
or medicinal preparation specially designed for the treatment of ve-
nereal diseases."
The regulation under which the purchase and distribution are war-
ranted reads: —
The Local Government Board may during the continuance of the war, au-
thorize any local authority or person to purchase and distribute any drug, medi-
cine or medicinal preparation specially designed for the treatment of venereal
diseases, and a local authority or person so authorized, and any person obtaining
a supply of any such drug, medicine, or preparation from or through them or
him, shall not be liable to any action or proceedings in respect of the importa-
tion, purchase, sale, distribution, or use thereof on the ground that any patent
or other similar rights are infringed thereby.
The Reporting of Venereal Disease in England. Dr. Arthur News-
holme, health officer of the British Local Government Board, in his
annual report for 1915-16, comments upon the recommendation of the
Royal Commission that the reporting of venereal diseases be not made
compulsory, and says that even if such notification should eventually
be required it ought not to be enforced until adequate facilities have
been provided for the gratuitous treatment of all persons suffering from
venereal diseases; and further, that treatment by unqualified persons
NOTE AND COMMENT 413
must be prohibited so that cases of venereal disease will come under
the care of competent physicians in their early stages. Under such
conditions Dr. Newsholme thinks that patients will generally seek
proper treatment either through public facilities or by their own phy-
sicians, and that it may be questioned whether notification would be
necessary.
Venereal Disease in the Italian Army. The Medicina Contemporanea
of Lisbon, February 25, 1917, gives a summary of what has been ac-
complished in the active Italian army in prophylaxis of venereal dis-
eases. Drastic measures are taken to prevent clandestine prostitution.
Women, even married women, are forced to submit to medical inspec-
tion when the concordant testimony of infected soldiers points to them
as the source of their contamination. These women recognized as
sources of venereal infection are isolated in special services and are
kept there until cured. In the course of two recent months, 277
women were thus arrested and 232 were found liable to transmit in-
fection. The military authorities have ample power to expel from the
war zone every vagabond prostitute. The brothels are inspected four
times a week, once by an army medical officer. These brothels are
installed close to the firing line, there being, for example, three at Cer-
vignano, two at Palmanova and two at Caporetto. The houses are
well installed and abundantly supplied with "preventives" and calomel
salve. The women are not allowed to admit any men but soldiers.
The establishment of these brothels caused considerable protest, as it
was argued that the regions having been deserted by the populace,
there is no occasion for the wearied soldiers to break their enforced
continence.
In regard to prophylaxis, very strict measures are enforced; the men
are given frequent " sanitary inspections," and men going out and re-
turning from a furlough are examined with special care. Talks, lec-
tures, lantern slides, moving pictures and other means are used to im-
press on the men the advantages of continence, the dangers of visiting
such women, and the consequences of venereal diseases from the point
of view of the individual, of the family and of society at large, grave if
untreated, but generally benign if treated from the start by a physi-
cian. The use of the preventive disinfection stations is also explained.
These cabinets for disinfection post coitum are installed in the different
camps in charge of a military orderly under the direction of a physician .
The results demonstrate the efficacy of the measures that have been
414 SOCIAL HYGIENE
taken and promise still more success when the projected organization is
complete. In the course of November and December, 1915, the num-
ber of cases of venereal disease recorded was 5,422 and 5,409. In the
month of April, 1916, the number was only 3,224.
Professor Stanziale of the chair of syphilography at the University of
Naples has been delivering addresses on the "Profilassi celtica" in war
time at Rome, Naples and elsewhere. He extolled the measures that
have been enforced in the war zone by the military authorities, but em-
phasized the necessity for supplementing them with coordinated meas-
ures throughout the rest of the country where soldiers on leave or pass-
ing through are free from all restraints. He urged that the whole
question of venereal prophylaxis should be placed in the hands of a
central administrative body with full powers to act, entrusting it with
the responsibility of warding off venereal diseases, and of combating
in particular clandestine prostitution which now escapes all restraining
measures according to the present laws. He advocated the organiza-
tion of special dispensaries with laboratory equipment for medical in-
spection of suspects. He emphasized the increasing prevalence of ex-
trasexual contagion, especially of syphilis, wherever there is crowding
in home or at work, above all in factories where the mutual use of tools,
dishes, etc., throws wide the portals to infection. Urgent measures
are needed as the men of the troops come and go and industrial crowd-
ing becomes more acute. He remarked in conclusion that the war has
awakened the public conscience and the state to many salutary reforms,
the benefit from which will long outlast the war, and the social prob-
lems are not the least to be considered. — The Journal of the American
Medical Association.
The Prevention of Venereal Diseases in the French Army. Reports
affirm that a considerable increase in venereal diseases has been ob-
served among the civil population, and still more among the soldiers.
There can be no doubt that an increase in clandestine prostitution is
the principal cause of this state of affairs; but it is also certain that this
epidemic has been propagated among the classes which one would have
expected to remain unaffected; and that many married women, in-
cluding the wives of men at the front, have been infected and will
ultimately contribute to the spread of the disease. On account of
the gravity of this venereal peril, the undersecretary of state for the
medical service of the army has reinforced the prophylactic measures,
particularly by creating special organizations for the diagnosis and
treatment of these diseases. These organizations are divided into (1)
NOTE AND COMMENT 415
urology, (2) dermatology and syphilology centers. To these centers are
to be sent as early as possible not only all patients with characteristic
chancres, but also those presenting the slightest suspicious erosion or
ulceration. It is expressly forbidden to keep under observation at the
regimental hospital a man presenting a suspicious ulceration in order
to clear up a doubtful diagnosis. There is one venereologic center for
each region, composed of a hospital service, a consultation service, a
dental service and a laboratory. This intensive treatment by salvar-
san and mercury is necessitated by the urgency of returning valid men
to the army as soon as possible. Orders have been issued that peri-
odic lectures on venereal diseases shall be given in all depots and in the
medical formations of the army, and that pamphlets on this subject
written in a clear and concise style shall be distributed in order to prop- -
agate correct ideas on prophylaxis. Further, the military surgeons
are called on to lend the utmost support and collaboration to the civil
authorities to insure the best possible conditions for the functioning
of the venereal service for civilians of both sexes. Daily consultations
will be given, the hours of which will vary from day to day, thus mak-
ing them accessible to all classes of patients. On the other hand, the
Ligue frangaise, being of the opinion that the present means of fighting
the extension of venereal diseases are inefficacious, has proposed that
these diseases be assimilated to other contagious diseases by the adop-
tion of quarantine. Infected women would then remain isolated in
special hospitals until cured.
The German Campaign Against Venereal Diseases. The Prussian
'medical commission has formulated the following rules of governing
the campaign against venereal diseases: (1) General rules for combat-
ing venereal disease: (a) improving the economic status of the popula-
tion so as to make early marriage possible, and to guard the female
population against delinquency; improving housing conditions and in-
stituting official supervision of homes; (b) instituting instruction on
sexual life and especially on the dangers of extramarital sexual relation-
ship and of sexual diseases; (c) improving the physical and moral status
of youth by means of gymnastics, play and sport; (d) instituting a
campaign against the misuse of alcohol ; (e) improving the diagnosis
and treatment and preventing the spread of venereal diseases; (f)'
improving the means and methods for treating venereal diseases, erect-
ing dispensaries in which such diseases can be treated, with the assur-
ance of absolute secrecy as to the identity of the individual and treat-
ing all severe cases in an institution; (g) proper instruction by the
416 SOCIAL HYGIENE
physician as to the dangers of venereal diseases, their method of spread
and especially the precautions which must be taken by one who is un-
der treatment; (h) reducing the price of the newer specific drugs, and
(i) campaign against quackery. (2) An amendment of Paragraph 180
of the imperial crime punishment regulations is urged. (3) Supervision
of prostitution, the burden of which shall hereafter fall on the medical
man and not on the police. (4) Enforcement of the law of October 28,
1905, and the ministerial edict of December 11, 1907. (5) Keeping
the prostitutes off the streets and out of public places, and segregating
them for moral as well as police reasons. — Journal of the American
Medical Association.
- Social Hygiene in New South Wales. Three or four years ago the
Royal Commission declared that out of every 100 young men in
Australia under twenty-five years of age, 80 were suffering from gonor-
rhea. The publication, a little later, of the report on venereal dis-
eases by a select committee appointed by the Legislative Council of
New South Wales to investigate the subject, and an additional report
of a committee appointed by the Commonwealth authorities, aroused
the general public to the fact that some instruction in sex hygiene was
essential to the welfare of the community.
Especially active in promoting this work, have been the various
women's organizations. A year ago the Women's Progressive Asso-
ciation urged the appointment of police women, the establishment of
an industrial farm for women off the streets, the raising of the age of
consent to twenty-one years, and some system of instruction in sex
hygiene. The Feminist Club has had the teaching of sex hygiene on
its program for some time, and last year arranged for a series of lectures
on the evolution of 'sex. The Parents and Citizens' Association also
has taken up the matter of sex education and has appointed a commit-
tee to consider ways and means of carrying out the proposals made at
their last conference.
An Association for Public Health and Morals was formed by dele-
gates from the various women's organizations of Sydney at a conference
held in June, and an Interstate Conference has been planned by the
Educational Association at which the question of sex hygiene and edu-
cation will be considered and the proceedings printed for public infor-
mation. With so many forces at work, it will not be long before the
young people of Australia are more carefully protected from venereal
and allied diseases. — The Sunday Times, Sidney, Australia.
SOCIAL HYGIENE AND THE WAR
WILLIAM F. SNOW, M.D.
General Secretary, The American Social Hygiene Association; Secretary, General
Medical Board, Council of National Defense
War was declared April 5, 1917, and immediately the nation
had a condition and not a theory to face.
The President from time to time in the weeks which followed
voiced the growing conviction of the people "that in a democ-
racy the duty to serve and the privilege to serve fall upon all
alike." In his registration day address he said: —
There is something very fine, my fellow citizens, in the spirit of the
volunteer, but deeper than the volunteer spirit is the spirit of obliga-
tion. There is not a man of us who must not hold himself ready to
be summoned to the duty of supporting the great government under
which we live. No really thoughtful and patriotic man is jealous of
that obligation. No man who really understands the privilege and
the dignity of being an American citizen quarrels for a moment with
the idea that the Congress of the United States has the right to call
upon whom it will to serve the Nation. These solemn lines of young
men going today all over the Union to the places of registration ought
to be a signal to the world, to those who dare to flout the dignity and
honor and rights of the United States, that all her manhood will flock
to that standard under which we all delight to serve, and that he who
challenges the rights and principles of the United States challenges
the united strength and devotion of a Nation.
Again, in his flag day address :
We meet to celebrate Flag Day because this flag which we honor
and under which we serve is the emblem of our unity, our power, our
thought and purpose as a Nation. It has no other character than
that which we give it from generation to generation. The choices
are ours. It floats in majestic silence above the hosts that execute
those choices, whether in peace or in war. And yet, though silent, it
417
418 SOCIAL HYGIENE
speaks to us — speaks to us of the past, of the men and women who
went before us and of the records they wrote upon it. We celebrate
the day of its birth; and from its birth until now it has witnessed a
great history, has floated on high the symbol of great events, of a great
plan of life worked out by a great people. We are about to .carry it
into battle, to lift it where it will draw the fire of our enemies. We
are about to bid thousands, hundreds of thousands, it may be mil-
lions, of our men, the young, the strong, the capable men of the Nation,
to go forth and die beneath it on fields of blood far away — for what?
For some unaccustomed thing? For something for which it has never
sought the fire before? American armies were never before sent
across the seas. Why are they sent now? For some new purpose,
for which this great flag has never been carried before, or for some old,
familiar, heroic purpose for which it has seen men, its own men, die
on every battle field upon which Americans have borne arms since the
Revolution? These are questions which must be answered. We are
Americans. We in our turn serve America, and can serve her with
no private purpose. We must use her flag as she has always used it.
We are accountable at the bar of history and must plead in utter
frankness what purpose it is we seek to serve.
From the beginning of preparation for this war medical pre-
paredness and conservation of moral standards of both mili-
tary and civil population have been under consideration. A
new attitude toward vice and venereal diseases has been
evident.
It was generally recognized by those interested in social hy-
giene that the government must declare a definite policy and
provide for carrying it into effect if a million men or more were
to be called to the colors without having their efficiency seriously
impaired by vice and venereal disease. It was also recognized
that war conditions would accentuate the need for adequate
civil control of prostitution, alcohol, and exposure to syphilis
and gonococcus infection. Accordingly, conferences were ar-
ranged with officers of the government upon ways in which state
and local resources could be made to supplement the federal
resources for combating these evils.
Without attempting even to summarize all the agencies which
have participated in bringing about the actions taken since the
SOCIAL HYGIENE AND THE WAR 419
Woodrow Wilson, President of the United States, authorized by Act of Congress
to protect the military forces of the United States from the evils resulting from the
use of alcohol.
420 SOCIAL HYGIENE
beginning of the war, a few outstanding facts may be cited as
indicative of the great progress of the social hygiene movement
which may be expected as one of the results of America's en-
trance into the conflict.
1. The President of the United States, by direct authoriza-
tion of Congress, will endeavor to protect the military forces
from the evils resulting from the use of alcohol.
2. Congress has empowered and directed the Secretary of
War to establish and regulate such zones about military places
as may be necessary to protect soldiers from prostitution.
3. The Secretary of War has created a Commission on Train-
ing Camp Activities for the purpose of suppressing vice in mili-
tary camps and surrounding zones and of counteracting harm-
ful influences by a constructive program of entertainment,
education, recreation, physical contests, and social activities
participated in by both military and civil populations under
auspices approved by the Commission.
4. The Secretary of the Navy has taken steps to safeguard
the officers and men of the naval establishment by a similar com-
mission. This work is closely correlated with that for the War
Department through having one chairman for both Commissions.
5. The Council of National Defense has considered social
hygiene questions to be of first rank among the problems of
nation-wide preparedness for this war, and has adopted resolu-
tions which clearly define its policy to be favorable to the carry-
ing out of a comprehensive social hygiene program.
6. The Surgeons General of the Army, Navy, and Public
Health Service have endorsed the program outlined and have
planned administrative measures in accordance with it.
7. The General Medical Board of the Council is devoting
every effort to the study and solution of unsettled questions
bearing on the details of this program.
8. The American Red Cross through its Director General of
Military Relief and the personnel of its hospital units is planning
cooperation particularly in the foreign field.
9. The War Work Council of the Young Men's Christian
Association, through its activities including sex education and
its leadership of other correlated national agencies working
SOCIAL HYGIENE AND THE WAR 421
under the supervision of the Commission on Training Camp
Activities inside the camps and designated zones, is exerting a
powerful influence in maintaining the moral tone of camp life
and standards of conduct of the individual soldiers.
10. The American Social Hygiene Association, through its
cooperation with the departments of government on the one
hand and the civil authorities on the other, is serving as a clear-
ing house for social hygiene societies and allied agencies par-
ticularly in the medical and hygienic phases of the work and in
organizing public opinion in support of the measures adopted.
11. The American Playground Association has raised a spe-
cial fund and has begun vitally important work in improving the
environmental conditions about the camps and cantonments.
12. Other national and local volunteer agencies are at work
in various practical ways of value in the complete program.
This program in topical form may be stated as follows as it
relates to the venereal diseases: —
I. Measures under Military Auspices
1. Printed and personal advice to every man applying or
drafted for enlistment to include information upon the venereal
diseases.
2. Protection so far as possible of all accepted applicants
from time of acceptance to arrival at the concentration camp,
and during furloughs to destinations outside the military zones.
3. Medical examination of all recruits to include —
(a) Preliminary inspection for syphilis or gonorrhea on en-
listment; (b) final examination including the Wassermann
reaction at the cantonment.
4. Exclusion of prostitution and alcohol from all camps and
surrounding zones.
5. Arrangements in camps and military zones for recreation,
entertainment, social activities, and education.
6. Instruction of officers and men in the epidemiology of
syphilis and gonorrhea.
7. Requirement of early prophylactic treatment for all officers
and men exposed to infection.
422 SOCIAL HYGIENE
8. Follow-up treatment of all infected cases, including trans-
fer to isolation camps or base hospitals when necessary, and
appointment of genito-urinary and other specialists to special
services in treatment and supervision of cases.
9. The detail of medical officers for carrying out the measures
adopted, as a part of the program for control of infectious
diseases.
10. Issuance of such printed matter, regulations, and authori-
zations as may be necessary to give effect to the measures
adopted, and to give assurance of close cooperation between the
military and civil authorities in all measures affecting the dis-
semination of the venereal diseases.
II. Measures under Civil Auspices
1. Education of public opinion in support of the necessary
measures.
2. Enactment and enforcement of civil measures equivalent
to those adopted by military authorities.
3. Institution of special temporary measures to aid in the
protection of enlisted men passing through towns and cities en
route to mobilization camps.
4. Establishment of advisory and dispensary facilities under
such auspices as will most effectively provide for the venereal
diseases among civilians.
5. Correlation of all activities indirectly of importance in
combating the venereal diseases.
III. Problems under Special Consideration
1. The protection and control of girls and women among the
civil population within military zones and accessible to military
and naval establishments.
2. The securing of an adequate supply of salvarsan for mili-
tary and civil needs.
3. The determination of public health and other civil admin-
istrative policies bearing upon the eradication of these diseases
SOCIAL HYGIENE AND THE WAR 423
among groups not directly related to the military forces but of
importance to national efficiency at this time.
4. The promotion of a practical program of sex education for
the civil population.
5. The examination of men for discharge from the govern-
ment service, and transfer to civil supervision of those dis-
charged with syphilis or gonorrhea in a communicable stage.
The first of the measures under military auspices was originally
begun by recruiting officers cooperating with the American Social
Hygiene Association by direction of the Secretaries of War
and the Navy during mobilization along the Mexican border.
A further development of this cooperation is planned by the
War Department in an effort to begin the protection of the
recruit before he leaves home. The second measure is like-
wise one in which the military authorities must depend largely
upon civilian cooperation, and plans have been made for the
correlation of unobtrusive activities of many agencies. The
remaining measures under military auspices are under the
immediate direction of the Surgeons-General except four and
five which deal with prostitution, alcohol, and recreation ; and for
which the training camp commissions are primarily responsible.
The measures under civil auspices are not essentially different
from those adopted by the Army and Navy, but the large
number of local authorities to be consulted complicates the
situation. The American Social Hygiene Association and the
state and municipal societies are redoubling their efforts to
create public opinion in support of the program. The partici-
pation of many organizations of nation-wide influence may be
depended on to secure action in matters of law enforcement,
protection of girls, entertainment, and recreation. The Young
Women's Christian Association, the Traveler's Aid Society, the
General Federation of Women's Clubs, the Intercollegiate
Alumnae, the Woman's Christian Temperance Union are types
of organizations which are quietly and effectively organizing
civilian resources for the entertainment and protection of en-
listed men passing through towns and cities en route to military
camps and cantonments. The medical profession and hos-
I
424 SOCIAL HYGIENE
pital and public health authorities are also showing a keen
interest in providing adequate advisory and treatment facilities
for civilians.
The Council's Committee on Venereal Diseases has under
consideration many important suggestions upon special prob-
lems and details of the program outlined. The five of these
specified are indicative of their variety and scope. Some of
them seem well-nigh hopeless, but by way of encouragement it
should be constantly borne in mind that the social hygiene
movement is the outgrowth of many converging efforts of socie-
ties, alliances, and organizations that have struggled during the
past quarter of a century for public recognition of the untold
misery, sickness, inefficiency, and economic waste which result
from the commercialization of prostitution and the unchecked
ravages of venereal diseases. Had it not been for the patient
endeavor of a few hundreds of these far-seeing pioneers, among
whom stand out only a dozen or more whose names have re-
ceived national recognition in this connection, there could be
no concerted plan such as the Army, Navy, and civil author-
ities are now about to put to the test.
The challenge is squarely before the American people today.
As indicated above, the President of the United States, the
Congress, the secretaries of War and Navy, the other cabinet
members of the Council of National Defense, the Secretary of the
Treasury, the members of the Advisory Commission, the chief
medical and line officers of the military and naval establishments,
the General Medical Board of the Council, and its Committee
on Hygiene and Sanitation including the sub-committees on
venereal diseases and alcohol, the Commission on Training
Camp Activities have all placed themselves on record as favor-
ing an effective campaign to protect the American troops from
vice and disease. As evidence of serious purpose and good
faith, each of these governmental agencies, immediately after
the declaration of war, took such action and has devoted such
study as has been required in developing the program which
it is proposed shall be followed.
. How successful the United States may be in dealing with this
SOCIAL HYGIENE AND THE WAR 425
problem of preventive medicine and conservation of moral
standards now depends largely upon the degree of administrative
efficiency attained. The Army and Navy have declared their
intention to do their part; the civil population must be
roused to do its part. The social hygiene societies par-
ticularly have a great opportunity and a great responsi-
bility. All the results of pioneer work in this field for the
past twenty-five years — in one sense of all the centuries in
which society has been building up its moral standards for the
safeguarding of the race and equipping itself with scientific
knowledge of the venereal diseases — are in their hands for ap-
plication. If these are wisely applied during the war, the Amer-
ican nation will demonstrate a victory over disease and moral
disaster which will rival its epoch-making record in master-
ing yellow fever during the war with Spain. As in that problem
of preventive medicine, so in this, the civilian forces have a part
to play, but in the prevention of venereal diseases the Army
and Navy have far more need for and the civilian population
as a whole has far more to gain by intelligent and adequate
cooperation than in the combating of yellow fever and malaria.
The government is about to call to the colors at least five
hundred thousand young men in the prime of life. These men
are the trustees of five hundred thousand combinations of char-
acter units which future generations should receive and mould
for the nation's further progress. Some of these heredities
must of necessity be cut off in the stress and strain of battle,
but no man, woman, or child should be permitted to be crippled
mentally, morally, or physically through society's failure to
apply the safeguards now recognized in the prevention of syphilis
and gonococcus infections, and in the no less damaging undermin-
ing of character which accompanies sexual license.
The Army and Navy have studied and experimented and
appealed to the civil authorities for years. Similar studies, ex-
periments, and appeals have been made by civilian groups. The
present program is the outgrowth of past experience plus the better
understanding which has come from the demonstration of ways
and means afforded by the mobilization of troops on the Mexican
426 SOCIAL HYGIENE
border in the summer of 1916. Clearly, if the American people
intend to stand behind the administration in the effort to main-
tain the nation's efficiency during this war, the leaders among the
men and women of every town and village in the United States
must include social hygiene in their plans for preparedness.
The following letters and resolutions selected as types from
many are full of encouragement for the social hygiene worker.
Some of them, such as Secretary Baker's letter, are destined to
become historically important not only in the annals of this
campaign against the last of the great uncontrolled groups of
communicable diseases afflicting mankind, but in the annals as
well of advances in safeguarding the moral standards of the
nation and educating the people to an understanding of the
meaning of rational sex life.
The Committee on Hygiene and Sanitation of the General Medical
Board Recognizes the Importance of Prompt Action
The venereal diseases. Among the communicable diseases disseminated
through human contacts, syphilis and gonorrhea are preeminently of first im-
portance in their bearing upon military efficiency. Under present conditions
it is vitally essential that a practical program for the control of these diseases
be adopted and immediately placed in operation. This program will include
at least three lines of effort.
1. Discovery, treatment, and supervision of individuals infected.
2. Instruction and protection of individuals not infected.
3. Investigation, demonstration, and public education directed toward the
development of more effective measures than are at present applicable.
The epidemiology of the venereal diseases is such that military and civil
requirements for their control are interdependent, and are closely related to the
problems of control of prostitution and alcohol.
Following the experience of the English government in appointing the Royal
Commission on Venereal Diseases for the purpose of studying this question and
creating an informed public opinion through the hearings and sittings of the
Commission, it would seem advisable that the Committee on Hygiene and
Sanitation should hold at an early date a hearing on this subject inviting for
the purpose prominent sanitarians, urologists, dermatologists, syphilologists,
genito-urinary specialists, and representatives of social hygiene and welfare
agencies.
The above paragraphs were incorporated in an outline of the
committee's plan of activities adopted April 12, one week after
war was declared. The committee's report was adopted by the
SOCIAL HYGIENE AND THE WAR
427
Newton D. Baker, Secretary of War, empowered and directed by an Act of Con-
gress "to do everything by him deemed necessary" to protect men in military train-
ing from prostitution.
428 SOCIAL HYGIENE
General Medical Board and the first hearing arranged for April
15, 1917. Resolutions, unanimously endorsed at the hearing,
were presented to the executive committee of the General
Medical Board, amended, adopted, and formally brought before
the Advisory Commission and the Council for approval, final
favorable action being taken April 21, 1917.
May 7, 1917.
Resolutions of the Committee on Hygiene and Sanitation, as
Amended and Adopted.
WHEREAS, venereal infections are among the most serious and disabling dis-
eases to which the soldier and sailor are liable;
WHEREAS, they constitute a grave menace to the civil population;
Therefore, the Committee on Hygiene and Sanitation of the General Medical
Board of the Council of National Defense, recommends that the General Medi-
cal Board transmit to the Council of National Defense for the guidance of the
War and Navy Departments the following recommendations: —
1. That the Departments of War and Navy officially recognize that sexual
continence is compatible with health and that it is the best prevention of venereal
infections.
2. That the Departments of War and Navy take steps toward the prevention
of venereal infections through the exclusion of prostitutes within an effective
zone surrounding all places under their control, and by the provision of suitable
recreational facilities, the control of the use of alcoholic drinks, and other
effective measures.
3. That the said Departments adopt a plan for centralized control oT venereal
infections through special divisions of their medical services.
4. That the said Departments consider the plan of organization herewith
attached.
WHEREAS, the use of alcoholic beverages is generally recognized as an im-
portant factor in the spread of venereal disease in the Army and Navy; and
WHEREAS, these diseases are among the most serious and disabling ones to
which soldiers and sailors are liable;
Therefore, be it resolved that we endorse the action of the Army and Navy in
prohibiting alcoholic beverages within military places in their control and we
further re'commend that the sale or use of alcoholic beverages be prohibited to
soldiers and sailors within an effective zone about such places.
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430 SOCIAL HYGIENE
A News Item Sent to the Press of the United States by the Council of
National Defense
THE CONTROL OF VENEREAL DISEASES AND THE REGULATION OF THE USE OF
ALCOHOL IN THE ARMY AND NAVY
ACTION BY THE COUNCIL OF NATIONAL DEFENSE UPON RECOMMENDATION OF THE
GENERAL MEDICAL BOARD
As a strict war measure, the Council of National Defense has taken decisive
steps for the hygienic and mental welfare of the soldiers and sailors of the nation.
It has struck at the presence of venereal diseases and at alcoholism in all military
commands.
Guided by the General Medical Board, which is constantly studying medical
problems in connection with the Army and Navy mobilization, the decisions of
the Council are these : First, that under military control an effective zone shall
be created about all military commands as the most practicable and effective
measure to prevent venereal diseases. Second, that these military zones shall
serve also as a means of control of alcoholic beverages to the troops. These
decisions are reached by the Council after exhaustive study of conditions today
among great European armies.
Zones about the military commands will, therefore, be created and conditions
in these zones will be guarded by military measures so as to prevent the spread
of venereal diseases. The two military arms of the government officially recog-
nize that continence is compatible with health.
The Council also recommends, as a further solution of the problem, that all
military commands be provided with good facilities for the recreation of the
troops. It urges that all suitable athletics be encouraged.
The use of alcoholic beverages on the part of soldiers and sailors in military
commands has long been under military control. But the creation now of these
military zones will in effect extend such control over the troops when they are
off duty out of the commands.
"To face these ugly facts in an unflinching and no half-hearted fashion."
said Dr. Franklin H. Martin, member of the Advisory Commission of the Coun-
cil of National Defense, "makes for the fighting power of the nation. But
our troops are inseparably a part of our civil life, and a clean, wholesome, tem-
perate life among these troops will in the end make for our civil advancement,
compared to which the cost of the war is nothing. The whole nation is indebted
to the General Medical Board for its thorough-going research, and for its definite
recommendations in the matter of real protection to our boys."
The recommendations were unanimously approved by the members of the
General Medical Board, and by other men of National prominence who attended
the first hearing on these important problems, as follows:
SOCIAL HYGIENE AND THE WAR 431
Surgeon General William C. Gorgas, U.S.A., Surgeon General William C.
Braisted, U.S.N., Surgeon General Rupert Blue, U.S.P.H.S., Colonel Jefferson
R. Kean, American Red Cross, Rear Admiral Gary Grayson, Dr. H. W. Wiley,
Dr. William C. Woodward, Dr. William C. Rucker, Prof. Earl Phelps, Dr.
Sterling Ruffin, Dr. William A. White, Dr. George M. Kober, Washington; Dr.
Charles H. Peck. Dr. George E. Brewer, Dr. Simon Flexner, Dr. Hermann M.
Biggs, Arthur Hunter, Prof. Charles B. Davenport, Prof. Marsten Bogert, V.
Everit Macy, Dr. Haven Emerson, Prof. Edward T. Devine, Dr. Eugene Lyman
Fisk, Homer Folks, Dr. John A. Fordyce, Dr. Edward L. Keyes,, Jr., Dr. Victor
C. Pederson, Raymond B. Fosdick, Abraham Flexner, Dr. J. Bently Squier,
Dr. William F. Snow, New York City ; Dr. William H. Welch, Dr. Winford Smith,
Dr. John M. T. Finney, Dr. Theodore Janeway, Dr. George Walker, Dr. W. H.
Howell, Dr. Donald R. Hooker, Baltimore; Dr. Edward Martin, Dr. Edward P.
Davis, Dr. Edward C. Kirk, Dr. Alonzo Taylor, Philadelphia; Dr. Franklin Mar-
tin, Dr. Frederic A. Besley, Dr. George H. Simmons, Dr. Ludwig Hecktoen,
Dr. W. A. Evans, Dr. William A. Pusey, Chicago; Dr. William J. Mayo, Dr.
Charles H. Mayo, Rochester, Minn.; Dr. Victor C. Vaughan, Prof. Warren P.
Lombard, Ann Arbor; Dr. George W. Crile, Dr. William E. Lower, Cleveland;
Dr. Richard P. Strong, Dr. Walter B. Cannon, Dr. Richard C. Cabot, Dr. R. F.
O'Neill, Dr. Charles J. White, Dr. A. J. McLaughlin, Boston; Prof. Thomas N.
Carver, Dr. M. J. Rosenau, Cambridge; Dr. Frank F. Simpson, Pittsburgh;
Dr. Joseph M. Flint, Prof. Irving Fisher, New Haven; Dr. Stuart McGuire,
Richmond; Dr. John Young Brown, St. Louis; Dr. Thomas W. Huntington, San
Francisco; Dr. Hubert A. Royster, Raleigh; Frank A. Fetter, Princeton; S. S.
Kresge, Detroit; Dr. Alec N. Thomson, Brooklyn; Dr. Charles F. Stokes,
Warwick.
Congress Specifically Empowers the President and Secretary of
War to Deal with the Social Hygiene Problem
In order to make certain that the military authorities of the
United States should have ample authority to safeguard their
troops, Congress added the following sections to the "Act to
Authorize the President to Increase Temporarily the Military
Establishment of the United States:"1
SELECTIVE CONSCRIPTION LAW, SECTIONS 12, 13 AND 14
SEC. 12. That the President of the United States, as commander in chief of
the Army, is authorized to make such regulations governing the prohibition of
alcoholic liquors in or near military camps and to the officers and enlisted men
of the Army as he may from time to time deem necessary or advisable ; Provided,
That no person, corporation, partnership, or association shall sell, supply, or
have in his or its possession any intoxicating or spiritous liquors at any military
!H. R. 3545, approved May 18, 1917.
432 SOCIAL HYGIENE
station, cantonment, camp, fort, post, officers' or enlisted men's club, which is
being used at the time for military purposes under this act, but the Secretary
of War may make regulations permitting the sale and use of intoxicating liquors
for medicinal purposes. It shall be unlawful to sell any intoxicating liquor,
including beer, ale, or wine, to any officer or member of the military forces while
in uniform, except as herein provided. Any person, corporation, partnership,
or association violating the provisions of this section or the regulations made
thereunder shall, unless otherwise punishable under the Articles of War, be
deemed guilty of a misdemeanor and be punished by a fine of not more than
$1000 or imprisonment for not more than 12 months, or both.
SEC. 13. That the Secretary of War is hereby authorized, empowered, and
directed during the present war to do everything by him deemed necessary to
suppress and prevent the keeping or setting up of houses of ill fame, brothels,
or bawdy houses within such distance as he may deem needful of any military
camp, station, fort, post, cantonment, training, or mobilization place, and any
person, corporation, partnership, or association receiving or permitting to be
received for immoral purposes any person into any place, structure, or building
used for the purpose of lewdness, assignation, or prostitution within such dis-
tance of said places as may be designated, or shall permit any such person to
remain for immoral purposes in any such place, structure, or building as afore-
said, or who shall violate any order, rule or regulation issued to carry out the
object and purpose of this section shall, unless otherwise punishable under the
Articles of War, be deemed guilty of a misdemeanor and be punished by a fine
of not more than $1000 or imprisonment for not more than 12 months, or both.
SEC. 14. That all laws and parts of laws in conflict with the provisions of this
act are hereby suspended dViring the period of this emergency.
The Secretary of War Acts
On May 26th the Secretary of War addressed to the governors
of all the states and the chairmen of the state councils of defense
the letter previously mentioned which, for its historical interest
and importance is reproduced in fac simile.
SOCIAL HYGIENE AND THE WAR 433
Letter addressed by Secretary of War Newton D. Baker to the Governors of all
the States and the Chairmen of the State Councils of Defense, May 26, 1917.
COUNCIL OF NATIONAL DEFENSE
WASHINGTON
Uay 26, 1917.
Dear Sir:
I am very anxious to bring to the attention of the State
Councils of Defense a natter in which they can be of great service to the
Ear Department. In the training caraps already established or soon to be
established large bodies of men, selected primarily from the youth of the
country, will be gathered together for a period of intensive discipline
and training. The greater proportion of this force probably will be made
up of young men who have not yet become accustomed to contact with either
the saloon or the prostitute, arid who will be at that plastic and generous
period of life when their service to their country should be surrounded by
safeguards against temptations to which they are not accustomed.
Our responsibility in this matter is not open to question.
We cannot allow these young men, most of whom will have been drafted to
service, to be surrounded by a vicious and demoralizing environment, nor
can we leave anything undone which will protect them' from unhealthy influ-
ences and crude forras of temptation. Not only have we an inescapable re-
sponsibility in this matter to the families and communities from which these
young men are selected, but, from the standpoint of our duty and our deter-
mination to create an efficient army, we are bound, as a military necessity.
434 SOCIAL HYGIENE
to do everything in our power to promote the. health and conserve the vital-
,ity of the men in the training camps.
I an determined that our new training camps, as well as the
surrounding zones within an effective radius, shall not be places cf temp-
'tation and peril. The amendments to the Army Bill recently passed, a copy
of which I enclose herewith (Sections 12 and 13), give the '.Var Department
more authority in this matter than we previously possessed. Cn the other
hand, we are not going to be able to obtain the conditions necessary to the
health and vitality of our soldiers, without the full cooperation of the
local authorities in the cities and towns near which our camps are located,
or through which cur soldiers will be passing in transit to other points.
Will you give earnest consideration to this matter in your
particular State? I aa confident that much can be done to arouse the cities
and towns to an appreciation of their responsibility for clean conditions;
and I would suggest that, through such channels as nay present themselves
to you, you impress upon these communities their patriotic opportunity in
this matter. I would further suggest that as an integral part of the war
machinery your Council make itself responsible for seeing that the laws of
your State and of Congress in respect to these matters are strictly enforced.
This relates not only to the camps established under Federal authority,
both the present officers' training carnps and the divisional training carnps
soon to be opened, but to the more or less temporary mobilization points of
the national guard units. It relates, too, as I have indicated, to the
large centers through which soldiers will constantly be passing in transit
to other points.
SOCIAL HYGIENE AND THE WAR 435
- 3 -
As I say, the Y/ar Department intends to do its full part i»
these natters, but we expect the cooperation and support of the local
communities. If the desired end cannot otherwise be achieved, I propose
to move the caraps from those neighborhoods in which clean conditions
cannot be secured.
In this connection let me call your attention to the Commission"
on Training Camp Activities which I have organized to advise with me on
questions relating to the moral hazards in our training centers, as well
as to the promotion of rat^ojial recreation facilities within and without
the camps. The members of this commission are as follows:
Raymond B. Fosdick, Chairman
Lee F. Haruner
Thomas J. Howells
Joseph Lee
Malcolm L. UcBride
John R. Llott
Charles P. Neill
Major Palmer E. Pierce, U.S.A.
Joseph E. Raycroft
It is possible that the chairman of this commission or some of its mem-
bers will consult with you in regard to the activities which they have
in hand. I bespeak for them your utmost support and cooperation.
Very truly yours,
Secretary of War
and
Chairman of the Council of National Defense.
Enclosure
436 SOCIAL HYGIENE
The Secretary of the Navy Makes his Position Clear
In consequence of vicious conditions reported to exist in New-
port, R. I., Secretary Daniels issued the following statement,
June 20, 1917:-
Having received numerous complaints of immoral conditions at the city of
Newport, R. I., from citizens of Newport and from the parents of many of the
young men now gathered there in the great Naval Training Station and the en-
campment of the Naval Reserve, I deemed it proper to call the matter to the
attention of the governor of Rhode Island.
In reply the governor returned to this department a report from the mayor
of Newport, representing that there was no unusual degree of immorality in
that city, denying the truth and justice of the complaints, and generally min-
imizing the situation. Thereupon this department, through its own agents and
with the assistance of the Department of Justice instituted an investigation at
first hand. As a result of that investigation, I have just sent to the governor of
Rhode Island a list in detail of some of the most notorious houses of prostitution
and open gambling houses in Newport, also calling his attention to the extent
and methods of illegal sale of liquor to sailors and Naval Reserve recruits, and
informing him that the department is ready to furnish him with further specific
evidence if the State's own officers do not produce it.
SACRED TRUST FOR GOVERNMENT
At Newport and other places are gathered several thousands of the finest
youth of the land who have offered their lives for the service of their country at
a time when this sacrifice is no figure of speech. Most of them have come from
carefully guarded homes, and their parents have given them to their country in
sacred trust that the Government will safeguard them from unnecessary perils.
I am charged with the duty of training these young men for service in the
Navy. State and local officers are charged with the duty of seeing that the laws
of their States and of the United States are faithfully executed. There lies
upon us morally, to a degree far outreaching any technical responsibility, the
duty of leaving nothing undone to protect these young men from that contami-
nation of their bodies which will not only impair their military efficiency but
blast their lives for the future and return them to their homes a source of dan-
ger to their families and to the community at large.
DANGERS MULTIPLIED IN WAR
These dangers are bad enough in ordinary times; in time of war, when great
bodies of men are necessarily gathered together away from the restraints of
home, and under the stress of emotions whose reactions inevitably tend to dis-
lodge the standards of normal life, they are multiplied manifold, and the harpies
of the underworld flock to make profit out of the opportunity. If we fail in
vigilance under these conditions the mothers and fathers of these lads and the
country generally will rightly hold us responsible.
SOCIAL HYGIENE AND THE WAR 437
I feel confident that the governor of Rhode Island and the local officers re-
sponsible to him, and the civil authorities at other places where the Navy has
gathered large numbers of men enlisted for service, will appreciate the vital
importance of this matter and will take such steps as will make unnecessary any
further steps by the Government of the United States. I am determined that,
so far as this department is concerned, nothing shall be left undone that is pos-
sible to discharge the duty of protecting these lads who have been committed
to our care.
The Commission on Training Camp Activities and Its Program of
Work
Mr. Raymond B. Fosdick, Chairman of the Commission, in
discussing the work of the Commission on Training Camp
Activities has said: —
June 8, 1917.
Our Commission has two distinct functions: First, we are charged with the
responsibility of keeping the Secretary of War informed as to conditions in train-
ing camps and the zones surrounding them. Secretary Baker is determined that
the training camps shall be as free from vice and drunkenness as it is humanly
possible to make them. In the second place, our task is to coordinate the dif-
ferent agencies that are seeking an opportunity for service among the soldiers.
We are operating as a clearing house to eliminate the waste and competition of
overlapping organizations, at the same time stimulating rational recreational
facilities.
Our first function is aimed, of course, at the elimination of the evils that
nearly always have been associated with army life in America, and in Europe
as well. Our boys are to be drafted into service. We cannot afford to draft
them into a demoralizing environment. The responsibility of the Government
is doubly obvious in view of the measure of conscription. A man might volun-
teer for service and run his chance with vicious surroundings; but when conscrip-
tion comes into play, the Government itself must assume the responsibility for
eliminating these evils. It is a responsibility which we owe to the men, to their
families, and to the communities from which they come.
The amendments to the Army bill will, of course, be of immense aid to the
Government in carrying out this purpose. Other instruments, however, can
be employed. It will be possible in many cases I believe, to secure the coopera-
tion of the local Government officials to keep local conditions clean. When
such cooperation is not possible, and in the failure of all other attempts on the
part of the Government to eliminate vicious surroundings, it is the intention of
the Secretary of War to move the camp.
On the positive side of our program is the necessity of competing with what
I have termed "demoralizing influences," such as the saloon and the vice resort.
This function of our work divides itself naturally into several lines. Within
the camp, the activities of the Y. M. C. A., an organization now officially recog-
nized by an executive order of the President, as Commander in Chief of the armies,
438 SOCIAL HYGIENE
form an important part in the recreational program. In connection with the
work, but under the direct control of the army, is the promotion of athletic
sports and games such as are now carried on in England under the Aldershot
plan, and promoted to a large extent in Canada. Briefly, these games are built
up on the inter-unit system, their idea being to develop the competitive instinct
in the soldier. Boxing, wrestling, bayonet exercise, and all forms of hard physi-
cal games are followed. Everybody must take part. Squads compete with
squads, companies with companies, regiments with regiments, brigades with
brigades, and divisions with divisions.
A member of the British Mission recently in Washington, Colonel Goodwin,
told me that these games, which had been encouraged, in fact, enforced by the
army officials in France, were one of the great influences in keeping men sane
and balanced behind the lines. The War College in Washington now has under
consideration an adaptation of the Aldershot system, submitted by our com-
mission. It will be carried out, I believe, in all the camps in the United States.
Another important function lies in the line of cooperation between camps and
the communities in the neighborhood — to make the community feel its respon-
sibility for providing amusement and recreation, and plenty of amusement and
recreation for men on leave. Joseph Lee, a member of the commission, is him-
self President of the Playground and Recreation Association of America, and has
general charge under the commission of this important activity. We shall have
an expert community organizer in every town or city in the neighborhood of all the
camps in the United States, whose aim it will be to coordinate all such activities.
Just at present we have thirteen of these trained men in the communities nearest
the thirteen Reserve Officers' Training Camps now opening up. Dr. Rowland
Haynes, for example, is representing us at Plattsburg; through his efforts a local
committee has been organized, and all agencies intending to work in Plattsburg
will find full scope for their plans in the large program that has been laid out.
At the same time overlapping will be eliminated.
In some communities, for example, outside the camps, women's organizations
will run "canteens" for the soldiers, where food and tobacco can be obtained at
cost prices, and where an opportunity will be afforded for meeting and talking
with women of the right sort. In Toronto the "Take the Soldier Home for Din-
ner Movement" was organized, and through this agency a number of men found
homes where they were welcome to visit whenever they were on leave in the city.
Work of this kind can be multiplied almost indefinitely.
Too many of the evils surrounding camp life in the past are traceable to the
lack of adequate amusement and rational recreation for the soldier. Our
commission does not intend to attempt to apply impracticable idealistic stand-
ards. We shall be dealing with a fine lot of healthy, red-blooded men, and we
must have healthy, red-blooded forms of recreation. My point is that there
must be plenty of it to absorb the surplus energies of the soldiers in their hours
of relaxation.
SOCIAL HYGIENE AND THE WAR 439
Early Action by the Interurban Clinical Club
THE PRESBYTERIAN HOSPITAL,
New York, April 16, 1917.
William C. Gorgas, Surgeon-General,
United States Army,
Washington, D. C.
SIR:
At a meeting of the Interurban Clinical Club in Boston, April 13th, the under-
signed who represent all the members present, formulated the following request
which they hope you will consider with all seriousness: —
"That steps be taken to instruct officers in the early diagnosis of syphilis
by modern laboratory methods and the importance of early diagnosis and
treatment.
"That a standard method of the treatment of syphilis be established, and
made obligatory, and that suitable facilities and suitably trained persons be pro-
vided in connection with all large bodies of troops to carry out these measures.
"And further recommend that a board be appointed to institute measures
for strict exclusion of prostitutes from the vicinity of camps and the prevention
of venereal disease."
[SIGNED] DR. R. C. CABOT, Boston,
DR. H. A. CHRISTIAN, Boston,
DR. D. C. EDSALL, Boston,
DR. E. P. JOSLIN, Boston,
DR. F. T. LORD, Boston,
DR. E. A. LOCKE, Boston,
DR. J. H. PRATT, Boston,
DR. GEORGE BLUMER, New Haven,
DR. W. TILESTON, New Haven,
DR. RTJFUS COLE, New York,
DR. W. T. LONGCOPE, New York,
DR. F. S. MEARA, New York,
DR. R. H. M. LANDIS, Philadelphia,
DR. T. McCRAE, Philadelphia,
DR. G. W. NORRIS, Philadelphia,
DR. D. RIESMAN, Philadelphia,
DR. J. SAILER, Philadelphia
DR. L. V. HAMMAN, Baltimore,
Respectfully yours,
[SIGNED] WARFIELD T. LONGCOPE,
Secretary.
The Medical Profession Endorses the Policy of the Government
The following resolutions were presented to the House of
Delegates of the American Medical Association by the Section
on Hygiene and Preventive Medicine, June 7, 1917, and unani-
mously adopted: —
440 SOCIAL HYGIENE
WHEREAS, venereal infections are among the most serious and disabling dis-
eases to which the soldier and sailor are liable; and
WHEREAS, they constitute a grave menace to the civil population; and
WHEREAS, the Congress of the United States has authorized the President
and has empowered and directed the Secretary of War to control prostitution
and alcohol within effective zones surrounding all military places; and
WHEREAS, The Council of National Defense has adopted resolutions outlining
a general policy for the combating of venereal diseases; and
WHEREAS, a grave responsibility rests upon the civil population and par-
ticularly the medical profession for participation in making effective these and
other measures for the eradication of venereal diseases;
Therefore, Be It Resolved: That the American Medical Association endorses
the actions of Congress and the Council of National Defense and commends the
following as the basis for a program of civil activities : —
1. That sexual continence is compatible with health and is the best preven-
tion of venereal infections.
2. That steps be taken toward the eradication of venereal infections through
the repression of prostitution, and by the provision of suitable recreational
facilities, the control of alcoholic drinks, and other effective measures.
3. That plans be adopted for centralized control of venereal infections through
special divisions of the proper public health and medical services.
4. That the hospitals and dispensaries be encouraged to increase their facil-
ities for early treatment and follow-up service for venereal diseases as a measure
of national efficiency.
5. That the members of the medical profession be urged to make every effort
to promote public opinion in support of measures instituted in accordance with
these principles of action in the control of venereal diseases.
Influential Organizations of Men and Women in Every Part of the
United States Commend the Campaign Against Alcohol,
Prostitution, and the Venereal Diseases
Hundreds of copies of minutes such as the following adopted by
women's clubs, church organizations, and other societies have
been sent to the President, the Council, the Commission on
Training Camp Activities, and the secretaries of War and
Navy. They have been very reassuring to the officers and
have given the military authorities confidence that the public
fully approves.
Resolved: That the Association hereby expresses its earnest desire to further
in every way possible the request of the General Medical Board already pre-
sented to Secretary Baker, the Council of National Defense, the Congress, and
the President, that there be created about all military camps an effective zone
within which the sale of liquor and the presence of prostitutes are prohibited.
We respectfully but urgently petition the War Department to create such zones
SOCIAL HYGIENE AND THE WAR 441
about all camps now existing or hereafter to be established and to establish
military camps only on condition that such zones be created and that adequate
regulations for the moral protection of the men be enforced.
In order that such protection may actually be secured, we petition the War
Department to demand as a prerequisite to the establishment of a military camp
at any place the cooperation of the municipal authorities in the removal of
every vicious resort in the vicinity and the maintenance of a complete absence
of such resorts throughout the period of the existence of the camp upon penalty
of its removal.
We petition further that the War Department adopt as a part of its policy
of moral sanitation not merely the prevention of the spread of venereal disease,
but the prevention of prostitution; and that the enforcement of regulations to
this end be not left to the discretion of individual commanders, but that uniform
procedure be established through military orders from headquarters.
The International Committee of the Y. M. C. A. and the American
Social Hygiene Association Plan Special Educational Work
under the Supervision of the Commission on
Training Camp Activities
GENTLEMEN: May 23, 1917.
When the troops were being mobilized on the Mexican border, the Bureau of
Social Hygiene, the American Social Hygiene Association and the International
Committee of Young Men's Christian Associations, in joint cooperation, sought to
direct the moral welfare of the soldiers. Two lines of action were entered upon;
first, to influence the Government to adopt and make effective a policy for the
elimination of prostitution and drink from the environment of military camps;
second, to carry out a program of moral education with reference to sex with the
enlisted men.
A deputation, representing these three organizations, laid the matter before
the Secretary of War. He at once chose personal representatives to study the
problem on the border and earnestly sought to ameliorate these evils.
A plan of sex education for troops was carried out by the International Com-
mittee of Young Men's Christian Associations in cooperation with the American
Social Hygiene Association.
As a result of the experience on the border, the Department of War at Wash-
ington has become thoroughly aroused as to its responsibility in safeguarding
the moral welfare of the soldier in the greater army now mobilizing, both from
the viewpoint of military efficiency and the broader viewpoint of social welfare.
The Government has adopted a policy of making the environment of military
camps "as wholesome as it is humanly possible to make it" and it has put into
operation adequate machinery and forces for making that policy effective.
Congressional action has been secured authorizing the suppression of commer-
cialized vice and drink in designated zones about military camps, and military
orders in line with the above policy have been issued. The War Department
has appointed a Commission of eight outstanding national leaders, known as
The Commission on Training Camp Activities, to study the problems involved,
to keep the War Department informed of conditions, and to carry out an exten-
sive program of activities — athletic, recreational, social, educational and re-
442 SOCIAL HYGIENE
ligious — with a view to rendering the life of the enlisted men as normal and whole-
some as possible. The Commission also seeks to stimulate the cleaning up of
our cities, especially those to which the soldiers will have access. In this con-
nection, there is abundant opportunity for effective work on the part of all local
and state societies interested in furthering moral sanitation among our troops.
The following are the members of the Commission : —
Mr. Raymond B. Fosdick, of the Bureau of Social Hygiene, Chairman; Dr.
Joseph E. Raycroft, Professor of Hygiene and Physical Training at Princeton Uni-
versity ; Mr. Joseph Lee, President of the Playground and Recreation Association
of America; Dr. John R. Mott, General Secretary of the International Committee
of Young Men's Christian Associations; Mr. Lee F. Hanmer, of the Russell Sage
Foundation; Charles P. Neill of Washington; Thomas J. Ho wells of Pittsburgh;
Malcolm McBride of Cleveland; Major Palmer Pierce of the United States Army.
Permit us to call your attention to the fact that in this matter our Govern-
ment has taken action far in advance of any taken by other nations. Other
nations have assumed that vice cannot or should not be suppressed and have
confined their efforts to dealing with its consequences — with disastrous results
as the facts show. Our Government now assumes that vice is not necessary
and seeks not merely to minimize its consequences but to eliminate vice itself.
In addition to this, medical measures for the health protection of the soldiers
and society also far in advance of any heretofore observed and entirely in accord
with the above program, are being put into operation with the approval and coop-
eration of the War Department.
As a part of its program, the government Commission on Training Camp
Activities has requested the International Committee of the Young Men's
Christian Association to carry out in the army an adequate program of moral
education with reference to sex. In order that the social hygiene and simi-
lar interests may be represented in this work and that the greatest efficiency
may be secured, the International Committee will work in cooperation with
the American Social Hygiene Association in this task.
We wish you to know these facts: first, that you may rejoice with us in that
the growing movement for social morality in recent years is showing results
in this important way and second, that you may cooperate with us more
effectively.
We have before us a list of fifty-one organizations which have for their object
the advancement of social health and morality. Many of these will be com-
mendably eager to undertake work for the soldiers in the camps. These organ-
izations have different methods of work, their own agents and most of their own
literature. It will be obvious to you that if this work for social health and
morality among the soldiers is not coordinated under one directing head but each
organization seeks to bring into these camps its own particular appeal and its own
literature through its own agents, there must necessarily result excessive over-
lapping of effort, confusion and overdoing the whole matter such as would result
in most unfortunate reaction.
For the sake of efficiency, it is the desire of the government Commission on
Training Camp Activities, that the International Committee working in coop-
eration with the American Social Hygiene Association coordinate all work of
that nature in the military camps. May we request, therefore, that if you have
SOCIAL HYGIENE AND THE WAR 443
literature which you regard as useful, or capable speakers or if you have sug-
gestions to make, that you send the information or copies of literature to us at
the American Social Hygiene Association, 105 West 40th Street, New York.
We shall give careful consideration to all suggestions and material sent in. It
will readily be seen, however, that we cannot use all good literature nor all
good speakers. Both are now so numerous that selection must be made from
these.
Permit us to suggest that perhaps the most important task now before all
organizations interested in safeguarding the moral life of the soldiers is that of
securing the suppression of prostitution and the liquor traffic in our American
cities. It is necessary, not only that the environment of the military camps be
kept clean but that the cities to which they will have access also give them a
decent chance to remain clean. .
Very truly yours,
[SIGNED] M. J. EXNER,
ISIGNED| WILLIAM F. SNOW.
The General Federation of Women's Clubs Through its Public
Health Department Calls Upon Its -Members
for Effective Cooperation
When America's call to arms was sounded the Mid-Biennial Council was
assembling at New Orleans. Pre-arranged programs were willingly sacrificed
upon the altar of patriotism, and the Federation faced, woman-fashion, the duty
of preparing to do its bit in the crisis. Department chairmen suddenly found
themselves confronted with a demand for outlines of work best calculated to
do the greatest good to the greatest number of our people during the period of
the war.
Obviously it was impossible on such short notice for the Department of Public
Health, with its diversified and far-flung activities, to do more at the moment
than tersely indicate the paramount lines on which its workers should concen-
trate, leaving the plan of action to be elaborated and announced later. These, in
the judgment of the Chairman, were stated to be: —
1. Work to conserve child life.
2. Work to create a moral sanitary environment for our boys and men in
mobilization camps.
It was explained from the Council platform, and is here repeated for the bene-
fit of all concerned, that this course is imperative for the following reasons:
The administrative policy of the Department is based upon recognition of the
fact that it can only hope to accomplish worthwhile results in its immense field
by securing and maintaining close and cordial relations of cooperation with state
boards of health and powerful national and international specialized Public
Health agencies. It was realized then, and has since been demonstrated, that
those agencies would require reasonable time to determine the nature, scope
and order of precedence of their efforts under the same martial emergency, and
to coordinate them with the specific aims of the Federal Government; and that
it was not until that had been done that we could definitely fix our own status
as sane and practical helpmeets
444 SOCIAL HYGIENE
The anxious concern of mothers for the moral welfare of their sons soon to be
drafted and held in concentration camps, is only equalled by their patriotism
in God-speeding their own flesh and blood, often forever, to respond to their
country's "battle cry of freedom." With the unspeakable immoral horrors of
the late Mexican border camps still casting their blot upon civilized manhood
and menacing national posterity, our women can be depended upon to "work to
create a moral sanitary environment for our boys and men in mobilization
camps;" and one of the most hopeful and cheering signs of the dread times through
which we are passing, is the assurance the Department already has (and will
soon definitely publish) of governmental appreciation of and efforts to abolish
this evil. As a practical preliminary measure of moral support of this course,
the following is urgently recommended : —
Telegraph at once, to Secretary of War Baker, at Washington, your confidence
that the Government will successfully and promptly work out this great problem.
In localities where military camps are established, let the club women unite
with the best elements of municipal government to foster clean moral conditions.
If the municipal authorities fail in this duty, appeal without delay to the Federal
Government.' — An Emergency Service Forecast by Mrs. Elmer Blair, Chairman,
Public Health Department, General Federation of Women's Clubs.
The Action of the Chicago Woman's Club is Typical of What
Many Similar Organizations Are Doing
The following letter and resolutions tell their own story: —
CHICAGO WOMAN'S CLUB
410 SOUTH MICHIGAN AVENUE
June 4, 1917.
A meeting was held, May 18, 1917, under the auspices of the Chicago Woman's
Club and the Woman's City Club, at which representatives from numerous or-
ganizations were present. The purpose of this meeting was to coordinate the
efforts of all agencies working for the protection of the health and morals of
soldiers and sailors stationed in the vicinity of Chicago. A committee of three
members was appointed to formulate resolutions to be presented at a future
meeting. The resolutions were drafted and are herewith enclosed. These
resolutions will be passed upon and further action taken at a dinner conference
to be held in the rooms of the Chicago Woman's Club, Friday evening, June 8,
1917, at 6.30 o'clock. We will appreciate your attendance, but if you cannot
come, kindly send a representative who is interested in the situation.
MKS. HARLAN WARD COOLEY,
MRS. DUNLAP SMITH,
MRS. EDWIN L. LOBDELL,
MRS. JAMES L. HOUGHTELING,
MRS. OLIVER W. STEWART,
MRS. HAROLD LE CLAIR ICKES,
MRS. ROBERT F. PALMER,
MRS. TIFFANY BLAKE,
DR. RACHELLE S. YARROS, Chairman.
SOCIAL HYGIENE AND THE WAR 445
A Suggested Form of Resolutions to be Endorsed by Organizations in Chicago and
Vicinity Interested in Conditions in and about Military
and Naval Training Camps
I
The undersigned organizations and individuals, interested in the welfare of
soldiers and sailors, respectfully commend and congratulate the Council of Na-
tional Defense for the stand taken with regard to the protection of the health
and morals of the men in the army and navy of the United States. We are con-
vinced of the wisdom and practicability of the policy adopted by the Council
of National Defense for the protection of the morals of enlisted men, the pre-
vention of exposure to venereal disease, and the provision of ample facilities
for early and skillful treatment of venereal diseases, thereby reducing their
duration and seriousness. (A copy of the statement of policy of the Council
of National Defense is attached hereto.)
II
We respectfully offer to cooperate with the Council of National Defense in
making the declared policy of the Council effective, particularly as applied to
Chicago and vicinity. We recognize the heavy responsibility which communi-
ties, that provide the environment for recruits, bear not only toward individual
soldiers and sailors, but toward the nation as a whole and the nation's allies.
We desire vigorously and intelligently to discharge our duties in this respect.
Ill
Recognizing community responsibility for the health and morals of soldiers
and sailors, we propose to cooperate with the Council of National Defense, with
the State Council of Defense, and with the Chicago Council of Defense, in carry-
ing out the following program of work: —
A. Educational Work.
1. We will carry on an educational campaign among civilians, pointing
out their responsibility to the nation for the health and morals of
enlisted men, and we will particularly direct our attention to the
education of mothers and girls residing in the vicinity of military
or naval stations. The work among civilians will be carried on
through lectures, exhibits, and printed matter.
2. We will cooperate with other organizations in placing before soldiers
and sailors in military and naval stations the facts and modern
point of view with regard to prostitution, the venereal diseases,
and sex ethics. This work will be carried on by invitation from
the military authorities through addresses, exhibits, and printed
matter.
B. Recreation outside of Military and Naval Stations.
We will work together to provide wholesome recreation and amusement
for the soldiers and sailors outside their stations. We propose to coop-
erate in establishing canteens, where soft drinks, confectionery, etc.,
etc., can be sold to the soldiers and sailors at cost; in providing whole-
some theatrical entertainment and dances; in arranging athletic
contests and out-of-door games; and in general, providing the soldiers
446 SOCIAL HYGIENE
and sailors with wholesome associations, in order to satisfy the natural
social cravings.
C. Enforcement of Law, Particularly in the Environment of Camps.
We will cooperate with organizations for the enforcement of laws rela-
tive to prostitution and the sale of alcoholic beverages. Recognizing
the laxity which sometimes characterizes the enforcement of law in
the vicinity of military and naval stations, and the serious individual
and social damages which may be done by the illicit sale of liquor
and the practice of prostitution, we will exert ourselves to the utmost
to see that public officials enforce the law vigorously, persistently,
and intelligently. This we regard as one of the most patriotic duties
of citizenship— the sine qua non of patriotism among civilians.
D. Cooperation in the Treatment of Venereal Diseases.
1. We hold ourselves ready to cooperate, upon request, with medical
officers of the army and navy in securing the volunteer part-time
services of competent physicians — specialists in treating the vene-
real diseases. (We will cooperate in developing a system of treat-
ment whereby persons exposed to venereal diseases may be pre-
vented from becoming infected.) If desired by the army and navy
we will assist in providing early and skillful treatment for soldiers
and sailors in case of infection, in order that the duration and
seriousness of the disease may be reduced.
2. We recognize the fact that venereal diseases are contracted by the
soldiers and sailors from the civilian population, consequently we
propose to establish improved and modern facilities for the treat-
ment of venereal diseases among the civilian population. We will
carry on a program of education, urging persons who have been
exposed to venereal disease to apply at once for treatment which
may prevent actual infection. This early treatment will be an
important part of the work of this dispensary.
E. General.
In general, we propose to cooperate with and coordinate all forces which
work intelligently, earnestly, and patriotically for the preservation
of the health, morals and efficiency of men who have been called to
defend the ideals of our nation. We shall particularly look to the
Council of National Defense, to the American Social Hygiene Asso-
ciation, and to the International Committee of the Y. M. C. A. for
suggestions, guidance, and assistance in carrying out this program of
work.
It is suggested that a coordinating committee, representing all organizations
to which this set of resolutions will be presented, should be formed in order to
carry out the program of work suggested. Added to this coordinating committee
should be a carefully selected group of advisors, particularly men and women
who have had experience and training bearing upon the problems with which this
program of work has to deal.
DR. WILLIAM ALLEN PUSEY,
PROF. ROBERT GAULT,
MR. WALTER CLARK,
DR. RACHELLE S. YARROS.
SOCIAL HYGIENE AND THE WAR 447
A State Health Department and a City Department Prepare for
Action
CALIFORNIA STATE BOARD OF HEALTH, SACRAMENTO
May 15, 1917.
DEAR SIR:
At a meeting of the State Board of Health held on Saturday, May 5, 1917,
the following resolutions were adopted and the Secretary was directed to send
them to the mayors of all incorporated cities of the State.
WHEREAS, every possible protection to health and physical welfare should
be afforded those enlisting in the Federal service and the citizens of the State
at large; and
WHEREAS, experience shows that unless restrained by public authority pros-
titutes gather in large numbers near army camps and spread venereal diseases
among the soldiers; and
WHEREAS, said diseases are a serious factor in morbidity and reduced effi-
ciency, and a menace to the public health ; therefore, be it
Resolved, that the State Board of Health of California urge upon all mayors
throughout the State that they demand from their health officer, police depart-
ments, and other appropriate officials, an active policy of protection of the
enlisted men and of the civil community against this menace to the public health;
and, be it further
Resolved, that detailed reports be requested of said officials, setting forth the
recommendations made by them and the methods of "preparedness" being en-
forced by them to meet this public health problem.
You are requested to give immediate attention to the establishment of a local
policy regarding the prevention of venereal diseases and to notify the State
Board of Health of the methods which will be followed in your city.
Respectfully yours,
[SIGNED] W. A. SAWYER, Secretary.
DEPARTMENT OF PUBLIC HEALTH, SAN DIEGO, CALIFORNIA
May 25, 1917.
Dr. W. A. Sawyer, Secretary,
California State Board of Health,
Sacramento, California.
DEAR DOCTOR:
Pursuant to the resolution adopted by the State Board of Health, under date
of May 5, 1917, requesting all Health Officers and Police Departments to initiate
certain steps for the control and prevention of venereal diseases in their respec-
tive jurisdictions, I yesterday arranged a conference between the following
officials, Federal, State and Municipal: Col. J. P. O'Neil, Commanding the
Twenty-first Infantry; J. Edward Keating, Justice of the Peace; Lieut. Francis
W. Anderson, Twenty-first Infantry; Asst. Surgeon L. U. Clef, United States
Navy; Captain Brotherton, Commanding the Naval Training Station, Balboa
Park; Major T. C. Turner, Marine Corps; Captain Love, Surgeon of the Marine
448 SOCIAL HYGIENE
Corps; August Vollmer, Chief of Police of Berkeley, Calif.; Lieut. James Patrick,
Acting Chief of Police.
I have the honor to report that the following proposed course of action was
recommended as the result of said conference: —
First. That all cases of venereal diseases occurring within the ranks of army,
navy, or marine service shall be immediately reported to this office by case
number and where possible a history showing the probable source of contraction
will be appended thereto.
Second. That the state law providing for the red light abatement, etc., be
immediately enforced and all prostitutes eliminated from the city limits. While
it is not expected that this will be more than partially effective, it may be the
means of eliminating the worse element. The method to be pursued is: —
A. The prompt arrest under vagrancy charges and strengthening legal evi-
dence for presentation in court.
B. The courts have assured us of their intention to uphold the enforcement
of the act and, where convictions are possible, to be anything but lenient. There
will be no floater sentences.
Third. The regulation of all liquor establishments whereby those saloons
located in parts of the city not conducive to the best interests of the men will
be, if possible, put out of business. Those saloons where proper surroundings
may be maintained to be left without interference.
Fourth. All saloons and food establishments where liquor is sold to be re-
quested to cooperate in the matter of eliminating as patrons women of loose
character, in order to safeguard the men as much as possible who are behaving
themselves and who would not be exposed except for the fact that temptation is
forced upon them.
Fifth. A special course to the patrol men and police officers by legal authori-
ties on the compilation of evidence necessary for the successful prosecution of
this type of work. This is to be commenced by lectures from one of our local
judges.
Sixth. The detection of diseased women and the use of this evidence where pos-
sible against them.
Seventh. I have personally taken up the matter with all civilian practitioners
requesting the prompt reporting by case number of all venereal diseases with
the view of determining the comparative incidence in civilians.
I realize that the effort we have made will not prove satisfactory except to
a limited extent, but the spirit is evident to carry out the intentions of the State
Board of Health, and we hope to attain at least some results. I would suggest
as a possible means of strengthening the position of the local health officer that
syphilis, at least, be made quarantinable by resolution of the State Board of
Health "Whenever in the opinion of the local health officer the public health
will be endangered by not enforcing a strict quarantine." And, furthermore,
if it is possible that this quarantine shall be made transferable for sociologic
reasons, from the place at which the infection is located, to some state hospital
where segregation of this type of individual may be more readily carried out
without lay opposition, which would be a serious drawback at an isolation
hospital.
SOCIAL HYGIENE AND THE WAR 449
I believe that this quarantine could be established temporarily at police
headquarters and later on, by order of the health officer, coupled with authori-
zation from the State Board of Health, such a transfer be made as named above.
Kindly let me have your opinion relative to this matter and, owing to pressure
for time since the selection of San Diego for an important army and navy post,
it is my hope that if the plan I suggest seems feasible the State Board of Health
take cognizance of it without delay.
Yours respectfully,
[SIGNED] A. E. BANKS,
Health Officer and Superintendent of Public Health.
The Men of a University Pledge Themselves To Do Their Part to
Establish the American Uniform as the Symbol and
Guarantee of Real Manhood
"I quote below the exact text of the resolutions adopted by
the engineers and the men of the medical group of this Univer-
sity."— George E. Vincent, President University of Minnesota.
Four hundred engineers, practically all students of the College of Engineering
of the University of Minnesota, at a mass meeting on April 27, 1917, unanimously
adopted the following resolution: —
1. We stand to respond to the call of the country in ready and willing service.
2. We undertake to maintain our part of the war free from hatred, brutality
or graft, true to the American purpose and ideals.
3. Aware of the temptations incident to camp life and the moral and social
wreckage involved, we covenant together, as college men, to live the clean life
and to seek to establish the American uniform as a symbol and guarantee of real
manhood.
The same resolutions were adopted by the men of the medical
group of the University of Minnesota, including the colleges of
Medicine, Dentistry, and Pharmacy, in a mass meeting of four
hundred and fifty students and members of the faculty, with
the following additions: —
We endorse the program of the engineers and adopt their formula as our
standard.
As our specific contribution, we pledge ourselves —
1. To enlighten men regarding the dangers of impure living and to do our
share in maintaining wholesome moral conditions.
2. We register our commendation of the stand taken by the National Council
of Defense that "continence is compatible with health" and placing alcoholic
beverages under strict control, and in creating moral zones around American
troops.
450 SOCIAL HYGIENE
3. Convinced, in view of a possible world famine, that it is immoral and ab-
surd to waste approximately a sixth of our food cereals in the manufacture of
intoxicants, we appeal to the President of the United States and to Congress to
establish entire prohibition as a war measure.
A Thousand More Organizations and Departments of Civil
Government are at Work on this Problem
The letters and statements presented above have been se-
lected as illustrative of the varied efforts being made, and to in-
dicate that the nation is at last at grips with this problem.
It behooves every patriotic citizen seriously to study the situa-
tion in his community and to do his part in the local social
hygiene program whatever that program may be. Future ar-
ticles on Social Hygiene and the War will describe the work of
individual leaders among the civil population, in governmental
departments and commissions, in the army and navy, and in
Congress, who may contribute to the success of the movement.
Under ordinary conditions of peace no such concerted action
as is promised would have been possible. The opening of
the great cantonments, and the mobilization of army and
navy forces elsewhere have presented a national emergency
which the people have risen to meet. Whatever is accom-
plished by social hygiene in the protection of these military
establishments will be equally in the interest of towns and
cities in their vicinity.
Social Hygiene
VOL. Ill OCTOBER, 1917 NO. 4
THE VENEREAL DISEASES— A WORLD PROBLEM
IN EPIDEMIOLOGY
BY COLONEL T. H. GOODWIN
R. A. M. C. British Army
I have been asked to introduce the following papers on ways
and means of combating the venereal diseases. In no other
problem of control and ultimate eradication of a disease do we
have progress so dependent upon education of the entire mass
of the population, conscientious attention to prolonged treat-
ment of ambulatory cases apparently in good health, and com-
plicated management of environmental conditions. Added to
these is the hitherto insuperable difficulty of inducing the public
to deal with commercialized and clandestine prostitution as the
principal factor in the epidemiology of this group of diseases.
It is of basic importance to recognize that so long as measures
for the conservation of moral standards and for the conservation
of health are in conflict little progress can be expected; however,
there would appear to be no valid reason why the two schools
of thought should not meet in entire accord, the common object
being the safeguarding and improvement of health with, at the
same time, the conservation of moral standards. The attain-
ing t>f either of them, in greater or less measure, would have
a direct influence in the improvement of the other. Permanent
advances seem to have been made during the present war in
developing a common ground of accepted activities in both the
medical and social fields of the problem. In England this has
been brought about largely by the appointment of the Royal
451
452 SOCIAL HYGIENE
Commission on Venereal Diseases and the Government's recogni-
tion of the National Council for Combating the Venereal Dis-
eases as an authorized body for the purpose of spreading knowl-
edge and giving advice in regard to the question of venereal
disease in its varied aspects. Military measures are now being
supplemented by the establishment of diagnosis and dispensary
facilities in all civil districts, and a general educational campaign
is being intensively conducted. In France the reports of the
permanent Commission of Hygiene and Prophylaxis of the
Interior has served a purpose similar to that of the English com-
mission. The Minister of the Interior has directed attention
to the necessity of instituting special dispensaries, to be known
as hospital annexes, for offering to persons infected with venereal
disease every facility for personal treatment. Special efforts
have been made to impress upon the chiefs of every grade the
importance of developing the idea of personal responsibility in
each man. Other nations nbw at war have in varying degrees
undertaken civil-military programs. Special and widely dif-
ferent measures have been instituted by Canada, Australia, New
Zealand, and other parts of the British Empire.
I have just been on a tour of observation in Canada. The
question of venereal disease is there, as elsewhere, a serious
problem and has occasioned considerable anxiety. Efforts are
made to safeguard the men by educational methods. Enter-
tainment and recreation features are provided, and known
immoral houses are ordered out of bounds. Failure to report
for early treatment, after exposure, constitutes a punishable
offense. A patient in hospital with venereal disease loses fifty
cents daily pay. Diagnostic facilities are provided. An in-
teresting effort is being made at the Toronto Base Hospital to
work out a social case sheet, which is described in Captain Gordon
Bates' paper.1 If the reaction is positive, he undergoes treatment
until a cure is effected. Alcohol has made trouble among the
return troops, but this has been markedly lessened in the Prov-
ince of Ontario by the enactment of the prohibition law. The
1 See page 471.
A WORLD PROBLEM IN EPIDEMIOLOGY 453
"discharge depot" is an important institution and its workings
as it relates to the possibilities of safeguarding the civil popu-
lation from venereal diseases should be studied. This institution
acts as a sieve for returned men. No actual treatment other
than that of a simple nature is carried out here. Cases requir-
ing treatment are drafted to hospitals, careful records are kept,
and the cases evacuated within ten to fourteen days to the
districts from which they were originally recruited.
The United States has the opportunity not accorded to other
nations of preparing to meet the situation in advance of mobili-
zation. The social hygiene program proposed is comprehensive
and sound, and is in line with the best experience of military
and civil authorities in England. The Council of National
Defense and the American Social Hygiene Association are
evidently agencies paralleling in function the Royal Com-
mission and the National Council for Combating the Venereal
Diseases. The administrative facilities provided in the Com-
mission on Training Camp Activities of the War Department,
the section on venereal diseases of the Surgeon General's office,
and the military welfare committees and similar civil bodies
created by state councils of defense, should prove ample if
supported by public opinion and provided with men and money.
I understand that equivalent facilities have been arranged by
the Navy Department through the Naval Commission on Train-
ing Activities.
The American troops in France will probably meet conditions
similar to those surrounding the Canadian troops. The men
on furlough will not have homes to return to as have the French
and English men. This should he borne in mind in planning
broadly for the social hygiene program. In addition to the
facilities already provided I would suggest that club houses
for officers and for men should be maintained at all ports of
embarkation both here and in Europe. Such clubs for the Eng-
lish have proved of very great service.
"GOD KEEP AND GUIDE YOU, SOLDIERS OF THE
NATIONAL ARMY"
To the Soldiers of the National Army:
You are undertaking a great duty. The heart of the whole
country is with you. Everything that you do will be watched
with the deepest interest and with the deepest solicitude not
only by those who are near and dear to you, but by the whole
nation besides. For this great war draws us all together, makes
us all comrades and brothers, as all true Americans felt them-
selves to be when we first made good our national independence.
The eyes of all the world will be upon you, because you are in
some special sense the soldiers of freedom.
Let it be your pride, therefore, to show all men everywhere
not only what good soldiers you are, but also what good men
you are, keeping yourselves fit and straight in everything, and
pure and clean through and through. Let us set for ourselves
a standard so high that it will be a glory to live up to it, and then
let us live up to it and add a new laurel to the crown of Amer-
ica. My affectionate confidence goes with you in every battle
and every test. God keep and guide you!
WOODROW WILSON.
The White House,
Washington.
454
METHOD OF ATTACK ON VENEREAL DISEASES
AN OUTLINE OF ACTIVITIES AND COOPERATING AGENCIES
PLANNED TO REDUCE THE PREVALENCE OF
THE VENEREAL DISEASES
Methods of attack upon venereal diseases divide themselves
into four classes: —
A. Social measures to diminish sexual temptations.
B. Education of soldiers and civilians in regard to vene-
real diseases.
C. Prophylactic measures against venereal diseases.
D. Medical care.
A. SOCIAL MEASURES TO DIMINISH SEXUAL TEMPTATIONS
(1) The suppression of prostitution and the liquor traffic.
(2) Provision of proper social surroundings and recreation.
These activities which have to do with social matters largely
fall outside the jurisdiction of the medical service of the army,
but this service can render these activities more efficient by
stimulating and supporting them, and wherever practicable
such support should be given.
(1) Suppression of prostitution and liquor traffic in zones.
Keep careful track of conditions as regards these two matters
in surrounding districts, in cities or towns where soldiers go,
and in travel gateways.
In camps and zones, we have the following agencies which
may be utilized: —
The constituted authorities, military and civil.
The Commission on Training Camp Activities, War Depart-
ment.
Local and national volunteer agencies may be utilized to
discover failures and abuses, and to help otherwise in
the work under direction of the proper authorities.
455
456 SOCIAL HYGIENE
Outside the zones, a large number of forces can be used.
Among these : —
State Councils of National Defense.
Civil police and health administrations.
Associations of commerce.
Women's clubs.
The press.
Social hygiene and vigilance societies, and other social and
religious organizations of influence in civil communities.
(2) Provision of proper social surroundings and recreation.
In camps and zones, plan to :—
Develop social activities and amusements.
Provide places where soldiers may go for comradeship, to
meet friends, to "loaf."
Supply an attractive place, or places, for soldiers to meet
their women callers in camps and near camps.
Establish, under police authority, women patrols in zones.
Enforce rules against women being received in soldiers' tents
or being allowed the freedom of camps.
Encourage facilities for interesting the soldier in reading,
lectures, music, congenial friendships, hobbies.
For this purpose, we have for use in camps or zones, or both : —
The Commission on Training Camp Activities supervising
activities of the Young Men's Christian Association,
Playground and Recreation Association, Knights of
Columbus, Young Women's Christian Association
through its hostess houses, the American Social Hy-
giene Association, and other national and local organiza-
tions invited to carry on special activities.
Similar provisions for social diversions and proper social sur-
roundings should be provided outside the zones, and if
possible, provision at least for their inspection by mili-
tary inspectors should be provided.
For use outside the zones, we have practically all the above
agencies which are organized to conduct similar work
in communities accessible to soldiers but not within
military zones.
METHOD OF ATTACK ON VENEREAL DISEASES 457
An effort should be made to stimulate local organizations in
towns near camps and at raiload centres to furnish
proper social diversions and amusements for soldiers,
and to provide places where they may go when on leave.
Enlisted men's clubs for this purpose, charging a small
monthly membership, say twenty-five cents, are greatly
to be desired.
Organizations of men and mature women to furnish mem-
bers to meet soldiers in a friendly way, and to give them
information and directions are desirable in towns and
at railroad centres and other points in large cities where
soldiers come in numbers. Fraternal organizations
should be enlisted in this work.
Pressure should be brought to bear on the civil authorities
to suppress vicious amusement places, to clean up parks
and other recreation places, and to furnish for such
places morals police. For this purpose, the members of
special law enforcement organizations could be used.
Inspection of social and moral conditions in the camps, in the
zones, and in contiguous districts, and of the work being
done by the various agencies for social betterment
should be made by federal authorities. Similar volun-
teer inspections by dependable vigilance and other civic
associations should be encouraged.
B. EDUCATION OF SOLDIERS AND CIVILIANS
(1) For soldiers: (a) Lectures; (b) Pamphlets; (c) Exhibits.
(a) Lectures to soldiers should be given by medical and line
officers and by competent volunteers furnished by outside
agencies under invitation and direction of the Medical
Department. These, beside inculcating continence,
should explain the risk and waste of venereal diseases
and the program adopted to avoid ^hem. Lecturers
without authority should not be permitted.
(b) A pamphlet should be given the soldier as soon as possi-
ble after enlistment. This pamphlet should be very
brief and should warn the soldier of the venereal dangers
to which he may be exposed and give him instructions,
458 SOCIAL HYGIENE
if he should be exposed, to report as promptly as possible
to his regimental infirmary.
It would be very desirable if a pamphlet could be dis-
tributed at the place of meeting of Exemption Boards.
Later somewhat fuller pamphlets should be distributed
to soldiers through medical and line officers, or by
accredited volunteer social hygiene societies,
(c) Exhibits, such as the Coney Island exhibit of the New
York Society of Social Hygiene, the exhibit of the
National Cash Register Company, the exhibits of the
Oregon Social Hygiene Society, the Missouri Society,
and other exhibits and demonstration methods worked
out by the American Social Hygiene Association should
be adapted to the needs of military life and furnished to
each cantonment.
(2) For civilians: —
In the attack upon the venereal problem, it is highly desir-
able that such educational activities as those outlined
above for soldiers should be stimulated for the civilian
population.
The influence of the military authorities should be given to
the national organizations for social hygiene and to
the numerous sanely conducted local organizations of
the same sort.
Encouragement should be given to the organizations which
are undertaking to arouse the interest of the woman
population of the country in matters of social hygiene
and for instructing women in regard to venereal diseases.
Organizations dealing with these matters which attempt to
reach women should be encouraged, especially in the
vicinity of camps. An increasing number of influential
organizations such as the General Federation of
Women's Clubs and Patriotic Women's League, are in-
dorsing and supporting sound social hygiene pro-
grams, and supplementing the more specialized efforts
of such organizations as the Young Women's Christian
Association and the Women's Christian Temperance
Union.
METHOD OF ATTACK ON VENEREAL DISEASES 459
C. PROPHYLACTIC MEASURES
Instruction in Prophylaxis: —
Soldiers should be informed of the fact that there are prophy-
lactic measures that reduce the dangers of venereal in-
fection. But this instruction should take particular care
to inform them that there are limitations to such prophy-
lactic measures and that they furnish only partial pro-
tection and in no sense give freedom from risk.
Regimental Infirmaries : —
The provision of prophylaxis (early treatment) in regi-
mental infirmaries, which should be open day and
night, is imperative in any sane attack upon venereal
diseases. The prophylactic station should be utilized
as a place for personal advice and education against
future exposure, and should be conducted as an early
treatment dispensary. Any spirit of levity or condon-
ing sexual promiscuity should be discouraged, and
obscene stories or objectionable conduct should be
rigidly repressed. The men assigned as officers in
charge of these stations should be mature and with the
personality and force of character calculated to gain
the confidence and respect of the men applying for
treatment. The medical officer in command should be
impressed with the strategic importance of the prophy-
lactic station for education, appeal, and the securing of
social facts of vital importance in the prevention of
venereal diseases.
Infirmaries in Civil Centers: —
In cities, where there are no adequate civil dispensaries to
be used and through which soldiers in considerable
numbers pass, either while on leave or in travel, there
should be provided in accessible locations regimental in-
firmaries. In a few cities, where dispensary services are
particularly well developed, regimental infirmaries may
be replaced to advantage by accrediting these civil dis-
pensaries for use. Information should be furnished to
460 SOCIAL HYGIENE
soldiers of the existence and location of such regimental
infirmaries and available dispensaries.
Leaves of Absence: —
In the interest of health, long leaves of absence for soldiers
should be as far as possible discouraged. Leaves of
absence of more than twenty-four hours are particularly
dangerous, and it would be desirable if leaves of absence
should be timed from as early an hour in the day as
possible.
In cases where soldiers have been exposed, particularly if for
any reason exposure seems unusually dangerous, special
observation of such exposed men should be made, and
if practicable these observations should be repeated at
intervals of a couple of days for two or three weeks.
All pressure possible should be made by military authorities
against houses or women which experience shows are
frequent sources of infection, and this should be ex-
tended as far as practical to prostutition generally. The
more effective the repression of prostitution can be made
the greater will be ftie reduction in venereal diseases.
All possible influences should be brought to bear to encour-
age civil authorities in the attack upon prostitution in
all its phases. A medical program for civil communi-
ties equivalent to the military program for prevention
and treatment should be encouraged.
D. MEDICAL CARE
Hospital Organization : —
There should be a special service in each cantonment hospital
to care for skin and venereal diseases.
As far as possible, all such cases should be in charge of the
venereal service, and where for any special reasons, such
cases must be under other services, the senior officer of
the venereal services should be, if possible, consulted in
regard to them.
In the venereal disease service, there should be at the head
an experienced specialist in these diseases, and when-
METHOD OF ATTACK ON VENEREAL DISEASES 461
ever possible, another medical officer trained in venereal
diseases should also be in the service. The other med-
ical officers assigned to the service need not necessarily
at the beginning be trained in venereal diseases.
In the event that mature specialists from the Medical Offi-
cers Reserve Corps can not be furnished for the head
of the service in each one of the cantonment hospitals, it
would be practicable to use two half-time men, serving
on alternate days, to act as head of this service. These
men to be obtained from adjacent large cities. Under
such conditions, there should always be furnished a
qualified junior officer.
Instruction in Venereal Diseases for Medical Officers : —
One of the important functions of these services will be to
train a group of men in venereal diseases. The service
will, if well conducted, rapidly develop the knowledge of
these diseases among medical officers.
It should be distinctly understood that one of the duties of
the trained specialists who go into this service will be
that of teachers of venereal diseases to the less well
trained medical officers, and regimental officers should
be encouraged to avail themselves of the opportunity for
instruction furnished by these services.
Emphasis should be placed upon the necessity of high stand-
ards of technique in carrying out treatment.
Hospital Cases: —
The cantonment hospitals should have under their care all
cases of venereal diseases which are in the acute, infec-
tious stages. These include: —
All cases of acute gonorrhea.
All cases of syphilis during the early infectious stage and
which have chancres, mucous patches, or condylo-
mata.
But it should be seen to that hospitalization of venereal
disease does not become an abuse which is allowed
to interfere unduly with military duty.
There should be no leaves of absence for infectious
462 SOCIAL HYGIENE
venereal cases, and cases which have passed the
acute infectious stage, but which might become dan-
gerous through the possible development of mucous
patches or of chronic gonorrheal discharge, should
not be allowed leaves of absence from camp.
Standard Records: —
The syphilitic register of the army should be carefully and
fully kept and social facts of epidemiological importance
should be secured in every case if possible.
Standardized Treatment :—
An effort should be made to standardize in a general way
methods of treatment, and provision should be made for
some special instructions in venereal diseases for all
medical officers who have charge of troops. To this end,
a manual of instructions should be issued to each of the
medical officers in the army. This should especially
emphasize the great importance of early diagnosis and
treatment in venereal diseases and outline suitable
methods of treatment.
There should be furnished cards of brief instruction to
patients with gonorrhea or syphilis.
Laboratory Facilities : —
Laboratory facilities are necessary: —
(1) For demonstrating gonococci and other bacteria.
(2) For demonstrating spirochetes by dark field illumina-
tion.
(3) For urinalysis (which should be required once a week
for every syphilitic patient under treatment).
These laboratory facilities should be in the wards of the
venereal service.
(4) For Wassermann tests.
These to be in the general laboratory.
Inspections : —
In order to keep up a high standard of effectiveness, there
should be provision for inspection of these services by
special inspectors in venereal diseases from the Surgeon
METHOD OF ATTACK ON VENEREAL DISEASES 463
General's office. These inspections should cover each of
the four classes of attack specified.
WM. ALLEN PUSEY
FRANCIS R. HAGNER
GROVER W. WENDE
S. POLLITZER
HENRY H. MORTON
Advisory Committee.
COL. F. F. RUSSELL, M. C.,
In charge, Division of Infectious Diseases.
Published by permission of the Surgeon General
August 22, 1917
SOCIAL HYGIENE EDUCATION
WAR DEPARTMENT
WASHINGTON
September 12, 1917.
MY DEAR MAJOR PULLMAN :
I am glad to know of the plans for the use of moving pictures in the educa-
tional campaign which the Federal Gov ernment and municipalities are conducting
for the control of vice diseases.
The United States is spending great sums to c onserve the health and welfare
of its soldiers; far greater sums than have ever been spent before in the coun-
try's history. Our medical and sanitary provision is on the most generous scale,
and both time and money are being spent without stint to teach our soldiers
how to participate in this war with the least loss of life and limb, as well as with
the greatest effectiveness against our adversary.
It is, therefore, very appropriate that our soldiers should be given the plain
facts about vice. The exhibition of the picture "Damaged Goods" is an effec-
tive way of telling these facts, and I shall be glad to have every officer and man
in the army, from the oldest to the youngest, see this picture ; not that many of
them need its warning, but that all of them can have its warning in mind to re-
peat to others when necessary.
The waste of war is bad enough at best, and it requires an heroic occasion to
justify a nation in exposing the lives of its choice young men in such a contest;
but that waste ought not to be increased as it is increased whenever the lesson
of "Damaged Goods" is forgotten.
The soldier should remember that he owes his country the full strength of a
well body, and that it would be better for him and for his country both for him
to come back from this war wounded by an adversary blow, than to come back
unscathed by our enemy but marked with the ineffaceable stain of this sort of
disease.
The young American who makes up our armies is a wholesome-minded, clean-
living man. His great asset is that he knows how to use knowledge. In this
lies the virtue of giving him knowledge about this essential means of protecting
himself and serving his country at the same time.
Cordially yours,
[SIGNED] NEWTON D. BAKER,
Secretary of War.
Major Raymond W. Pullman,
Metropolitan Police Department,
Washington, D. C.
[EDITOR'S NOTE: Letter written in reference to the program of a meeting
under the auspices of the Metropolitan Police Department of Washington, D. C.,
the Sub-Committee on Venereal Diseases, Council of National Defense, the Com-
mission on Training Camp Activities and the District of Columbia War Service
Commission, Sunday, September 16, 1917; to which citizens and the soldiers and
sailors encamped in the vicinity of Washington were invited.]
464
ENGLAND MAKES PROGRESS IN COMBATING
VENEREAL DISEASES
BY LINSLY R. WILLIAMS, M. D.
Medical Member, National Research Council Commission, Appointed to Inves-
tigate the Various Scientific Problems Arising in France and England as a Re-
sult of the War.
The report and recommendations of the Royal Commission
on Venereal Diseases resulted in the organization of a 'society
known as the National Council for Combating Venereal Dis-
easefe. Lord Sydenham, who had been chairman of the Royal
Commission, became chairman of the National Council.
Since its organization the National Council has worked in
harmony with the Local Government Board. The Local
Government Board has the authority to require various county
councils, county boroughs, and municipalities to make pro-
vision for the care of cases of venereal disease, and this authority
has been exercised as is already known to the readers of SOCIAL
HYGIENE.1
The orders of the Local Government Board, requiring treat-
ment to be provided, specified that treatment centers should
be ready within six months, and during this time the local
authorities were to submit to the Local Government Board the
different schemes by which they would provide treatment.
In June, 1917, I found that Sir Arthur Newsholme, Medical
Officer of the Local Government Board, was very well satisfied
with the progress that had been made. Progress was in some
districts slow because the Local Government Board did not
desire to force the communities to establish treatment centers
1 SOCIAL HYGIENE. The British Royal Commission on Venereal Diseases,
July, 1916; Venereal Disease Regulations of the British Local Government Board,
October, 1916; The British National Council for Combating Venereal Diseases,
January, 1917; What England is Doing for the Venereally Diseased, April, 1917;
What Great Britain is Accomplishing, July, 1917.
465
466 SOCIAL HYGIENE
if there was a good prospect of their taking up the work volun-
tarily. Consequently a working arrangement was made with
the National Council for Combating Venereal Diseases, and
whenever the Local Government Board notifies the National
Council that provision for treatment is delayed in a certain
municipality, the National Council then takes action.
Agents of the Council visit the municipality or borough,
interview important citizens and hospital subscribers, organize
mass meetings, and secure publicity.
In some municipalities it was found that the hospital trustees
feared to establish a clinic for venereal diseases on the ground
that their local hospital subscribers would not continue their
subscriptions. In order to prevent this action, agents of the
Council visit a considerable number of the hospital subscribers,
interest them in the work of preventing venereal diseases, and
in some instances have held meetings of the subscribers where
resolutions have been passed stating that they would not con-
tinue their subscriptions unless the hospital would undertake
treatment of venereal disease. It is found that in some in-
stances the health officer is opposed to the treatment centers
notwithstanding all the pressure that is brought to bear upon
him. In one city in England, notwithstanding the opposition
of the health officer, various meetings were held and the hos-
pital authorities determined to provide for the treatment.
Another cause of delay is due to the fact that in some hos-
pitals there is not sufficient available space for treating ward
patients and the out-patient departments are so overcrowded
that no additional special class of patients can be handled and
it has not been possible for the hospital trustees to secure the
necessary funds at the present time for the necessary capital
expenditure. Arrangement has therefore been made permitting
the county council or municipality to advance the funds to
the hospital after an investigation and recommendation has
been made by the Local Government Board to that county
council or municipal council. These capital advances are then
repaid by the hospital in installments over a period of years.
ENGLAND MAKES PROGRESS 467
Very successful work has been done in Portsmouth, Liver-
pool, London, and in the Newcastle District, and there are now
adequate facilities for providing treatment for any case of ve-
nereal disease occurring in these districts. In one of these dis-
tricts over four thousand cases have been treated in hospital
and dispensary up to June, 1917. In some districts the cities
are the only places where there are sufficient hospital facilities
to provide treatment, and in the schemes approved by the
Local Government Board adjacent boroughs are allowed to
enter into the city scheme, with the expectation that in the
future the neighboring boroughs will organize their own treat-
ment centers.
Venereal disease is now recognized by the public as a com-
municable disease and it is realized that it must be treated as
such. Editorials have appeared in the daily press and speeches
have been made on the subject of venereal disease in the House
of Commons. In May, 1917, Parliament enacted a law entitled
the Venereal Diseases Act. This law makes it illegal for any-
one other than a duly qualified medical practitioner to treat
venereal diseases.* It forbids the use of any advertisement or
public notice by any person whomsoever offering to treat these
diseases. The Act also prohibits the sale or the advertisement
or the offering for sale of any proprietary medicine, chemical,
or other ingredient, for the treatment of these diseases.
Efforts are being made to call the attention of mothers of
the newly born to the dangers of these diseases, and the Mayor
of Liverpool at a public meeting in London stated that all the
midwives at Liverpool were instructed to report to the local
health officer the name and address of any child or mother who
they thought showed evidence of venereal disease. The diag-
nosticians were then sent to examine the patient and, if the
assumption of the midwife was found to be correct, treatment
was provided.
During the investigations of the Royal Commission on Ve-
nereal Diseases many efforts were made to ascertain the number
of persons affected with venereal disease. The only local fig-
ures which were believed to be accurate were those obtained
468 SOCIAL HYGIENE
from the records of the British Army. It has been the policy
of the British Army to take into the hospitals for treatment
every soldier affected with one of these diseases and the total
number of cases treated and the proportion of cases admitted
to hospital have been published in the annual reports of the
War Office. The reports of the health of the army in peace
times in Great Britain show that there was a constant diminu-
tion in the number of admissions per thousand troops every
year from 1905 to 1914. During this period the average num-
ber of troops in Great Britain was approximately one hundred
thousand. During the past three years the number of troops
in England has enormously increased, and notwithstanding
this increase in the military population, the number of admis-
sions per thousand troops to hospital has constantly diminished.
It is interesting to note that the lowest admission rate in any
military command in England is at Aldershot where there are
abundant facilities for healthy recreation — swimming pools,
gymnasiums, cricket, and so on. The admission rate at Alder-
shot is less than one-third the admission rate for London, where
no such opportunities for outdoor amuseme'ht are available.
The diminished rate in the British Army is quite in contrast
to what has been surmised by those of us in this country who
have been interested in the subject of venereal diseases. Ru-
mors have gone about that these diseases were markedly increas-
ing in England and that huge special hospitals had been estab-
lished in France for the treatment of officers and soldiers who
had become infected.
It is not only true that the proportion of cases has diminished
in England, but also the proportion of cases in the British Army
in France is less than one-half the proportion that exists in the
home army. On the other hand, it is true that the actual num-
ber of cases is greater and it is true that there are large hospitals
in France for the treatment of cases of these diseases occurring
among the British troops. But, considering the enormous
number of soldiers, the admission rate to venereal disease hos-
pitals in France is as low as the admission rate to hospitals for
the same diseases in the United States Army.
ENGLAND MAKES PROGRESS 469
An earnest endeavor has been made, not only by the medical
service of the British Army, but also by the National Council
for Combating Venereal Diseases to give instruction to all
recruits and young soldiers in cantonments. A large number
of lecturers are constantly visiting the camps and in simple
language and popular form advising the soldiers of the dangers
which may result if they become infected with one of these
diseases. Lectures are also given by the officers of the medical
service.2
The development of venereal disease in a soldier is not a
punishable offense, as it is in our army, but the commanding
officer specifies in general orders that for a soldier to acquire
such a disease is contrary to good conduct and he issues an order
requiring every soldier who may be affected with one of these
diseases to report promptly to the medical officer for treatment,
and if he fails to report, punishment may be meted out.
The medical officer of every unit is charged with the duty of
providing early treatment for every soldier who applies for it.
There has been a somewhat higher proportion of cases of
venereal disease among the colonial troops than exists in the
British Army. This I believe to be due primarily to two
reasons. • The exposure to infection most frequently occurs
while the soldiers are on leave and the colonial troops receive
a dollar a day while the English soldier receives only one shil-
ling. Consequently the colonial soldiers have more money to
spend. This fact seems to be appreciated by the feminine
population in the cities of England. The second reason is that
the British soldier when he returns on leave is able to go to his
own home and temptation is not so great as in the case of the
colonial troops who have no particular place to go.
Leaves are usually granted for a period of one week, and the
medical service of one army, realizing that the cities of Eng-
land were the greatest source of danger to the men, proposed
2 Volunteer organizations have also done valuable educational work both by
the preparation and circulation of pamphlets of information and by providing
lecturers. Among such organizations are the Liverpool Medical Institute and
the Alliance of Honour.
470 SOCIAL HYGIENE
a new plan of treatment. With the consent of the higher
authorities, permission was secured to establish a viseing office
in London and every man was required to report at this office
within twenty-four hours after his arrival. When the man re-
ports to have his pass visaed, inquiry is made as to the pos-
sibility of infection and prophylactic treatment given if neces-
sary. A soldier may at any time be requested to show his
pass to one of the military police, and if his pass is not properly
visaed, he is put under arrest and immediately returned to his
command in France. This method has very largely reduced
the percentage of infections in this army. The older procedure
of regulation has not been found successful and every effort is
made to have the soldiers report promptly, and every facility
provided for giving immediate prophylactic treatment.
As a result of my investigations, I feel sure that in the interests
of our American soldiers adequate facilities should be provided
in all cantonments for healthy outdoor amusements, that
popular lectures should be given to the soldiers to instruct them
in the dangers of venereal disease, and that a sufficient equip-
ment and proper personnel should be stationed at each canton-
ment in the United States and France to give early prophylactic
treatment.
THE CONTROL OF VENEREAL DISEASES1
GORDON BATES
Captain C. A.M. C., Officer in Charge, Venereal Section, Base Hospital, Toronto
The question of the control of venereal disease is so large
that it is difficult to attempt to deal with it in a brief paper. One
may roughly resolve it into two topics, namely, the control of
prostitution and the control of venereal disease itself. Both of
these are perfectly legitimate public health fields.
One cannot but feel that in regard to these subjects we are
hampered by our ignorance of both their extent and seriousness.
I am unable to find any extensive Canadian statistics as to the
prevalence of prostitution and only lately has the work of a few
investigators using the Wassermann reaction given us the idea
that in dealing with venereal diseases we are attempting to solve
a problem of extreme gravity.
With the idea of arriving at some conception of the sort of
situation before us we have lately instituted at the Base Hos-
pital, in addition to a medical case sheet, a social case sheet for
the investigation of venereal cases. It is obvious that if we are
ever going to deal with these subjects as questions of public
significance of the same variety as poverty, child-labor or any
other cause of disease, inefficiency or social misery of any sort,
some such method of obtaining exact information must be
undertaken.
Since this method of history-taking has just commenced, I am
only able to report the result of the examination of 100 cases.
Since, however, venereal admissions to the Base Hospital are
approximately 1500 yearly, probably a more comprehensive re-
port will be possible next year. The method of case-taking is
simply to ask each venereally infected man a definite series of
1 Read before the Ontario Medical Health Officers' Association. May 29,
1917.
471
472 SOCIAL HYGIENE
questions in regard to matters in connection with his infection
which are felt to be significant.
Briefly our results are as follows: —
Sources of Infection
89 men were infected through illicit sexual intercourse.
11 men were apparently infected by their wives.
59 infections took place in Toronto.
30 infections took place outside.
The outside places included Hamilton, Brantford, St. Cath-
erines, Orillia, Barrie, Collingwood, London, Montreal, and a
number of smaller places.
With the idea of obtaining the cooperation of the police or
other authorities, the exact name and address of the woman act-
ing as a source of infection was asked and in not a few cases
obtained.
Among 93 women from whom infection was contracted the age
varied from 16 to 34.
17 women were estimated to be 18 years of age.
70 were between the ages of 18 and 25.
In 16 cases (in spite of prohibition) either one or both
parties had indulged in alcohol.
Payment rendered
The following details as to payment rendered were secured: —
42 men paid actual cash. The amount varied from $1.00
to $15.00. The usual price was $2.00.
18 men provided a meal as payment. The price of this
varied from 50 cents to $5.00.
2 men made presents of clothes or other articles.
22 men paid nothing whatever.
Place of Infection
In 9 cases infection had taken place definitely in a house
of prostitution. In only two instances was this true
in Toronto.
THE CONTROL OF VENEREAL DISEASES 473
In 31 cases the men had gone home to the girls' boarding
houses.
In 30 cases infection had taken place outside.
In 12 cases the man and woman had gone to a hotel and
registered as man and wife. .
In 20 cases they had gone to strange rooming houses.
Occupation of Woman
An attempt was made to find the occupation of the infecting
woman. This was difficult as in many cases no information
regarding occupation was forthcoming.
41 had gainful occupations or means of support in addition
to prostitution.
9 were definitely prostitutes.
From 39 no information could be obtained.
64 women were single.
1 was a widow.
7 were married.
21 unknown.
As to the married or single state of the infected men we have
no record, as it was felt that the fact that enlisted men are a
special class would impair the value of such a record.
So much for the information obtained from the social case
sheets. As to the amount of venereal disease in the community —
rural and urban Ontario — we can only guess.
As I have said, the admissions to the Base Hospital are approxi-
mately 1500 per year. In the Toronto General Hospital, Wasser-
manns done by Dr. Detweiler prove that for the first three
months of 1917 12 per cent of all public ward patients gave a
positive Wassermann reaction. By such means 238 new syphi-
litic cases were discovered. This is at the rate of 952 cases
yearly. I need not remind you in this connection that gonorrhea
is perhaps six times as prevalent as syphilis.
Questions one is inclined to ask oneself are these : If in one
general hospital nearly 1000 syphilitics (two-thirds of them
474 SOCIAL HYGIENE
previously undiagnosed) are discovered in a year, how many
(treated and untreated) are there in the community outside the
hospital?
If in a military district through which troops are passing
and in .which the average number of troops is certainly less than
10,000, 1500 venereal cases (mostly fresh) arise — again in what
state of health, so far as venereal diseases are concerned, is the
community at large?
Fifteen hundred soldiers infected means approximately 1500
women from whom they received their infections and in dealing
with soldiers we are dealing only with one class of the males.
We cannot doubt that similar conditions exist elsewhere.
The medical results of such conditions are found in the facts
that 25 per cent of the male admissions to Toronto Hospital
for the Insane in a year are suffering from general paresis and
in the large number of other final results of gonorrhea and
syphilis which play a large part in keeping up the population of
our hospitals and asylums. I need not go into that subject on
this occasion. The social results connected with the expense of
disease, the death or incapacity of the bread-winners of f amilies,—
these results are just as serious. The question for us to face is
whether we are going to permit this condition of affairs to con-
tinue when it is possible to eradicate venereal diseases just as it
is possible to stamp out typhoid fever or malaria.
As to the means to be adopted, I would suggest first a broad
and energetic scheme of public education. Lectures, pamphlets,
moving-pictures — anything is commendable which will destroy
the ostrich-like attitude of the public and even many physicians
— the attitude which is exemplified by the fact that it is im-
possible to show either the dramatic or film version of "Damaged
Goods" in Ontario.
Some system of investigation of the sordid facts of prostitu-
tion in our midst would be of value if widely adopted, but the
facts should be given wide publicity. The truth in regard to vene-
real disease will eventually rouse the public to a realization of
the fact that low wages, the lonely boarding house, poor education,
THE CONTROL OF VENEREAL DISEASES 475
and late marriage in men and women are causal social factors
which eventually they hold it in their power to remedy.
From the purely medical standpoint we must look forward to
the time (I hope not far away) when the reporting of venereal
disease is practicable. Both irom the statistical standpoint and
the standpoint of control this is important as in any other
communicable disease. It will come when public education has
advanced sufficiently.
Early and free diagnosis, especially the dark-field microscopic
examination and the Wassermann reaction, should be possible
for every patient and I am glad to know that within the past
few weeks the Provincial Board of Health has arranged for free
Wassermanns in Ontario. The free treatment of all venereal
disease should also be available and it should be possible to iso-
late or quarantine infective cases which refuse treatment.
The issuing of instruction cards to all patients, laws against
the treatment of venereal disease by quacks or druggists, and the
elimination of newspaper advertising by so-called specialists,
better control of the feeble-minded, and, because it is practicable,
treatment of all infected soldiers before they are discharged from
the army, seem to be problems immediately before us. These
and others are no less capable of solution because they are new,
or less worthy because their solving means so great an advance
in the health and welfare of the community at large.
THE DOCTOR AND THE WAR1
It is the duty of the doctor in the military service to aid his commanding
general in every way possible to defeat the enemy. He fulfils this duty in many
ways. He must take care of the wounded, restoring them as rapidly as possible
to the fighting line. Similarly he must take care of the sick. More important
than either of these is the duty of preventing men from getting sick. The great-
est cause of sickness reported in the average sick report of military forces is
venereal disease, and the average period of sickness from these diseases is longer
than that for any other group of preventable diseases, so you can readily see
how important this problem is to the medical men of the military establishment.
The organisms causing these diseases are known, together with all the other
facts which are essential to their control, but only a beginning has been made
in combating them because the public has not understood and been willing to
apply the scientific knowledge which is at hand.
I think every one who is engaged in sanitation appreciates that the principle
of success lies in getting the people concerned to cooperate with him and give
him their support. For more than twenty years of my professional life, I have
been engaged in fighting communicable diseases on this principle, and to me it
is more obviously essential in attacking the venereal diseases and vice than in
any of the other evils which I have been called upon to fight. There now seems
to be an opportunity to secure the cooperation of the people and if we can apply
measures of prevention in the same practical way in which we have dealt with
yellow fever and malaria and other diseases and can teach the people how the
venereal diseases are contracted and how infected persons should be treated, you
can see what great possibilities there are for their control.
It is a very strong appeal to patriotism now to point out the fact that the
greatest injury any soldier can do our country is to voluntarily contract a dis-
ease which will take him from the fighting line for a number of weeks or for even
a longer period of time. Both the army and the people want to help the soldier
to avoid this injury to himself and the cause in which he is enlisted.
I am impressed strongly from my recollections of boyhood that the average
boy from fourteen or fifteen years of age wants to do what he believes to be the
manly and proper thing to do. Now, with sexual intercourse, I am inclined to
think that a very great motive with the soldier is that very motive of wanting
to appear manly and of thinking that it is the proper thing from a manly stand-
point. We know that sexual intercourse is not necessary to health and that if
we can make the soldier understand this and can keep him busy with both work
and recreation which thoroughly interest him, he will not find it difficult to con-
trol his conduct in this regard.
As I have said, it is the purpose of all the medical military establishment to
direct its efforts toward keeping as many men as possible for as long a time as
possible in the fighting force. Obviously, therefore, the medical department
of the army is deeply concerned in every effort of education, recreation, law
enforcement, and treatment which will reduce the non-effective rate of venereal
diseases. These four lines of attack constitute the basis for the program in
combating these diseases which will be carried out by the Army. It is hoped
that the civil authorities will simultaneously place the same program in opera-
tion. By successful cooperation, important results will be achieved.
MAJOR GENERAL WILLIAM C. GORGAS,
Surgeon General of the United States Army.
1 Extract from address before a public audience of citizens and soldiers,
National Theater, Washington, D. C., Sunday, September 16, 1917.
476
RECENT PROGRESS IN NEW YORK'S VENEREAL
DISEASE CAMPAIGN
LOUIS CHARGIN, M.D.
Chief, Division Venereal Diseases, Department of Health, City of New York
With the introduction, in 1912, of the Department's regula-
tions covering the venereal diseases, a new and important ac-
tivity in public health was inaugurated in the city of New York.
This comparatively untrodden field presented many difficult
and unusual problems and it was recognized early that progress
would necessarily be slow. The sex diseases for centuries had
been, if not entirely evaded, dealt with very meagerly by both
the profession and the public. One of the principal difficulties
encountered in dealing with this entire problem was the fact
that it required a complete reversal of a viewpoint long held
by the laity and indeed by a large portion of the medical pro-
fession as well. Now that it is generally accepted that vene-
real diseases should be classed and dealt with exactly as is any
other group of communicable diseases, greater and more rapid
strides are certain to follow.
Nowhere in public health is the cooperative assistance of the
hospital, the dispensary, and the laboratory of greater utility
than in these diseases. Successfully to combat them the earnest
coordination of these agencies is essential and yet it is precisely
here that difficulties have been met in this city.
A few years ago, in order to provide systematic treatment
for the venereally infected, the Department sought to establish
community clinics. It was demonstrated at that time that the
existing facilities were inadequate to cope with the situation
but the required funds were not appropriated by the City Board
of Estimate and Apportionment and accordingly the Depart-
ment was compelled to fall back upon dispensaries conducted
by private enterprise.
477
478 SOCIAL HYGIENE
In order that there should be some uniform standard main-
tained, the genito-urinary section of the Associated Out-Pa-
tient Clinics, at the Department's request, prepared an outline
of the necessary requirements for a properly conducted venereal
disease clinic and the Department, by repeated publication, took
steps to make these regulations known to all concerned, in the
hope that these regulations would be universally adopted and
lived up to. But despite the numerous efforts in this direction,
two separate and distinct surveys, undertaken in 1916 and 1917
have revealed that there are not as many as a score in a total
of about forty clinics that measure up to the required standard.
It became perfectly evident that nothing could be gained by
further delay and, in view of the importance of the matter,
definite action became imperative. The Department is charged
with the control of communicable diseases by whatever means
seems necessary and it would be derelict in its duties if some
measures were not taken to remedy the dispensary situation.
Accordingly, the Board of Health at the June, 1917, meeting
determined upon and adopted the following resolution:—
Resolved that Article 12 of the Sanitary Code be and is hereby
amended by adding thereto a new section to be known as Sec-
tion 223.
Section 223, Dispensaries, communicable diseases: Regulation. No public
dispensary, where communicable diseases are treated or diagnosed shall be
conducted or maintained otherwise than in accordance with the regulation of the
Board of Health.
Under this section the Department expects to compel dispen-
saries either to maintain the standard regulations set, or to aban-
don the treatment of the venereally diseased. If it is found that
there is an insufficient number of properly equipped and man-
aged clinics the Department has in mind to recommend anew
the establishing of municipal clinics conducted entirely by the
Department.
A special committee was appointed for the purpose of suitably
altering the. regulations of the Associated Out-Patient Clinics.
After due deliberation, this committee recommended the fol-
lowing which were accepted by the Board of Health: —
PROGRESS IN NEW YORK'S VENEREAL DISEASE CAMPAIGN 479
Resolved: That the following Regulations Governing the Con-
duct and Maintenance of Dispensaries Wherein Human Beings
Affected with Syphilis or Gonorrhea are Treated or Cared For,
and relating to Section 223 of the Sanitary Code, be and the
same are hereby adopted: —
A
SYPHILIS
Regulation 1. TREATMENT OP SYPHILIS: SPECIAL DEPARTMENT. The treat-
ment of syphilis, whatever its manifestations, shall be conducted in a special
department maintained for such purposes or in the department for dermatology
connected with the dispensary or hospital. Provided, however, when the nature
of the part affected, such as the eye, throat, viscera, etc., necessitates treat-
ment in some other department of the dispensary, treatment may be given
jointly by the two departments.
Regulation 2. MICROSCOPICAL EXAMINATION REQUIRED. Every department
for the treatment of syphilis shall make microscopical examinations of all sus-
pected lesions.
Regulation 3. WASSERMANN TESTS. Laboratory facilities for making Was-
sermann tests should be provided in every dispensary. If such laboratory
facilities are not so provided, provision shall be made for the prompt delivery
of specimens to the Department of Health or other approved laboratories where
such tests are made.
Regulation 4- NUMBER OF PATIENTS TO BE TREATED. The number of pa-
tients to be treated at a dispensary shall be regulated by the number of physicians
in attendance and the equipment and facilities provided in the dispensary. The
maximum number of patients treated by a physician shall not exceed ten (10)
per hour.
Regulation 5. SALVARSAN OR ITS ANALOGUES TO BE ADMINISTERED. In
view of the fact that the obligation to render a person affected with an infectious
disease innocuous at the earliest possible moment rests on the institution to
which the patient has applied for treatment, salvarsan or its analogues, in
sufficient quantities and at proper intervals, shall be administered with the
addition of mercury or other accepted means of treatment to all cases of syphilis.
Regulation 6. RECORDS. A complete and adequate record shall be kept of
every case of syphilis treated at a dispensary. Such records shall not be open
to inspection by the public or to any person other than the representatives of
the Department of Health of the city of New York and such persons as may be
authorized by law to inspect such records.
Regulation 7. FOLLOW-UP SYSTEM. A follow-up system, approved by the
Department of Health, to secure regular attendance by patients shall be estab-
lished and maintained.
Regulation 8. PROCEDURE GOVERNING THE DISCHARGE OF PATIENTS. A
standard procedure governing the discharge of patients shall be followed. Such
standard shall embrace suitable tests and subsequent persistent observations.
480 SOCIAL HYGIENE
B
GONORRHOEA
Regulation 1. MICROSCOPICAL EXAMINATION REQUIRED. Systematic micro-
scopical examinations of all discharges shall be made in every department of a
dispensary wherein persons affected with gonorrhoea are treated and cared for.
Regulation 2. FACILITIES TO BE PROVIDED. Every department of a dispen-
sary wherein persons affected with gonorrhoea are treated or cared for shall be
provided with and employ proper facilities for asepsis and antisepsis.
Regulation 3. URETHROSCOPIC AND CYSTOSCOPIC WORK TO BE PERFORMED.
Every dispensary shall be provided with facilities for urethroscopic and cysto-
scopic work and such facilities shall be regularly employed by the physicians in
attendance.
Regulation 4- COMPLEMENT FIXATION TEST TO BE PERFORMED. Every such
dispensary should be( provided with the facilities for making a complement
fixation test for gonorrhoea. If such facilities be not provided at the dispensary,
proper provision shall be made for the prompt delivery of specimens to the
Department of Health or other approved laboratories where such tests are
made.
Regulation 5. NUMBER OF PATIENTS TO BE TREATED. The number of patients
to be treated at a dispensary shall be regulated by the number of physicians in
attendance and the equipment and facilities provided in the dispensary. The
maximum number of patients treated by a physician shall not exceed ten (10)
per hour.
Regulation 6. RECORDS. A complete and adequate record shall be kept of
every case of gonorrhoea treated at the dispensary. Such records shall not be
open to inspection by the public or any person other than the representatives
of the Department of Health of the city of "New York and such persons as may
be authorized by law to inspect such records.
Regulation 7. PROCEDURE GOVERNING THE DISCHARGE OF PATIENTS. A
standard procedure governing the discharge of patients shall be followed. Such
standard shall embrace suitable tests and subsequent persistent observations.
Regulation 8. DISPENSARIES TO BE OPEN AT LEAST THREE (3) DAYS A WEEK.
Dispensaries shall be open at least three (3) days a week.
It will be seen that these regulations, while fairly comprehen-
sive, are at the same time eminently just. There is not a single
item that could be dispensed with, without defeating the pur-
pose in view. They embrace such requirements as any well
conducted clinic should conform to. A few words of comment
may be permitted upon the regulation requiring a follow-up
system. This perhaps will prove to be one of the greatest bur-
dens added to the clinic; but it is not insurmountable. It need
not necessarily involve a large financial outlay. Without en-
tering into an analysis of the causes, it is a fact, that one of the
PROGRESS IN NEW YORK'S VENEREAL DISEASE CAMPAIGN 481
greatest difficulties experienced in the venereal dispensary is to
obtain regular and continued attendance on the part of the
patients. It is equally a fact that but few clinics make syste-
matic efforts to insure such attendance. The greater cer-
tainty with which cure may be expected when cases are taken in
hand early and treatment persisted in over a sufficiently pro-
longed period makes it desirable for exceptional efforts to be
made in this direction. It is clear that unless a follow-up sys-
tem was made a requirement, the regulations would be lacking
in an essential detail. No particular plan is specified — that
being left to the individual clinic management to work out —
though it is required that such system be acceptable to the
Department. The arrangement so successfully put in operation
at the Brooklyn Hospital Dispensary is inexpensive and perfectly
acceptable.
The supervision of private laboratories, especially where tests
for communicable diseases are performed is certainly a legiti-
mate function of public health officials. The importance of
properly performed and accurate laboratory examinations is too
obvious to require comment. It is a known fact that there are
altogether too many variations in the Wassermann technique
and reagents used to obtain fairly uniform results. Some de-
gree of uniformity ought to be obtained though a single tech-
nique or reagent may not be agreed upon. Experience has
shown that if fairly accurate results are to be expected, a check
on laboratories will have to be maintained. These considera-
tions have led the Department to the belief that supervision of
laboratories is imperative and accordingly a regulation requir-
ing a permit to operate has been introduced. Rules and regula-
tions for the conduct of privately controlled laboratories have
been formulated and the Sanitary Code amended by the addition
of Section 105.
Section 105. DIAGNOSTIC LABORATORIES REGULATED. No laboratory offer-
ing facilities for the diagnosis of communicable diseases shall be conducted or
maintained in the City of New York without a permit therefor issued by the
Board of Health or otherwise than in accordance with the Regulations of the
said Board.
482 SOCIAL HYGIENE
RULES AND REGULATIONS GOVERNING THE CONDUCT AND MAIN-
TENANCE OF LABORATORIES
Resolved that the following Regulations Governing the Con-
duct and Maintenance of Laboratories Offering Facilities for the
Diagnosis of Communicable Disease be and the same are hereby
adopted to read as follows: —
Regulation 1. APPLICATIONS. Applications for permits to conduct and
maintain laboratories offering facilities for the diagnosis of communicable dis-
ease shall be made by the person in charge of the laboratory upon official appli-
cation blanks furnished by the Department of Health.
Regulation 2. A DULY QUALIFIED PERSON TO BE IN CHARGE. The person in
charge of the laboratory shall be a duly licensed physician or a person whose
qualifications are satisfactory to the Department of Health.
Regulation S. SPECIMENS TO BE NUMBERED. Every specimen received at the
laboratory for the purpose of determining the presence of communicable disease
shall be numbered and so designated as to definitely establish the identity of
each particular specimen.
Regulation 4- REGISTER TO BE KEPT. The person in charge shall cause a
register to be kept wherein shall be entered the following information: —
a. The laboratory number and date of the receipt of every specimen to be
tested to determine the presence of communicable disease.
6. The name of the physician submitting the specimen.
c. The result of the laboratory test.
d. The name of the person to whom the report of the result of the test was
forwarded.
Regulation 5. EQUIPMENT. The laboratory shall be equipped with ade-
quate facilities to properly perform such tests of specimens as the laboratory
undertakes to make.
Regulation 6. METHODS. The methods employed shall be such as are gener-
ally recognized as effective.
These regulations will serve not merely to supervise the lab-
oratories but will furnish an additional source through which
reports of communicable diseases will reach the department,
making more effective control possible.
Of great value in bringing about efficient administrative con-
trol of venereal diseases is the State Law recently enacted and
to take effect September 1, 1917, regarding venereal disease ad-
vertisements. The misrepresentation practiced by quacks and
nostrum manufacturers constituted one of the chief obstacles en-
countered by health authorities in dealing with venereal diseases.
This state is to be congratulated upon the passage of so pro-
PROGRESS IN NEW YORK'S VENEREAL DISEASE CAMPAIGN 483
gressive a measure from which much good is certain to result.
It reads : —
1142 a Advertisements relating to certain diseases prohibited. Whoever
publishes, delivers or distributes or causes to be published, delivered or dis-
tributed in any manner whatsoever an advertisement concerning a venereal dis-
ease, lost manhood, lost vitality, impotency, sexual weakness, seminal emis-
sions, varicocele, self abuse or excessive sexual indulgences and calling attention
to a medicine, article or preparation that may be used therefor or to a person
or persons from whom or an office or place at which information, treatment or
advice relating to such disease, infirmity, habit or condition may be obtained, is
guilty of a misdemeanor and upon conviction thereof shall be punished by im-
prisonment for not more than six months, or by a fine of not less than fifty dol-
lars nor more than five hundred dollars, or by both such fine and imprisonment.
This section, however, shall not apply to didactic or scientific treatises which
do not advertise or call attention to any person or persons from whom or any
office or place at which information, treatment or advice may be obtained nor
shall it apply to advertisements or notices issued by an incorporated hospital
or a licensed dispensary or by a municipal board or department of health or by
the department of health of the state of New York.
It will be noted that while this provision strikes at quacks and
nostrum manufacturers, it scrupulously avoids interfering with
legitimate medical activities.
Another state measure placed upon the statute books and
destined to prove of some importance is the recently passed
amendment to the Domestic Relations Law. While not as
comprehensive in scope nor likely to prove as effective as is
theoretically possible in the application of the much advertised
Wisconsin "Eugenic Marriage Law" it still is sufficiently so to
make its beneficial influence felt. This law requires that an
individual applying for license to marry must testify to the
following effect:—
I have not to my knowledge been infected with any venereal disease, or if I
have been so infected within five years I have had a laboratory test within that
period which shows that I am now free from infection from any such disease.
This provision offers no certain safeguard to the public. It
will not deter the unscrupulous from practicing perjury but it is
certain to prove of immense educational value.
Early in the Department's venereal campaign, cards of in-
struction and circulars of information were prepared for distri-
484 SOCIAL HYGIENE
bution to applicants at the medical adviser's office. Occasion
was taken some time ago to offer these for distribution at the
dispensaries operated throughout the city. While nearly all
clinics signified their willingness to assist, we have reason to
believe that but few have actually kept their promise. It is
felt that if such circulars could be distributed to each and every
one of the infected individuals, it would prove of great benefit
from the educational, curative, and prophylactic standpoints,
and the Department has amended section 88 of the Sanitary Code
making it mandatory upon physicians to issue approved circu-
lars to all venereally infected patients. This amendment reads
as follows: —
It shall be the duty of every physician to furnish and deliver to every person
found by such physician to be affected with syphilis or gonorrhoea a circular of
instruction and advice, issued or approved by the Department of Health of the
city of New York, and to instruct such persons as to the precautions to be taken
in order to prevent the communication of the disease to others. No person
affected with syphilis or gonorrhoea shall, by a negligent act, cause, contribute,
etc., or promote the spread of such diseases.
It is proposed to offer the Department circulars freely to the
practitioner, hospital, and dispensary for distribution — other
circulars, approved by the department, may of course be substi-
tuted— and it is hoped that the cooperation of the profession in
this city will be obtained.
These are the recent steps that have been taken in the city
and state of New York in the matter of venereal diseases. It is
a source of gratification that we are enabled to register such prog-
ress in so difficult a field in so short a space of time. The De-
partment is not seeking to add a single burden to the profes-
sion but wishes to leave nothing undone which will be of service
in controlling this formidable group of communicable diseases.
Briefly, therefore, we may say that the policy of the Depart-
ment of Health, New York City, is to treat the control of vene-
real diseases upon the same principles which have proved effec-
tive in diminishing the incidence of all the other controllable
communicable diseases. Notification is compulsory, and is
being more and more generally complied with. Diagnostic
PKOGRESS IN NEW YORK'S VENEREAL DISEASE CAMPAIGN 485
facilities are provided free at the laboratory, and at the advisory
clinics of the Department of Health. Fraudulent diagnosis
and offers of service are checked by limiting public advertise-
ment, and by regulating private diagnostic laboratories. Dis-
pensary treatment, at present but ill provided, is not under
direct department control, but the dispensaries which do not
provide adequate diagnostic, therapeutic, and follow-up serv-
ice will be discontinued, and if necessary their places filled by
dispensaries operated by the Department of Health, or by- some
other municipal department, as the Department of Charities or
the Department of Bellevue and Allied Hospitals.
Quack medicines and " medicine men" are now for the first
time stripped of their greatest asset, the public press advertise-
ments.
Education follows and accompanies administrative measures
for control. Lectures, leaflets, and exhibits are used to supple-
ment the direct personal teaching at the advisory clinics, and the
attention which the law demands on the subject from those
applying for marriage licenses. Especial duty is imposed upon
the physician in his private office or at the hospital and dispen-
sary to put into the hands of the patient a clear statement
upon the diseases, so that he may avoid spreading the disease
further.
One phase of control of importance, but not a subject for ex-
tended publicity, is the power of the Board of Health, in addition
to the authority indicated in the enactment of the foregoing
sections of the Sanitary Code, to remove and detain, by force if
necessary, patients suffering from venereal disease in communi-
cable form, who are unable or unwilling to observe precautions
necessary for public safety. The Department now has a hos-
pital building with sixty beds, built and equipped for this par-
ticular purpose, and patients have already been detained by the
department under the authority of the Board of Health above
mentioned.
The present facilities for the free treatment of ambulatory
and bed patients, male or female, with syphilis and gonorrhoea,
are absurdly inadequate. This defect in our equipment for the
486 SOCIAL HYGIENE
campaign upon which we are already launched must be corrected
by private or public endowment before we can say we have the
means to use the almost complete information for the control
and ultimate elimination of these diseases which science has put
into our hands to use.
WHAT SOME COMMUNITIES OF THE WEST AND
SOUTHWEST HAVE DONE FOR THE PROTECTION
OF MORALS AND HEALTH OF SOLDIERS AND
SAILORS
BASCOM JOHNSON
Attorney, The American Social Hygiene Association
When Congress passed the act providing for the National
Army, May 18, 1917, there was written into it in sections twelve
and thirteen a brand new policy for the military forces of the
United States. The national government by this act announced
that alcohol and prostitution which had theretofore been re-
garded or largely tacitly recognized as necessary evils in con-
nection with army life were no longer to be tolerated; that a
government which drafted its young men to fight and perhaps
die for it could not longer permit them to be surrounded by
crude and vicious influences from which many would return
home maimed in body and soul. These provisions of the act
were received with astonishment and incredulity by many
communities which were familiar with army life. This act was
promptly followed up by Secretary of War Baker's letter to the
governors of all the states.1 This letter called for the coopera-
tion of the communities within each state where camps were
located in carrying out the purpose of Congress. It was stated,
however, that as a last resort, the camps would be moved from
those communities where clean conditions could not be obtained.
A similar position was taken by Secretary of the Navy Daniels.
Although this matter was given considerable publicity there
were large sections of the public who could not understand that
a serious attempt would be made to enforce this law. It fell
to the lot of the Commission on Training Camp Activities, ap-
pointed by Secretary Baker soon after the war started, to com-
1 See Social Hygiene and the War by William F. Snow, M.D., in SOCIAL
HYGIENE, vol. iii, no. 3, July, 1917, for this letter and other documents.
487
488 SOCIAL HYGIENE
plete the conversion of these communities. This conversion is
still going on and will perhaps need to go on more or less con-
tinuously during the war.
This article is a fragmentary account of what some communi-
ties which were quick to grasp the patriotic appeal which under-
lies this national policy have already done, or are doing to better
these conditions. Not all the conversion has been confined
to the communities, however; there were some army officers
converted. I have in mind at least one city that I personally
visited for the Commission where the tables were completely
turned. This city had abolished its red light district some years
before and, like the many other cities that have come into the
column of such self-respecting communities in the last six years,
it had no desire to return to the old regime.
It was reported to the mayor of this city by one of the city's
best known and respected citizens that the army officer command-
ing the camp nearby had stated publicly at a luncheon at which
this citizen was present that he was strongly in favor of the
reestablishment of a red light district within this city — that in
fact he was determined to have it if he had to establish martial
law to get it, or as a last resource he would recommend the
removal of the camp from the neighborhood of that city.
Although the mayor was at that very time negotiating for a
municipal loan to meet some of the city's pressing obligations and
although everyone regarded the permanent location of this
camp as a financial godsend to the city, the mayor sent the
following telegram to the authorities at Washington: —
1917.
HON. NEWTON D. BAKER,
Secretary of War,
Washington, D. C.
It is currently rumored here that effort will be made to secure reopening of
red light district in .... and that such effort will have the sympathy,
if not the approval, of officers of the army who are here.
On behalf of the city government of .... and especially on my own
authority as mayor, I wish to emphatically state that the people here do not
want an open red light district and will not now tolerate it. The policy of
suppression of houses of prostitution was put into effect in this city in ....
by me as mayor. Since that time I have been nominated and elected to
WHAT SOME COMMUNITIES HAVE DONE 489
.... additional terms and I am now serving my .... term. The
red light district question has been fought out in every one of these campaigns.
Will you kindly advise whether your department is back of any suggested
or reported endorsement of a plan to suggest or request the opening of red light
district, in order to accommodate the soldiers of United States Army. The
people of .... and the state of .... are standing by the presi-
dent and his administration; our young men are enlisting for army and navy
service, and our people are anxious to do everything possible in assisting the
army in every way, but I respectfully protest against any effort being made to
change . . . . 's policy with reference to the handling of houses of
prostitution.
I respectfully submit that the awful experience with venereal diseases of the
armies in Europe in the present war should be an object lesson constraining the
United States to adopt a vigorous, sane and efficient policy of enlightenment of
the men in the army and navy as to the possible far-reaching, disastrous effects
to them of contamination by venereal diseases.
Mayor.
In a few days the mayor received the following reassuring
reply :-
Washington, D. C.
1917.
Mayor
Your telegram .... indicates that you believe you have information
to the effect that efforts to reopen red light district in .... have the
sympathy and approval of army officers on duty at training camp. War Depart-
ment need not assure you matter of police regulations is one with which army
never interferes.
If you have any information tending to show that any officer of the army has
expressed sympathy or approval, or has in any way encouraged reopening of
red light district, your duty to the government will undoubtedly prompt you to
submit that evidence to the War Department.
On the very day that the mayor sent his telegram, the army
officer in question decided to issue a public statement to the
press denying flatly that he was advocating the establishment of
such a district near the camp.
Ever since this incident occurred there has been the utmost
harmony and cooperation between the military and civilian
officials at that city in all matters. In view of that fact the mayor
told me he thought no good purpose could be served by furnish-
ing the name of this army officer to the Washington authorities
490 SOCIAL HYGIENE
or by indulging in any public discussion of the matter.2 This
officer is no longer at this particular post. He was and is a good
soldier but he needed education, and he got it from an unex-
pected source, probably much to his astonishment.
Another city which I visited last May contained at that time
one of the largest and worst red light districts in the country.
Gambling houses were going full blast and there were a large
number of assignation houses, disreputable hotels, and rooming
houses outside the so-called segregated district. It should be
said, however, that that part of the conscription act prohibiting
the sale of liquor to soldiers received immediately in this city and
in most cities that I visited the active support of the city officials
and, in the great majority of cases, of the breweries and saloons.
It is true there was here, and there probably will continue to be
everywhere, considerable " bootlegging," that is the selling or
furnishing of liquor to soldiers "from the hip" by tramps and
other irresponsible characters. This traffic is being met by
drastic legal action and is already considerably reduced. It
will remain a source of considerable trouble, in "wet" states at
least, until the law prohibiting it is materially strengthened.
This city had had an army post for years. It had grown
used to drunken soldiers and to seeing its red light district
filled with them. A number of its short-sighted politicians and
business men were convinced that that kind of thing was good
for business and made for general prosperity. Furthermore,
there was considerable ground for the belief of the citizens of
that city that some at least of the hig-her officers in the army
who had been located at that post believed in a wide open town
and would be sorry to see the lid clamped down.
It is hardly to be wondered at under these circumstances that
this city was backward in cleaning up. When the citizens of the
city learned — and some of them made a trip to Washington to
make sure — that Secretary Baker meant just what he said, they
began to change conditions promptly and cheerfully and this
city, San Antonio, is today about as free from commercialized
1 The name of this city is not given at the request of the mayor.
WHAT SOME COMMUNITIES HAVE DONE 491
prostitution, gambling, and the selling of liquor to soldiers as
any city of its size in the country. The most encouraging
feature of this change is the fact that many of its most influential
citizens are now glad of it. "We ought to have done it long
ago," they said. "We all knew it, but we just needed a little
pushing to make us do it." San Antonio is now learning the
lesson so difficult for every city to learn, viz., that municipal
housecleaning like domestic house cleaning is a job that is never
finished ; that eternal vigilance is the price of cleanliness as well
as of liberty. But San Antonio, unlike so many cities which
have instituted repressive measures, is not content to rest there.
Some of its best doctors and a group of its socially-minded Jead-
ing citizens are trying hard to devise ways and means to educate
the parents and the young people of the city to the grave dangers
to public health and morals resulting from lack of restraint in
sex relations.
Furthermore an attempt will be made to locate every venereal
disease carrier and to provide diagnosis and treatment at the
earliest possible moment. By this method, which will include
confidential treatment in the private offices of certain designated
physicians at a charge which will be adjusted to the financial
status of each patient, it is hoped to save to lives of usefulness
certain misguided but not vicious girls and boys who have
acquired disease and become thereby a public health menace.
Many of this class have not been able heretofore to pay the
office fees of competent physicians and have, therefore, faced
physical ruin rather than the public disgrace which they imag-
ined would follow their attending venereal clinics or the hos-
pital. From . this class the sex specialist quack has reaped a
large harvest. These bloodsuckers rarely cure their patients
and trade on the fear of exposure of the credulous.
In order that San Antonio's program of law enforcement,
public health, and education shall receive the united support of
its citizens this group has requested the federal government
to assign one of its sanitary experts to set up the machinery for
its operation. The chances are that this request will be granted,
I am informed, providing a satisfactory adjustment of the limits
of local and national authority can be worked out.
492 SOCIAL HYGIENE
Another Texas city, El Paso, has cleaned up in the same
way. All that was needed here, was the clear understanding
by the officials that the War Department wanted this done.
City officials are, after all, Americans; their boys are enlisting
just as yours are; they have just as much of a stake in the coun-
try and often more than most people; many of them have
bought large amounts of Liberty Bonds, and I have found them
as a class even more responsive to the patriotic appeal than the
average citizen. I find it necessary to say this because we have
been taught in this country to regard with suspicion every man
who seeks or occupies municipal office.
El Paso's moral problem, like that of San Antonio, was and is
very greatly complicated by having a large Mexican population,
many of whom are refugees. The red light district in El Paso
was located in the Mexican quarter on the banks of the Rio
Grande as near the Mexican border as possible. Many large
new concrete houses were built last summer to accommodate the
women who " mobilized" there with the National Guard. But
many of the soldiers, I am reliably informed, preferred to ad-
venture in the blind alleys and quaint, but filthy, courtyards in
the Mexican quarter. There they continued to go in large num-
bers even after the red light district was closed early in June.
It was not until the Commanding General, George Bell, in co-
operation with the city authorities, established Overland Street
as the boundary south of which no soldier could go that these
conditions cleared up. When I last visited El Paso towards the
end of July this order had been in effect about a month with good
results. The reputable merchants south of Overland Street how-
ever had been protesting so vigorously against being punished for
the sins of their neighbors that General Bell had just raised the
embargo on two blocks of this district for a period of ten days
on trial. In consideration of this clemency, these merchants agreed
to help police the district and to institute a form of local self-
government. By extending this plan, bit by bit, General Bell
and the city authorities hope to make good citizens out of many
who have heretofore proven refractory and discordant elements
in the population.
WHAT SOME COMMUNITIES HAVE DONE 493
There was still considerable " bootlegging" of liquor to soldiers
when I recently visited El Paso, but the city council met on that
day and agreed to strengthen their ordinances in an attempt to
cover this situation as well as the problem of clandestine pros-
titution. There is, I am convinced, a genuine effort being made
here to keep El Paso clean. This effort is all the more praise-
worthy because El Paso has not the additional incentive that
San Antonio has in the location of largely increased numbers of
troops within its borders. This latter statement also applies to
conditions at Douglas, Arizona, which is the headquarters of the
Arizona district border patrol. There are some three or four
thousand troops in this district, mostly cavalry, under General
Greene. There is little or no prospect as far as any one knows
of this number being materially increased. The probabilities
are that it will be decreased. Yet Douglas completed on August
first a sweeping clean-up in its municipal morals. On that date
its red light district, an institution of long standing, was closed;
a new chief of police was installed to insure a fair trial for the
new policy; one member of the city council was forced out be-
cause of his reactionary actions and attitude on these ques-
tions; and new and stringent city ordinances on liquor, prostitu-
tion, and gambling in line with these new policies were put on
the statute books. All this was done because General Greene
and the representative of Secretary Baker's Commission on
Training Camp Activities intimated to the city government that
prostitution and alcohol were very much too easy of access to
the troops.
As these ordinances may be helpful to other cities who desire
to follow the patriotic example of Douglas, they are presented in
full here. It must be remembered in connection with the liquor
ordinance that Arizona is a dry state. This ordinance is, there-
fore, designed to give the city in its own courts the power to
enforce an existing state policy. Heretofore all violations of
the liquor laws have been tried in the county courts and, as seems
to be inevitable in communities with separate city and county
legal machinery, cooperation was not always complete and re-
sults were unsatisfactory. This ordinance is based on one that
I am informed has worked out satisfactorily in Bisbee, Arizona.
494 SOCIAL HYGIENE
ORDINANCE 173
AN ORDINANCE CONCERNING THE SALE OR GIVING AWAY OF ANY ARDENT SPIRITS,
ALE, BEER, WINE OR INTOXICATING LIQUORS OF ANY KIND WITHIN THE CITY
OF DOUGLAS, COUNTY OF COCHISE, STATE OF ARIZONA; AND PROHIBITING THE
KEEPING AND POSSESSION OF ANY SUCH LIQUORS IN PLACES OF PUBLIC RESORT
IN SAID CITY
BE IT ORDAINED by the Common Council of the City of Douglas :
Section I
All persons are hereby prohibited from selling, exchanging, bartering or dis-
posing of any ardent spirits, ale, beer, wine, or intoxicating liquors of any kind,
to any persons, within the corporate limits of the City of Douglas; and all per-
sons are hereby prohibited from giving away any such ardent spirits, ale, beer,
wine or intoxicating liquors of any kind to any person within the corporate
limits of the City of Douglas.
Section II
It shall be unlawful to keep or have, or permit to be kept, had or possessed
in any hotel, boarding house, eating house, restaurant, pool or billiard hall,
tobacco store, soft drink parlor, store of any kind, or any place of public resort,
or in any cellar, closet, room or space connecting with any of the above named
places for any purpose, any ardent spirits, ale, beer, wine or intoxicating liquor
of any kind. The finding of such liquors in any of such places shall be prima
facie evidence of the fact that the proprietor, or persons in charge of such place
at the time of the finding thereof permitted such liquors to be kept on such
premises; and all persons are prohibited from having on their persons, or in their
possession, or from drinking any such liquor in any public place described herein,
or in any public street, avenue, thoroughfare, alley or public park in the City of
Douglas.
Section III
Every person who shall violate any provision of this ordinance shall be guilty
of a misdemeanor and shall be punished by a fine of not less than $25.00 and
not more than $300.00, or by imprisonment in the City Jail for not less than ten
days nor more than three months, or by both such fine and imprisonment; and
the liquors possessed in violation of this Ordinance shall be by the Court ordered
destroyed.
Section IV
All ordinances or parts of ordinances in conflict herewith are hereby repealed.
Section V
WHEREAS, the immediate operation of this Ordinance is necessary for the
preservation of the public peace, safety and health, an emergency is hereby
declared to exist and this Ordinance shall be in full force and effect from and
after its passage by the Common Council, approval by the Mayor, and after
posting and publication required by law, and is hereby exempt from the operation
of the Referendum provisions of Arizona pertaining to cities.
Passed and adopted by the Common Council of the City of Douglas, this 28th
day of June, 1917.
WHAT SOME COMMUNITIES HAVE DONE 495
ORDINANCE NUMBER 176
AN ORDINANCE PROHIBITING GAMBLING IN THE CITY OF DOUGLAS, ARIZONA
BE IT ORDAINED by the Common Council of the City of Douglas, Arizona:
Section I
It shall be unlawful for any person in the City of Douglas, Arizona, to deal,
carry on or open, or cause to be opened, or to conduct, either as owner, proprie-
tor or employee, whether for hire or not, any game of faro, monte, roulette,
lasquenet, rouge et noir, rondo, vingt-un or twenty-one, poker, stud poker,
draw poker, bluff, fan tan, thaw, seven and one-half, chuck-a-luck, black jack,
or any similar game whatsoever played with cards, dice, or any other device,
or to operate or cause to be operated, any slot machine, or machine of like
character, whether the same be played for money, checks, credits or any other
representatives of value.
Section II
It shall be unlawful for any person in the City of Douglas, Arizona, to deal,
carry on, or open or cause to be opened, or to conduct, either as owner, pro-
prietor or employee, whether for hire or not, any banking or percentage game
whatsoever, played with cards, dice or any other device, whether the same be
played for money, checks, credits or any other representatives of value.
Section III
It shall be unlawful for any person, firm or corporation to conduct or carry
on, or to allow to be carried on or conducted, in or upon any premises owned
or controlled by him, it or them, any gaming or gambling, or any game or games
of chance whatsoever, played for money, checks, credits or any other representa-
tives of value.
Section IV
All ordinances and parts of ordinances in conflict herewith are hereby repealed.
Section V
Every person who shall violate any provision of this Ordinance shall be
guilty of a misdemeanor and shall be punished by a fine of not less than $20.00
and not more than 1300.00, or by imprisonment in the City Jail for not less than
ten days nor more than three months, or by both such fine and imprisonment.
Section VI
WHEREAS, the immediate operation of this Ordinance is necessary for the pres-
ervation of the public peace, safety and health, an emergency is hereby de-
clared to exist and this Ordinance shall be in full force and effect from and after
its passage by the Common Council, approval by the Mayor and publication as
required by Law, and is hereby exempted from the operation of the Referendum
provisions of Arizona pertaining to cities.
Passed and adopted by the Common Council of the City of Douglas, this 16th
day of July, 1917.
496 SOCIAL HYGIENE
ORDINANCE NO. 177
AN ORDINANCE DEFINING CERTAIN OFFENSES AGAINST PUBLIC MORALS IN THE
CITY OF DOUGLAS, ARIZONA, AND PROVIDING FOR THE PUNISHMENT OF THE
SAME
BE IT ORDAINED by the Common Council of the City of Douglas, Arizona:
Section I
That it shall be unlawful for any person or persons to set up, or keep or main-
tain a brothel, bawdy house, house of prostitution or house of assignation in the
City of Douglas, Cochise County, Arizona.
Section II
That it shall be unlawful for any person or persons who are the owners, lessees
or occupants of any building or buildings within the City of Douglas, Cochise
County, Arizona, the whole or any part of which is used for the purpose of pros-
titution, lewdness or fornication, to fail to suppress the same therein after being
notified by any peace officer of said City of Douglas, so to do.
Section III
That it shall be unlawful for any person or persons in the City of Douglas,
Cochise County, Arizona, to use or occupy any room or rooms in any hotel,
rooming house, dwelling house, tenement or other building whatever, within
said City of Douglas, for the purpose of fornication, prostitution or lewdness.
Section IV
That it shall be unlawful for any female person to pursue the vocation of a
prostitute, or to advertise in any manner, such vocation as prostitute in the
City of Douglas, Cochise County, Arizona.
Section V
That it shall be unlawful for any male person to cohabit with any female
person who has the general reputation of being a common prostitute, in the
City of Douglas, Cochise County, Arizona, or to be found publicly associating
with any such female in any public place or upon a public street or alley within
the said City of Douglas.
Section VI
That it shall be unlawful for any person or persons to act as a procurer or
panderer for another, or to offer to provide gratification for the sexual lust of
another within the City of Douglas, Cochise County, Arizona.
Section VII
That all ordinances and parts of ordinances in conflict herewith are hereby
repealed.
WHAT SOME COMMUNITIES HAVE DONE 497
Section VIII
That any person or persons who violate any of the provisions of this ordi-
nance shall be guilty of a misdemeanor, and shall be punished by a fine of not
exceeding Three Hundred Dollars ($300.00), and "by imprisonment in the City
Jail of Douglas, Arizona, not exceeding three (3) months, or by both such fine
and imprisonment.
Section IX
WHEREAS, the immediate operation of this Ordinance is necessary for the
preservation of the public peace, safety and health, an emergency is hereby
declared to exist, and this ordinance shall be in full force and effect from and
after August First, 1917, after passage by the Common Council approval by the,
Mayor and publication as required Iff- law, and is hereby exempted from the
operation of the Referendum Provisions of Arizona pertaining to cities,
Passed and adopted by the Common Council of the City of Douglas, Arizona,
this 2Sd day of July, 1917.
San Diego, California, wiJl have large numbers of soldiers,
sailors, and marines to care for and is rising to the situation with
characteristic hospitality. Linda Vista twenty miles to the
north will contain in its cantonment some forty thousand Na-
tional Guardsmen. In the heart of the city the beautiful expo-
sition buildings were turned over by the city to hundreds of
soldiers, marines, and sailors in process of training, and on
North Island in the harbor is an aviation camp destined, I am
told, to be one of the largest in the country. Every city has its
peculiar difficulties and problems. San Diego's is the Mexican
town of Tia Juana, across the border eighteen miles away. This
town is always wide open and during the winter horse-racing
season is reported to be a gathering place for gamblers, prosti-
tutes, crooks, and every species of underworld character. These
gentry pass through San Diego on their trips to and fro; some of
them try to make San Diego their headquarters from which to
operate. They are often free spenders and, while they probably
take t)ut of San Diego as much money as they bring in, they
give that city the appearance of a festive and hectic kind of
prosperity during the racing season. Those in San Diego who
profit by this false prosperity are loud in denunciation of any
plan to clean up Tia Juana, but some of her most substantial
citizens petitioned the federal government to close the border
to all except those having legitimate business on the other side
498 SOCIAL HYGIENE
in order that San Diego may have a fair chance to discharge the
responsibility it has assumed for the moral welfare of thousands
of young soldiers and sailors. In this connection it may be
stated that the newspapers of recent date carried the announce-
ment "that the Secretary of State had decided not to issue any
more passports to women and children to enter Mexico, and to
limit the number of passports to men for this purpose." When
certain bad conditions were recently pointed out to the mayor
as existing in the cafe's and massage parlors of San Diego, he
promptly agreed to do everything he could to eliminate them.
The police force which had been disorganized because it had been
without a real head for some months and seemed likely to be
without one for some time to come because of a political dead
lock, now appears sure of thorough reorganization and a com-
petent chief. Why? Simply because San Diego realizes it
must put its house in complete order to fulfill its obligations to
the boys in khaki.
At Los Angeles, California, is located a naval training station,
a harbor defense fort with its gun crews, and a few companies of
soldiers guarding bridges and other public utilities. The chief
problems of Los Angeles lie outside the city limits in Los Angeles
County at some of its beach resorts and road houses. The city
itself has reduced commercialized prostitution and the allied
evils to a minimum through the persistent efforts of its officials,
largely assisted and supported by a private law-enforcing organi-
zation known as "The Morals Efficiency Association." The
most complete harmony of thought and action appears to exist
between the city and county officials and this private agency
which has the financial and moral support of the most progres-
sive citizens of the community. Its executive secretary, has
been appointed a lieutenant of police without pay, and has had
assigned to him two plain-clothes men paid for by the city, who
work under his direction. The district attorney has assigned
one of his assistants to bring nuisance abatement suits under the
California Injunction and Abatement Law on evidence secured
by the secretary. This officer and the county officials are now
hard at work devising ways and means to clean up the condi-
WHAT SOME COMMUNITIES HAVE DONE 499
tions above referred to in the county, outside the city. These
conditions consist chiefly of dance halls where dancing goes on
until three or four in the morning, liquor is sold to those already
considerably under its influence, and women of the underworld
are permitted to mingle indiscriminately with the men patrons.
The county authorities have been handicapped by lack of laws
to cover these particular evils and by the fact that the com-
munities where these things take place are incorporated towns
with a measure of independence which they use to attract
thousands of pleasure-loving and often irresponsible transients
who spend their money and drive away. But the officials of the
beach resorts when appealed to on patriotic grounds promised,
at least, to protect the soldiers and sailors from liquor and also
to strengthen their rooming-house ordinances so as to prevent
such places from becoming the resorts of transient prostitutes
and of foolish young girls and their soldier and sailor friends on
furlough.
San Francisco, because of its strategic position as the financial
and recreational headquarters of the Bay District and for large
sections of California, has for years been the headquarters of the
underworld element of the Pacific Coast. Until February, 1917,
it had a red light district and many flourishing forms of the
allied evils of liquor and gambling. Since that date the lid has
been partly clamped down. There was, however, considerable
need of improvement at the beginning of the war. The old Bar-
bary Coast dance-hall district had taken on new life with the in-
crease of soldiers at the Presidio and sailors and marines at Mare
Island Navy Yard. There was selling of liquor to soldiers and
considerable prostitution. The only department of the city
government that was active or earnest in suppressing these con-
ditions was the police department, and particularly the morals
squad in that department, under the charge of a lieutenant.
This lieutenant has accomplished wonders in the face of discour-
agement and opposition. He has the confidence of the entire
community of law-abiding citizens and deserves the support
which he has secured. The squad was very much handicapped
by the antagonistic attitude of the police judges and of the
500 SOCIAL HYGIENE
district attorney's office, and by lack of funds. When this
situation was put clearly before the mayor and the president
of the police commission by the general commanding the mili-
tary forces and the representative of the Commission on Train-
ing Camp Activities, instant response was forthcoming. A re-
quest that an appropriation of three thousand dollars be made
to provide ammunition for the morals squad was met by a
promise on the part of the mayor that he would urge this appro-
priation strongly upon the city legislative body, and if it were
not forthcoming he would personally guarantee this sum. A
little later, in order that this problem, which was shared in by
all the communities surrounding San Francisco, might be met
in a spirit of broad and comprehensive cooperation, a conference
was called in the office of the mayor and attended by the state
and local health officers, law enforcing officials of the surrounding
communities, and the representatives of the army and navy.
At this conference the following broad and far-reaching program
was adopted : —
1. Prostitution is to be suppressed, vigorously and continuously through the
enforcement of the state law; and the issuance of certificates of health to pros-
titutes shall be no part of the program.
2. Prostitutes brought to the attention of the police or health authorities are
to be examined; and all persons, male or female, capable of spreading venereal
disease are to be isolated, under the provisions of the Public Health Act or local
ordinance, and treated at public expense as long as there is danger, in the opinion
of the health officer, of their exposing others.
3. Under no circumstances are infected prostitutes to be "floated" into other
communities, and if they are known to go from one community to another, the
health officials of the places of destination are to be notified at once.
4. The state law, requiring the reporting of syphilis and gonococcus infec-
tions, by physicians' office numbers, is to be enforced to the letter, and in addi-
tion, physicians are to be urged to obtain, and furnish to the local health officers,
the names of the persons who are suspected of disseminating infection. The
local health officers are thereupon to investigate and supervise or isolate infectious
cases, according to the circumstances.
5. To provide and encourage the instruction of young men and women in the
advantages of a clean life and the dangers from venereal diseases.
6. To provide adequate opportunities for expert diagnosis, treatment, and
advice, for infected persons financially unable to secure proper treatment for
themselves, and to encourage the continuance of treatment until the patient is
cured, or at least becomes noninfectious.
WHAT SOME COMMUNITIES HAVE DONE 501
7. To provide free laboratory tests for syphilis and gonococcus infections for
physicians, and to encourage greater use of the free tests for these diseases avail-
able at the laboratory of the Bureau of Communicable Diseases of the State
Board of Health.
The following self-explanatory resolution was adopted by the
Conference : —
Resolved: That this Conference on Co-operation of the Civil Authorities with
the Army and Navy in the Prevention of Venereal Diseases be regarded as per-
manent, and that an Executive Committee be appointed by the chair, and in-
clude one member from each of the groups represented in the call for the meeting.
No one who has not been familiar with the unsatisfactory moral
conditions at San Francisco in past years can realize what a
tremendous revolution this program involves. It was agreed
to promptly and cheerfully as a war emergency. It will involve
considerable municipal funds. It represents San Francisco's
answer to the patriotic appeal.
California has been one of our most progressive states. In
line with its progressive policy, California was first to meet
Secretary of War Baker's request for complete state coopera-
tion in protecting the health and morals of the soldiers. Imme-
diately after the receipt of Secretary Baker's letter, Governor
Stevens of California sent a strong letter to all the law enforcing
officials throughout the state, urging them to do everything in
their power to protect the soldiers and sailors from vicious in-
fluences. In order to make this cooperation effective Governor
Stevens, upon the nomination of the Chairman of the State Coun-
cil of Defense, appointed a committee of seventeen citizens to
carry on for the state the work which the Commission on Train-
ing Camp Activities is carrying on for the nation. That this
committee as well as the national commissions might keep in
close touch with actual conditions near military and naval
posts within its borders, the governor agreed to appropriate
from funds within his control a sufficient sum to employ an
executive secretary who should be a man mutually acceptable
to the state committee and the national commissions of the War
and Navy Departments. The purpose of this arrangement is
to link together state and national activities and to insure
502 SOCIAL HYGIENE
effective and harmonious action along the lines laid down in
Secretary Baker's letter. This state committee has organized,
divided into sub-committees, and has gone actively to work with
substantial results. The Governor and the State Board of
Control have just agreed to appropriate thirty thousand dollars
annually for the period of the war for the maintenance of a
bureau of venereal diseases in the State Board of Health. These
arrangements provide the administrative machinery to give
effect to the resolutions adopted. Thus California has answered
the nation's call for the protection of its military and civil
citizenry from vice and disease.
Oregon, Washington, and Arkansas have under consideration
the organization of state committees, similar to that appointed
in California. With the formation of such state committees
throughout the country, the requests of the Secretary of War
and the Secretary of the Navy will surely result in sympathetic,
intelligent, and effective cooperation between state and nation
in providing and maintaining clean and wholesome environments
for the men in training.
In Minnesota, through the instrumentality of the Minnesota
Public Safety Commission, appointed since the war began with
wide powers of control over environmental conditions and other
authority to remove officials who may stand in the way, condi-
tions in the saloons and cafe's have been much improved by an
order of the commission effective June 5, 1917. This order closes
all saloons between the hours of 10 p.m. and 8 a.m.; prohibits
the dispensing of liquor in clubs, cafe's, and all eating places
during the same hours; prohibits women from entering saloons
at all times and from being served with liquor at all times; pro-
hibits dancing and cabaret performances in places where liquor
is sold. This order followed the submission of evidence to the
commission by representatives of the Commission on Training
Camp Activities, indicating that commercialized and clandestine
prostitution were active and that liquor was being sold to
soldiers from the military encampment at Fort Snelling between
the cities of St. Paul and Minneapolis.
In Indiana, through direct action by the State Council of
WHAT SOME COMMUNITIES HAVE DONE 503
Defense and the Governor, supported by the Indianapolis Church
Federation, open prostitution and selling of liquor to soldiers in
that city was suppressed. This was done because there was an
officers' training camp at Fort Benjamin Harrison near India-
napolis and because these conditions were called to the atten-
tion of these officials by the Commission on Training Camp
Activities as being inimical to the best interests of the troops.
Here again, when once the War Department requested improve-
ment, there was wholehearted and instant response by these
officials.
As stated, this is only a fragmentary collection of notes on the
reaction of public officials and the people of certain states which
have received a good deal of publicity in the past because of their
failure to deal effectively with this series of difficult social and
health problems. The way in which the communities cited have
taken hold of the situation is an index of what is happening in
every section of the United States. The situation is, of course
serious, but the future seems full of promise for permanent
progress.
MY CREED1
THE WAY TO HAPPINESS — As I HAVE FOUND IT
Last summer, on the twelfth of August to be exact, I had my
fortieth birthday. I had never expected to be forty. Forty might
happen to other people, but it could never happen to me. And I
felt so frightfully young. I always feel young.
I had my fortieth birthday beside the Flathead River in Montana.'
We, the family and I, had been out on a riding tour in the wilderness
for weeks. We were not even exactly sure that it was the twelfth of
August, and it turned out afterward it was really the thirteenth.
For twelve years out of the forty I have been a writer. It is as if,
at twenty-eight, I had turned at a right angle to my former path, a
path which had seemed as fixed as the sun in its orbit, or the alphabet,
or a cement pavement, and had begun a journey into a far country.
It changed my life somewhat. It changed me entirely.
The one thing which has, thank God, remained unchanged, has
been my family.
In all of my life I have never before sat down and turned my eyes
inward. I have never had time to sit by the fire and feel. My life
has been purely objective, my family and my work — the family first.
It is not easy now to put my philosophy into words. Probably it
could be done in two words, love and work. And that, after all, is
the foundation of every normal life.
Love and work, and to live life to its fullest, and with honor, that
seems to me the universal creed. To take one's self lightly, and one's
work seriously, to be a good friend and a poor enemy, to work hard
and play hard, to look out and not in, has been the goal I have strug-
gled for. I have failed, of course. Is not the very fact that I am
writing this an indication that I am beginning to take myself seriously?
Life was very good to me at the beginning. It gave me a strong
body, and it gave me my sons before it gave me my work. I do not
know what would have happened had the work come first. But I
should have had children. I know that. I had always wanted them.
Even my hospital experience, which rent the veil of life for me and
showed it often terrible, could not change that fundamental thing
we call the maternal instinct.
MARY ROBERTS RINEHART.
1 The American Magazine, October, 1917.
504
THE MEDICAL ADVISER AND HIS CORRESPONDENCE
FILE
WILLIAM F. SNOW, M.D.
Every one who stops to think about it knows that the business
of the so-called cure of diseases, or imagined conditions of 'ill
health, by correspondence must be profitable to those who
offer such treatment. The millions of dollars expended annually
upon the advertising of patent medicines and free medical ad-
vice attest the fact, but many of us ignore this fact because we see
only the dangers or the charlatanry of the method. We fail to
comprehend the significant point — namely, that there is a demand
for free advice and that a large proportion of those seeking it
can pay for actual treatment. The treatment of "sex diseases"
has been especially exploited in this manner. Since two of the
most prevalent and dangerous of our communicable diseases —
syphilis and gonococcus infections — are included in this group, a
few health departments have endeavored to meet the demand
for free advice and to combat the sex-specialist charlatans by
advertising the services of a medical adviser without cost to
those who may apply either in person or by correspondence.
These experiments have continued long enough to prove that
the plan is feasible and worthy of general adoption within the
limitations which have been determined.
One cannot read the daily mail of these medical advisers, or sit
with them through their consultation hours, without realizing
that here is an urgent public health need and social service which
requires of the adviser the broadest medical training and knowl-
edge of men, together with sound moral and religious views. A
series of five hundred letters1 typical of thousands that have
1 These letters with such changes as were necessary to conceal the identity of
their writers, were made available for tabulation through the courtesy of the
Oregon State Board of Health and the San Francisco Health Department, the
Brooklyn Dispensary, the New York Health Department, and several other
departments. They represent blocks of letters in the order received, no attempt
being made at selection.
505
506 SOCIAL HYGIENE
been addressed to health departments and social hygiene socie-
ties are tabulated below in illustration of the need for extending
this advisory service to every part of the United States. Such
service may be of real value without attempting to offer either
diagnosis or treatment by correspondence. Four hundred and
fifteen of these letters were from men, sixty-five from women,
twenty from boys. The ages of correspondents ranged from
sixteen to seventy-seven, the largest group of those stating their
ages being nineteen to twenty-five and the next largest group
being thirty-five to forty-five. A large majority were evidently
not married, the figures for one hundred twenty-nine who defi-
nitely stated their marital status being — ninety-three single,
thirty-one married, four widowed, one divorced. Fully 75 per
cent did not state their occupations, but forty-five different ac-
tivities were given by the remaining 25 per cent. The nation-
alities most frequently mentioned in addition to American were
German, Japanese, Swedish, Greek, Portuguese.2 The majority
of the writers were apparently illiterate and many stated they
were unemployed. Fully 50 per cent mentioned or gave details
of how they had been the victims of medical " quacks." It is
significant that only one used an assumed name and four wrote
as if for a friend.
The subjects of inquiry in order of frequency are of interest.
Literature 124 Malformations 10
Gonorrhea 119 Enlarged prostate glands 8
Night emissions 43 Sexual "excitability" 7
Masturbation 39 Marriage relations 6
Impotence 39 Contraception 5
Syphilis 17 Advice before marriage 5
Varicocele 12 Miscellaneous 56
Many of the requests for literature came from mothers who
desired to instruct their children. A fruit rancher and a wire
chief each wrote for literature to distribute to their employes
after seeing health department signs in public toilets. The
letters concerning masturbation and emissions were largely
2 The nationality would vary with the section studied. The greater part of
these letters were received by the Oregon and California state boards of health.
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 507
from young and ignorant boys and often presented very pathetic
pictures of secret struggles and fears. A frequent appeal was for
directions or medicines to reduce sexual "passion." A few of the
most encouraging letters came from evidently continent young
men seeking information prior to marriage, but the larger num-
ber who mentioned probable marriage had been infected at some
time with gonorrhea. A number of married men were worried
about the heredity of their children. The majority of the letters
apparently were written as the result of seeing state or city
health department signs warning against venereal diseases and
medical quacks and offering free advice. These signs were seen,
as stated by the writers, in public toilets, in saloons, on ferry
boats, in hotels, in the Panama Pacific Exposition grounds, and
in railway coaches. Some said they had been advised to write
by friends.
An illustrative tabulation sheet and a few letters and answers
altered sufficiently to conceal the identity of the authors are
given below, to further suggest the important service which can
be rendered. All records of advisory departments of this char-
acter are held in the same strict confidence accorded to private
patients. It is interesting, however, that a large number of
requests are on postal cards. The correspondence is, of course,
primarily of value in inducing persons to place themselves in
competent hands for individual advice or treatment. It was to
be expected that personal interviews and follow-up work would
be demanded of the adviser. This is what occurred as shown
by the illustrations of the great variety of letters such as are
received and answered daily.
Extracts from letters
[LETTER]
THE ADVISER
Dear Sir: I got in trouble about seven months ago and would like to
have you advise me what to do to cure my ailment. I would like to
have your foulder for boys 18 years of age. I would like to have the
prescriptions for the two diseases mentioned in the sign you have up
in every toilet. Please answer in plain envelope.
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508
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 509
[REPLY]
Dear Sir: In answer to your letter of the 5th, this office does not
pretend to treat any case of any kind at all. The only thing for you
to do is to come to - — , put yourself in the hands of some re-
liable physician, be examined, find out precisely what is wrong and
take the necessary precautions to get cured. If you cannot afford
to do this, call on me personally and I will advise you further. The
pamphlet you request is being mailed.
[LETTER]
Dear Sir: Supposing a man having contracted venereal disease
married and had a son born to him ; would the son, having grown to
manhood and never contracted any disease himself, show symptoms in
the blood due to the father's disease? Would a physician grant such
a boy a clean bill of health for marriage?
[REPLY]
Dear Sir: In answer to your communication, it would be of first
and primary importance to know what the disease was. Gonorrhea
is not transmitted from one generation to the other, and syphilis
would undoubtedly show itself before the boy had arrived at the stage
of manhood. It would be better for you to call at the office of the
adviser, explain the condition to him precisely, and find out whether
or not any infection exists.
[LETTER]
Gentlemen: I am writing you for help and assistance as I am mar-
ried and live in a small town where it would be almost impossible to
secure medical help without everyone knowing just what was the
matter with you. Now, I will state my case as clearly as I can and
ask that you furnish me with medicine and advice which I will gladly
pay for, but I am not able to get away for treatment Now,
the facts are I am not so worried about myself as the wife I am to
marry. I don't want to have her contract a disease. Trusting that
this correspondence will be treated with the utmost sincerity and that
you will be able to help us, I am, respectfully awaiting your early
assistance.
510 SOCIAL HYGIENE
[REPLY]
The state does not treat diseases in any way and hence it is im-
possible for me to send you any medicine or prescription. For this you
will have to consult your family physician. I would advise you to
go to him at once. The public makes a mistake in not having a family
physician to whom they can go with their confidences. Pick out a
good man and state your case to him.
[LETTER]
I have noticed your bulletin of warning displayed in railroad trains
and hotels. Would appreciate very much receiving some of your lit-
erature. I have had a hard fight against a weakness of self-abuse,
and while I am confident I can overcome it, occasional yielding has
worried me a great deal. I shall be very grateful for your answer
and advice.
[REPLY]
Dear Sir: Though masturbation tends to rob a person of his strength
and mental energy if indulged in excessively, nature soon repairs any
damage that may have been done provided the habit is broken up.
Naturally he who has indulged in the habit to excess will find his ner-
vous system more or less excitable along those lines and at times it is
rather difficult to break up the habit. However, the same spirit of
manhood which induced you to write regarding the difficulty will also
help you to conquer the habit and by so doing you will not only regain
your full physical strength, but, what is more, you will regain your
own self-respect. Medicines and other appliances are absolutely use-
less in combating the habit. Manhood in facing the issue is your
main means of cure. Secret vices undermine character as much, if
not more, than open vices; and masturbation is very liable to lead
you into acts which will be the source of life-long regret. The average
man dwells too much upon the gratification of passion. The sex organs
are for reproduction and not for mere sensual pleasure. Get your
mind on other things and adopt some absorbing ambition upon which
you can concentrate your attention to the exclusion of the mere grati-
fication of sexual desires. In abusing your body you handicap your-
self in every endeavor. Man is more than a mere animal, but the
best help we have toward being a good man is to be a good animal.
Seminal emissions, in the great majority of cases, need be no cause
for worry and need no treatment. They are only nature's method of
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 511
relieving tension in the little sacs which retain the secretions of the
testicle preliminary to sexual intercourse. Most men have such "losses"
varying in frequency according to the individual. Pay no attention
to them unless they occur oftener than two or three times a week.
They are not a sign of "lost manhood" or "sexual weakness." Get your
mind off of sexual affairs, take regular exercise and live an even, regu-
lar life, and seminal emissions will take care of themselves. Many
men have paid out large sums of hard-earned money trying to get rid
of physiological processes which are perfectly normal. Seminal emis-
sions usually belong to that class.
[LETTER]
I am twenty-two years of age and was never sick in my life. I
have a varicocele which I have been told is very dangerous
I know you fellows will tell me the straight thing and help me if you
can. I know you can help me and will treat everything confidential.
I will pay you well if you will help me in this. Thanking you for a
prompt reply.
[REPLY]
Your varicocele has nothing to do with your difficulty at all.
. . . . You will doubtless be in the city some time during the
winter and I will be glad to talk matters over with you if you will
come to the office. Some pamphlets are being sent you which ought
to be helpful. However, self-control is your remedy and you should
pay no attention to the advising doctors who have tried to frighten
you.
[LETTER]
I have been bothered with gonorrhea for seven or eight years and
have been to several doctors and thought I was cured but it came
back later. Can these doctors guarantee a cure as they say?
[REPLY]
There is absolutely nothing for you to do but go to some compe-
tent specialist and fight your disease until all symptoms have been
cured. When in its chronic form, it is very difficult to cure and hence
get the best service you can. Avoid quacks, men who treat at a dis-
tance, and others using quack methods.
512 SOCIAL HYGIENE
[LETTER]
Gentlemen: I have seen your advertisement. I am going to give
you a clear account of my case I have been treating
with doctors for two years and they do not seem to do me any good.
[REPLY]
There is nothing to do for syphilis except give it good, rational
treatment. If the doctors to whom you have gone are unsatisfac-
tory, then, by inquiry, find out some good reputable man and go to
him for treatment. You cannot expect to cure syphilis in a very
short length of time. If you do not know where to find a good doctor,
write me again.
[LETTER]
My condition is a puzzle to me and for this reason I come to you
for advice. I am a young man of twenty-six years; though never
athletically strong, have never been in poor health. I am nervous and
sleepless. The work I am in, moving from one place to another in the
state has brought on a certain degree of dissatisfaction and worry, but
I often wonder if I would not be myself again if this extreme and in-
herent desire could be satisfied I consulted one physician
recently who believed I would be all right if I would go to prostitutes
at regular intervals. From what particulars I have given you, I do
not know that you will be able to understand and advise, but I am
anxious to know and understand the proper course to follow inasmuch
as I have no immediate prospects of getting married. Will you treat
this in absolute confidence?
[REPLY]
Any man who gives you such advice as you have received is taking
more responsibility on his shoulders than I would want to carry. He
who indulges in illicit sexual intercourse will sooner or later pick up
one of the venereal diseases and then his troubles have just begun.
It is unfortunate that the human race has for centuries so educated
itself along sex lines that at the present time the average man is an
irritable and sensitive nervous organism along these lines. What is
to be done about it is a very large problem. I am scarcely certain
in my own mind and hence I hesitate to give anything in the way of
advice to a man who writes such a letter as you have written. How-
ever, I am unable to reach any other conclusion than one. That is
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 513
this: Whatever the struggle may cost, I feel that it is a young man's
duty to keep in his mind his duty as a husband and a father. The
duties of an unmarried man to his wife-to-be are just as strong as the
duties of a husband to his wife-th,at-is, and the moral responsibilities
of a young man to his future son are just as strong as those of the
father with a family. To tell another man what is his duty along
sex lines is more than most of us care to undertake. I do not know
your circumstances. I do not know your nervous habits. In fact, I
know nothing about you on which to advise Every man
will have to fight out this problem on his own ground, according to
his own ideals. The general principle, however, of adherence to
social laws such as exist will have to be the basis if he is to fully suc-
ceed. And yet I am personally of the opinion that many of our social
laws and economic conditions will have to be modified radically be-
fore this problem can be solved satisfactorily. You are a man I
would like to know; if at any time it is practicable, come in and see me.
[SECOND LETTER]
I am indeed grateful for your letter. It has helped me to get a
better hold on myself and to look and think on these matters as I
know perfectly well I should. Worry and trouble has brought me to a
very nervous condition, and since I had always been rather inno-
cent about sex matters, I will admit that this was brought into my
group of worries. Am thankful that I had done nothing and am
determined that I will fight this thing throuhg now that I see clearly
the light. As soon as I can get a better hold on myself and revive the
knowledge of right and proper ideals which I must confess have been
known to me for years, I will be more completely master of myself.
I feel that it would do me good to meet you personally, so may have
time to call when in town next time. Again thanking you for your
advice and attention, I am
[LETTER]
Your circular and letter of advice received and thanks for the same.
One more question I want advice upon. I consider it out of nature to
have too many children, also too close together Wishing
your advice, I am
[REPLY]
The state cannot enter into any advice as to methods of preventing
pregnancy. The sex organs have been given for purposes of reproduc-
514 SOCIAL HYGIENE
tion and he who uses them merely for the purpose of gratifying pas-
sion is misappropriating the function and will regret so doing sooner
or later. If there is any definite reason why you should not bear
children, if you will consult your family physician and give him reasons,
he will possibly help you if the case justifies.
[LETTER]
I am in a hospital bed at the present time, waiting to undergo an
operation from an awful disease my husband had given me. My baby
is almost going blind. I have one girl and three boys. I want to
save them from this misfortune in the future and I am afraid they may
be inclined to take after their father. Please mail me any literature
on how to teach boys and girls what they ought to know.
[REPLY]
I deeply sympathize with you in your trouble and recognize that
it is very important to successfully instruct not only your children but
all children in the matter of sex education. When you are well, I will
arrange to have some one who can help you call upon you.
[LETTER]
I am a young single man expecting to be married within a few
months. I have taught several schools and I have brothers and sis-
ters, so what you give me I expect to have ready in mind for others'
good. I want to know what I should be told before marriage and
what I should do after marrying in regard to the question of sex.
[REPLY]
I advise that you select now a competent physician to be your
family doctor. Go to him and ask that he examine both yourself and
the girl you are to marry and advise both of you in all these matters.
There are a few books by authors of standing but none of them are
entirely satisfactory. In any event you will need the advice of a doctor
in your married life and he can best aid you by knowing all the facts.
[LETTER]
Seeing one of your little notices, I would like some information if
you will give it. I have been reading and got no information that
suited me and dislike to go to a doctor. I am healthy and robust,
don't use liquor; but passion seems to have the best of me. The
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 515
books I have read at the library tell what medicine to take to increase;
what I want is a brake and a good stout one. Other men of my ac-
quaintance don't think as I do and don't care to control themselves,
or else seem not to be tempted as I am. I want advice or some-
thing to do to cut out this sex feeling. Thanking you in advance, I
remain.
[REPLY]
Probably you don't have to work on Sunday. You can come to
the city and return on the same day. I am willing to make an ap-
pointment to see you next Sunday to talk your problem over. I
think I can help you and I believe you are the kind of man who can
be of great influence in your camp in getting other men to follow your
leadership in improving the conditions which are a source of special
temptations to you and to them. By separate post, some reading
matter is being sent you.
[LETTER]
I followed your advice and went to the — dispensary
for treatment. I wish to thank you for the interest you take in my
case but it is impossible for me to take treatments at this dispensary
on account of the hours. I am employed from 9 a.m. to 9 p.m. and
one day's absence would mean loss of my job which I cannot afford.
I would be greatly indebted to you if you would advise me how I can
obtain treatments from one of your physicians privately. I don't
want to stop treating. Hoping you will favor me with an early reply,
[REPLY]
The health department has no physicians who give treatment but I
can arrange for your being properly treated in the evening at another
dispensary which we have just induced to open an evening pay clinic.
The fees charged at this clinic are within your means and you will
not have to lose your job. Come and see me and I will give you a
card of transfer from the dispensary you have been attending to this
evening clinic.
[LETTER]
Mr. - received a card from you saying the hospital had
sent you word that he was not cured at his last visit. I reckon he did
not go again because he had no money. He only gets $5 a week. I
am his mother and a widow. I would gladly pay for the treatment
516 SOCIAL HYGIENE
if I could which I can't. Will you kindly see if he can be treated with-
out his having to pay for the treatment now and greatly oblige.
[REPLY]
Send your son to me and I will arrange for the continuance of his
treatment.
[LETTER FROM ADVISER]
Information indicates that you have not reported regularly at the
dispensary for treatment. You know that it is important both for
yourself and for the protection of the men with whom you work that
you should not neglect the treatment. Please come to see me at once.
[REPLY]
Hoping you will excuse the liberty I am taking in writing you this
letter but I can't come because I am trying to get a job. I couldn't
keep the date at the hospital owing to financial circumstances which I
can't see a way out of until next Thursday when I will get some pay.
Hoping I will be accepted then as a patient for the syphilis treat-
ment and that you will excuse me for not keeping my date before,
I am, thankfully yours,
[SECOND LETTER FROM ADVISER]
I have your explanation, which is satisfactory, but in future if
you are out of a job and can't pay for the drugs, or if you are going
to a private physician for his services, let me know immediately.
[LETTER]
I am returning this card to you to let you know that I did not re-
turn to the hospital because I didn't think it necessary of any further
treatment or observation. My condition is exceedingly fine. I
haven't got any trouble whatsoever. I am very much surprised at
such a quick cure. I thank you very much for such a quick cure,
and I am sending your card back because I do not want to lose the
privilege of your advice in the future.
i
[REPLY]
You have done what many other men foolishly do, that is, tried to
decide for yourself when you are well. It will be necessary for you
to return to the hospital and keep under treatment until your doctor
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 517
tells you you need no further treatment. I thought this had been fully
explained to you. If you do not understand, come in and see me.
For your own sake and that of the people with whom you live, you
must not stop treatment at this time.
[LETTER]
My husband, Mr. told me you would like him to take
another 606 before he is pronounced cured. Now it is impossible
for me to get the money as he earns so little and I can hardly buy
eats and pay the rent. Maybe I would be able to get it done in March
as I expect to get a janitorship then. Probably then I will get the
money. We want to get well but I don't know anything else to do.
[REPLY]
Bring your husband with you and come to see me in the health de-
partment. I may be able to do something to meet your situation.
[LETTER]
Our doctor tells me that he thinks two of our children which have
never been well ought to be given a blood examination which would
help him tell what treatment they should have. My husband says
he has talked with you about this when you were treating him, and
he thinks I better have the health department make this examination.
His health is very much better since you have been treating him and
I thank you for what you have done for us. Some time we will save
up some money to pay you. Please tell me whether the blood exami-
nation hurts and whether there is any danger to the children in having
it done.
[REPLY]
If you will bring your children to my office Thursday at four o'clock,
the blood examination will be made and the results reported to your
doctor. I think this is a very wise course for you to take. The
health department wants to help you get your children well and strong.
There are no charges for anything this department does for you.
Few even among physicians realize how many personal prob-
lems of sexual conduct and disease drive persons of every age
and both sexes to seek advice. These people want help but fear
to ask it from their home physicians or cannot afford it. Our
PUBLISHED BY ORDER OF THE
STATE BOARD OF HEALTH
Venereal Diseases
Gonorrhoea (or Clap) Causes:
1. At least 50 per cent of all surgical operations upon the female
organs.
2. Many childless marriages.
3. Many innocent wives to become invalids for life.
4. About 25 per cent of all blindness in the United States.
5. Gonorrhoea is OFTEN NOT CUBED when it seems to be cured.
The germs of gonorrhoea often remain hidden in the body
ready to cause serious trouble later, after the symptoms of the
drsease have been stopped by treatment. Often the disease is
completely cured, but very frequently it hides in the body and
then breaks out airain of itself after months or even years.
It may then be given ignorantly to an innocent wife, may
cause her untold suffering, may make her an invalid all her
life, and may cause a child to be born blind
yP M is as ***** a3 Gonorrhoea, if not worse.
PREVENTION
Sexual intercourse is not necessary to physical health.
Antiseptic washes and other preventive measures are not reliable.
The only way to prevent Gonorrhoea and Syphilis is to keep away from
prostitutes, both professional and non-professional
who claim to cure "Nervous Delibity," "Lost Manhood." "Enlarged Veins,"
"Blood Poison" and "Private Diseases of Men."
Night emissions (if not too frequent) are natural in men. These ad-
vertising Specialists get large sums of money for treating diseases which
do not exist.
Patent Sex Medicines are useless, and cause a waste of money.
HOW YOU CAN HELP
1. In justice and chivalry to our daughters and wives and unborn children
and our sisters, do not risk exposure; stand for the same standard of
honor for men as for women.
2. Protect boys from harmful ideas and smutty stories.
3. Send for circulars of information and help distribute them.
(A) For young men, (B) for older boys, (C) for younger boy*.
(D)sfor women, (E) for young girls, (F)'for parents
THE OREGON STATE BOARD OF HEALTH
720 Selling Building Portland, Oregon
FREE SEX ADVICE
Private Expert Advice is given free In regard to all sexual disorders and diseases
This department is intended to afford a place where persons in doubt
or trouble may be helped by reliable advice. It is purely advisory.
All correspondence treated confidentially. Letters cheerfully answered
in plain envelope.
Ask for or write to The Adviser, State Board of Health
Room 720 Selling Building
Portland, Oregon
Office Bonn: 11 A. M. to 12 M. and 2 P. M. to 4:30 P. M. Week Days.
Sundays 12 M. to 1 P. M. Tuesdays 7:30 P. M. to 8 P. M.
518
THE MEDICAL ADVISER AND HIS CORRESPONDENCE FILE 519
past policy of silence has left a clear field for the medical char-
latan who advertises free advice and inexpensive " guaranteed"
treatment for sexual disorders, and provides exhibits and large
editions of pamphlets for educational purposes — education
designed to convince the uninformed individual that he must
immediately undergo treatment by the concern mentioned. At
this time when national efficiency and economy are the watch-
words and the government is planning to apply every practi-
cable means for the prevention of prostitution and venereal dis-
eases, it is especially important that adequate facilities for com-
petent advice, as well as for treatment, be provided. The
health department is in a position to render this service.
Success demands a resourceful physician with the right per-
sonal qualifications and a policy of vigorous promotion of the
work. The details are comparatively simple and every health
department is equipped to carry them out. Signs are posted
in selected places, particularly wherever the medical charlatan
has fornid it profitable to post his signs. The New York City
Health Department has found that when its sign goes up, the
signs of the fakers come down. There are now many forms of
these signs. The wording of the Oregon sign, which was the
first one used, will serve to illustrate the general form of such
notices.
Many other ways of announcing the advisory service are being
used, notably the carrying of an advertisement in papers pub-
lishing the advertisements of quacks. These newspaper an-
nouncements read something like this: —
t> ESIDENTSof Rochester, avoid quack doctors,
u quack dentists and patent medicines. Your
time and money will be wasted; you will not be
cured and your health may be ruined by the use
of them; free confidential advice concerning your
health at the Health Bureau, Chestnut and James
Streets, Mondays and Thursdays, 3 to 4 and Mon-
days 7 to 8 P. M.
The office of the adviser must be equipped with stationery,
postage, and clerical assistance, and to be completely useful
should have facilities for clinical and laboratory diagnosis. The
520 SOCIAL HYGIENE
adviser then finds he must have cooperative relations with the
dispensaries and physicians willing to treat persons who consult
him.
A social service visitor has been found useful in follow-up
work, especially in cooperating with men who want to carry out
every precaution for the protection of their families or relatives
but can't understand or bring themselves to explain the details
of such protection to those with whom they live.
The pioneer efforts in this field have developed most encourag-
ingly. The American Social Hygiene Association will place its
information service and facilities at the disposal of any state or
local board of health willing to begin this work. In so far as
may be practicable, it will send a representative to confer upon
the details of plans adapted to each community.
THE FOOD AND DRUGS ACT IN ITS RELATION TO
SOCIAL HYGIENE
T. C. MERRILL
Bureau of Chemistry, United States Department of Agriculture
At this time of war stress and strain it is necessary to consider
every agency which counts for or against the welfare of the
race. The adverse influence of venereal disease is of no minor
interest to the nations which have been at war for the past
three years and to those nations which have recently become,
or which soon may become, belligerents. Every country now
at war has been compelled to recognize the fact that venereal
diseases are a serious menace to military and national efficiency
and to adopt especially stringent measures for the control of
these enemies of the home and the nation. Each warring coun-
try is engaged not only in conflict with a foreign enemy, but in
domestic strife against an internal foe which menaces at closer
range than machine guns.
The spread of venereal or "private" diseases is not checked
or decreased by the sale and use of preparations advertised and
recommended to the public for self-treatment of these diseases.
On the contrary, such preparations only further the increase of
disease because they tend to its concealment. As with any in-
fection, concealment of venereal disease promotes its extension.
Were it possible to eradicate syphilis, gonorrhea, or chancroid
by a routine method of treatment, formulated without regard
to differences in individual cases and recommended without
discrimination as to symptoms or complications, home treatment
might be advisable. It is well known, however, that such is
not the case. The sufferer who treats his venereal disease by
means of a ready-made medicinal preparation will almost cer-
tainly prolong his trouble and increase the difficulty of its cure.
Recovery under self-treatment must occur in spite of the same,
521
522 SOCIAL HYGIENE
and not on account of it. Such a recovery usually leaves the
patient more or less disabled, because the treatment is insufficient.
Again, there is danger in the fact that such preparations pro-
vide an easily obtainable means of treatment which can be
secured without embarrassment or loss of social prestige. Fur-
thermore, by extravagant promises they lead the sufferer who
depends on them to believe that he is cured, when in reality he
is not. They do not destroy infection; they fail to stamp out
the disease; arid they are therefore not only useless, but harmful.
That there is a vast difference between the promises made in
the labeling and the fulfilment of these promises is not unnoticed
by the federal authorities. Many prosecutions have been
brought under the Food and Drugs Act against the manufacturers
of preparations falsely and fraudulently represented to the public
as being curative or effective in the treatment of disease. In
connection with these prosecutions, it is customary for the De-
partment of Agriculture to issue Notices of Judgment from time
to time. These show the grounds upon which prosecution was
based and report the final action of the court. A review of these
notices exhibits a number of interesting features associated
with the sale to the public of drug products recommended for the
treatment of diseases affecting the sexual organs.
Such products are offered not only for the treatment of infec-
tious venereal diseases, but for the relief and cure of "lost man-
hood," " wasted vitality," " impaired nerve force," or "sperma-
torrhea," — names used chiefly for their effect upon the consumer's
mind. It is often the case that the advertising of such prepara-
tions is designed to suggest to the susceptible reader that he is
suffering from a serious disease capable of producing the gravest
results.
Conditions suggested and emphasized in the labeling of "lost
manhood" preparations are made to assume great importance
in the consumer's mind. So-called symptoms likely to be ex-
perienced at times by everyone are enlarged upon for the sake of
frightening the ignorant and impressionable. Nervous exhaus-
tion, self-distrust, failing memory, despondency, gloom, sadness,
and the effects of worry, excitement, and overwork are among the
THE FOOD AND DRUGS ACT 523
expressions found in the labeling which has been made the sub-
ject of court proceedings. Thus the manufacturer seeks to
persuade one who is temporarily indisposed that his condi-
tion is dangerous and that only "Dr. Vigor's Fountain of Force"
can save him from paralysis, melancholia or other horrifying
affection.
The composition of the preparations which have been brought
to the attention of the courts is by no means uniform. The
analyses made in the Bureau of Chemistry of a number of drug
products recommended for syphilis have shown that the most
commonly used ingredients are iodides, mercury, vegetable
cathartics, sulphur and certain plant drugs, of which prickly
ash, poke root, and sarsaparilla are types. Epsom salts, mineral
acids, camphor, acetates, turpentine, nitrates, salicylic acid, and
tonic drugs such as gentian and taraxacum (dandelion) have
also been reported.
Preparations advised for gonorrhea may consist of mixtures
for use by mouth, or may be injections, or may be marketed in
two parts which thus combine internal and topical application.
Medicines sold for use by mouth usually contain oils of copaiba,
cubeb, or sandal wood; powdered cubeb is frequently employed
and sarsaparilla has been found present. Injections are ordi-
narily composed of zinc compounds, borax, boric acid, carbolic
acid, or some form of hydrastis (golden seal); morphine has
also been noted.
The common ingredients of "lost manhood" medicines are
damiana, phosphorus, arsenic, iron, and vegetable tonic drugs,
such as cinchona and nux vomica, or their alkaloids. The popu-
lar belief that some of these drugs possess special aphrodisiac
qualities is widely utilized for advertising purposes. Any such
effects are due almost wholly to suggestion. The reputation that
damiana and phosphorus enjoy for being particularly capable of
renewing exhausted sexual power and worn-out nervous tissue
seems to have originated in over-confident medical opinion based
on insufficient evidence.
How little the manufacturers believe in the reputed value of
these drugs and in the truth of their promises to the consumer is
524 SOCIAL HYGIENE
indicated by the fact that they have, to date, entered pleas of
gtiilty or have failed to appear in court in all of the cases brought
by the government.
It is frequently asserted that new, obscure, or exotic drugs,
whose physiological action has not yet been fully determined,
possess particular virtues. For example, lecithin and the gly-
cerophosphates lend to drug preparations a superficial appear-
ance of being medically correct. They serve as a basis for many
absurd and extravagant representations referring to the nutri-
tion and restoration of the brain and nerves. To a certain ex-
tent they have superseded phosphorus, phosphoric acid, and
inorganic phosphates, to which selective effects upon nervous
tissues were attributed at one time.
Products offered for the treatment of disordered sexual organs
may, and frequently do, contain drugs which are recommended
in textbooks or commonly employed by physicians at some stage
of some cases of venereal or nervous diseases. The fact that
sexual disease resulting from infection or faulty hygiene is not
amenable to treatment by a rule-of-thumb method is ignored by
the manufacturer.
Cathartics and diuretics seem to be largely used in the manufac-
ture of drug products sold for the treatment of syphilis, gonor-
rhea, and "wasted vitality." Such drugs are especially impres-
sive from the manufacturer's standpoint, because they produce
results which are appreciable to the user. This fact is illustrated
by the following assertion, appearing in the labeling of a prepa-
ration said to be valuable for treating venereal disease, consump-
tion, and other affections: —
These pills operate in such a manner that they work on the lungs, skin,
kidneys and bowels as sudorifics, diuretics and purgatives, expelling all of the
impurities from the body, and by having perseverance the system will be
cleaned entirely from all of those corrupt humors which, deposited in the lungs,
are the cause of this disease.
Needless to say, in this case the manufacturer admitted the
allegations contained in the libel.
A word should be said about alcohol as a constituent of medi-
cinal preparations, not only of the class here considered but of
THE FOOD AND DRUGS ACT 525
drug products in general. It is sometimes believed that alcohol
is used as an ingredient of various products in order to further
their sale among persons addicted to the use of intoxicating
beverages. Contrary to this belief, it appears that alcohol is
not usually employed for this purpose, but because it is a pre-
servative and solvent. In many cases it is capable of dissolving
or extracting from crude drugs the particular substances which
produce the medicinal effects of the finished preparation. It
is, therefore, a necessity in pharmacy and a common ingredient
not only of preparations sold directly to the public, but of
tinctures, extracts, and other articles used by chemists, pharma-
cists, and physicians. For such purposes it is employed in
various proportions, from one-half of 1 per cent to 90 per cent.
Most of the preparations here referred to contain a little more
than 10 per cent.
Those so-called medicinal preparations which contain alcohol
in such form and quantity that they may be used as beverages
are amenable to laws and regulations administered by the Com-
missioner of Internal Revenue. The Federal Food and Drugs
Act requires that the quantity of alcohol and other habit-forming
substances present in a medicinal preparation shall be plainly
stated on the label.
In appealing to a polyglot population, such as that of the
United States, the manufacturer addresses the consumer in
various languages. French, German, Spanish, Italian, Swedish,
and Norwegian are observed most frequently. Then come
Russian, Polish, and other Slavic tongues or dialects, while
Danish, Portuguese, Dutch, Yiddish, Hebrew, Greek, Chinese,
and Japanese are not at all uncommon. A few labels printed hi
" Pennsylvania Dutch" indicate that few language groups of our
people are overlooked.
Following are a few typical examples appearing in the labeling
of medicinal preparations recommended for the treatment of
various diseases of the sexual organs:—
It appears to cause syphilis to steadily relinquish its hold, until finally the
disease gives up altogether, and you have conquered this monstrous malady.
526 SOCIAL HYGIENE
The principal drugs in this product were sulphur, wild cherry,
and aloes.
A reliable remedy for contagious blood poison in the primary, secondary or
tertiary stages of the disease.
This medicine contained turpentine, camphor, and mercuric
iodide.
Used with success in the following diseases: Scrofula, eczema, syphilis,
chancre, catarrh, blood poisoning, pulmonary diseases, weak lungs, influenza,
chronic coughs, anemia, ulcers, carbuncles, boils, white swelling, ache, pim-
ples, blotches on the face, poison oak and ivy, swelling of the knee or hip
joint, ulcerated mouth or throat, disease of the spine, diseases of the bones,
coxalgia, copper colored spots on the body, nervousness, debilitated constitu-
tion, sciatica and neuralgia.
Sugar, salicylic acid, sarsaparilla, and potassium compounds
were found in tjiis preparation.
A preventive and a certain and speedy remedy for chronic gonorrhea, gleet,
whites, etc.
This product was an injection containing acetate and sulphate
of zinc.
(Translation) : Positive recovery in all forms of exhaustion, anemia, simple
and nervous, debility of every kind, neurasthenia, scrofula, rickets, impotence
in males, spermatorrhea, spinal diseases, hemicrania, stomach troubles, etc.
The labeling of this article was printed in Italian and its active
ingredients were found to be iron, arsenic, phosphoric acid, ni-
trates, quinine, and strychnine; it was practically a Blaud pill.
Syphilis — either primary or secondary, syphilitic ulcers, nodes, swellings,
tumors, hard lumps, ulcerated and sore throat.
This mixture was a so-called " blood purifier," depending for its
effects upon arsenic and potassium iodide. .
Exaggerated and untrue representations, such as the fore-
going, are modified and softened in the relabeling which usually
follows court proceedings. References to the incurable and
more serious diseases are omitted and the general tone of the
revised labeling is much milder than the original which brought
the manufacturer or his preparation into court.
THE FOOD AND DRUGS ACT 527
The use and control of medicinal preparations are questions
to be solved by education as well as by regulation. Each com-
monwealth provides its own laws and is thus, within its own
jurisdiction, independent of federal law. The Federal Food and
Drugs Act, moreover, refers to misbranded preparations sold,
or offered for sale, in the District of Columbia, territories or
insular possessions of the United States, or those which are trans-
ported from one state, territory or district to another state,
territory or district; also to products imported into the United
States and to preparations exported from the United States into
foreign countries. It does not apply to goods which are not
shipped outside a state, or to advertising appearing in news-
papers, booklets, posters, street-car signs or otherwise in such a
manner that it is not actually a part of the package shipped,
with the article, into interstate commerce.
A discrepancy is often noticeable between the labeling accom-
panying the package and grossly exaggerated statements appear-
ing in newspapers or other advertising not a part of the pack-
age. Such a difference shows deliberate fraud.
TO ALL WOMEN AND GIRLS
We are a nation at war.
The country demands of every woman as well as of every
man a personal pledge of loyalty.
We women have already been taught many ways in which we
can serve our country. One most important thing we can do
is to help the men to be good soldiers.
We can help the national honor by demanding that the
soldiers respect all women.
Every woman who cheerfully sends husband, son, or lover
to the front is making it easier for him to look ahead and not
behind him. ,
Wherever military camps are pitched, women's love and
thoughtfulness go with the men. This is right.
Wherever military camps are pitched, immoral women and
thoughtless girls congregate outside the camp lines. This is
wrong.
Thousands of soldiers have been made unfit for service be-
cause of venereal diseases contracted from women.
Some women who will read these words do not know this fact
and do not want to know it. For the good of the country all
women should know it.
Intelligent women can protect the young girls who follow the
troops and can save them from temptation and the country
from the burden of illegitimate war babies.
It has been the fashion to blame the men alone for the im-
moral conditions which exist outside of army camps.
Women are equally responsible.
Other women — "sporting women" or prostitutes, who seek
to tempt the soldiers may read these words: —
Help the soldiers by keeping away from them.
If any woman is the means of making a man unfit to do his
duty as a soldier she is a traitor to her country.
The nation asks for the strength and courage of every man.
The nation asks for the purity and help of every woman.
All must work together; the men for the women, the women for
the men, and all for the country.
EDITH LIVINGSTON SMITH-
528
THE WAR AND VENEREAL DISEASE IN GERMANY
The disastrous experiences of the European nations, especially
during the earlier months of the war, in their attempts to deal
with prostitution and venereal diseases as war time problems
have been much discussed; since our own country has become
involved in the war they have assumed especial importance;
for, while our policy has been definitely fixed by the official
actions of the War and Navy departments, the experiences of
other nations, though based upon different principles, at least
have the force of reality: they show what has actually happened
under war conditions. Little material bearing on the situation
in Germany has been available. The following papers and
extracts appeared in German periodicals in 1914, 1915, and 1916.
THE COMBATING OF VENEREAL DISEASES IN THE WAR
DR. A. BLASCHKO
Berlin
In speaking of the diseases and epidemics which rise to a consid-
erable degree and therefore assume greater importance in war time,
generally only the grave acute, infectious diseases are thought of, as
diarrhea, cholera, spotted fever, smallpox, etc. And yet besides these
terrible pests which often claim more victims than the bullets of the
enemy, venereal diseases play a very important part. Of course more
are carried away outright by the acute diseases, but syphilis is all the
more dangerous because of its permanent effect.
It is easily understood that the tearing away of hundreds of thousands,
even millions of young healthy men from their customary mode of life,
the long separation from their wives and sweethearts, the daily contact
with women and girls of other cities and nationalities give rise to
sexual excesses. In former centuries, from the earliest times known
to us up into the eighteenth century, whole armies of prostitutes con-
stantly accompanied the soldiers. It was believed that such escorts
could not be done without, and the prostitutes themselves took good
529
530 SOCIAL HYGIENE
care to advance their own interests. And this female following often
numbered — in the Thirty Years' War just the same as in the Cru-
sades— tens of thousands, often even exceeding the number of the
regular troops and hampering the marching and fighting ability of the
army. But it became a hygienic danger only when in the sixteenth
century syphilis broke out among the soldiers, — a pest unknown up
to that time, — spread through the ranks, then with monstrous speed
over all Europe, where it has since remained a native guest. The
heaviest and most degrading punishments were applied as soon as
the danger was recognized — to no avail; centuries passed before the
camp-followers were entirely banished from the army. Not until
universal military service brought a fundamental change in the char-
acter of warfare was serious consideration given to the thorough
cleansing of the armies of the evil of prostitution. Yet even Napoleon
could not prevent that, especially in Germany, young women-folk
joined his army in hordes and partly even took part in the Russian
campaign. Yes, even in the Russo-Japanese War the Russian Army,
particularly the Russian officers had demi-mondaines with them in
great numbers.
Now even if our army does stand on quite a different moral plane
than the Russian, and if a complete pestification of our army with
prostitutes is quite impossible, and even though the present war is a
far more serious affair than any previous war, yet this time too the
possibility of a great increase in venereal diseases must be reckoned
with. The fighting army, to be sure, which is now facing the enemy,
is for the present hardly in danger from this source. But the land-
strum and the volunteers, hundreds of thousands of whom are, being
trained in the garrison cities, as well as the garrisons of the fortresses,
are very liable to be seduced. In several of these cities all brothels
were immediately closed; in others, however, where the hygienic value
of these institutions is still believed in, they nourish all the more.
But even where no brothels exist, conditions are not much better. I
personally have recently observed, here in Berlin, numerous fresh cases
of gonorrhea and syphilis among the recruits (in one case the infection
came through a girl in the dress of a Red Cross nurse) and in a neigh-
boring garrison, as a colleague there writes me, many infections re-
sulted from the coming in of diseased prostitutes from the large cities,
who, being robbed of their custom there, looked for new victims here.
The number of those found healthy when being recruited, who had to
be sent back to the hospital afterwards — some of them even from the
THE WAR AND VENEREAL DISEASES IN GERMANY 531
front — because of a fresh gonorrhea is much greater, too, than is gener-
ally imagined.
But even in the enemy's country it is not impossible that when the
terrible bitterness gradually gives way and the stay of our troops be-
comes extended, a closer relation with the native population, especially
the female part of it, will arise. And of course it is most likely that the
better female elements will stay away from the troops, while it is just
the diseased loose women and especially the professional prostitutes,
who, of course, having lost all their trade through the war, will soonest
give themselves up to the men. The experience of former wars, the
Franco-Prussian in particular, shows that in this way — especially in
the second half of the war — numerous infections come about. In the
Franco-Prussian war 9 per cent of all the sick men were down with
venereal diseases; a single day's stay of one division in Rheims is said
to have resulted in several hundred gonorrhea infections, and that
men infected with fresh gonorrhea are not the stuff with which to make
marches and win victories needs no further explanation.
If the military authorities do not exercise iron discipline and forbid
all intercourse with the foreign women, infection from this source is
greatly to be feared.
In the home garrison the suspicious women and girls must be placed
under strict watch. In my opinion regulation with or without intern-
ment has never accomplished much in hygienic regard. Under ex-
ceptional circumstances, as in war time, the problem is especially
difficult. In this case, strict supervision of all women who definitely
have intercourse with soldiers should be very useful. Such super-
vision, however, must not be restricted to the registered prostitutes,
but must extend to all suspicious elements. These must be examined
very frequently, say twice a week, and in case of sickness be treated in
hospitals. Absolute prohibition of public dancing, and early closing
hours for saloons, especially those close to barracks, would have to
support these measures.
All these rules would have to be applied also in the enemy's country
with the necessary changes and restrictions. Here too the lower class
of saloons and the animierkneipen1 (debits de vin in France) must be
closed altogether and all other cafe's be made to close early. The
greatest care must be taken also to prevent prostitutes under any
pretext from joining the troops, as they often do, in the guise of nurses,
1 See explanation of this term in Prostitution in Europe by Abraham Flexner.
532 SOCIAL HYGIENE
etc. To this end an unusually strict sifting process must begin right
in the provisional headquarter stations.
With stringent regulations for the men, education and warning must
go hand in hand, as is already provided in the military war-sanitation-
code. Following out this idea in the home garrisons, warnings are
now being given every week at roll-call about intercourse with un-
scrupulous women and girls at home and abroad. The German So-
ciety for the Combating of Venereal Diseases aims to emphasize these
warnings by giving the soldiers its educational pamphlets, availing
itself of the aid of the Committee for the Distribution of Literature for
Soldiers at the Front and in the Hospitals. Through this agency the
following little circular is to be distributed to the amount of hundreds
of thousands of copies.
It is the solemn duty of every soldier to keep himself healthy for his Father-
land, doubly and trebly so in war times, when the greatest demands are being
made upon him.
No other cause so impairs the health and capacity of the soldier as the venereal
diseases — syphilis and gonorrhoea. They not only cause great pain but also
make a man weak and incapable of marching and fighting — not to mention the
serious ills which these diseases carry in their train and which may last to the
end of life.
Venereal diseases are acquired from immoral girls and women who as a result
of their loose living are almost all diseased and transmit their diseases to the
men with whom they have intercourse. But in war time especially, the soldier
must remain far away from these girls, both in the enemy's country and at home,
wherever he is quartered. He must be especially careful in his use of alcoholic
beverages (whiskey, beer, wine) because in a state of intoxication, and even when
only slightly tipsy, he yields more easily to temptation. He must keep clean,
if at all possible, the sexual parts as well as the rest of the body.
During the entire duration of the war he must remain healthy and fresh, in
his own interest and in the interest of his country, which in its struggle for free-
dom needs the whole strength of every man.
Whoever is so unfortunate as to have already acquired a venereal disease,
even if before the outbreak of the war, should report the least sign of its getting
worse, so that no serious trouble may result through negligence.
The soldiers must — and this rule holds for every city — be in their
quarters early, and above all confess to the proper troop physician the
slightest suspicion of an infection in the sex organs. In small de-
tachments it will no doubt be impossible for the individual troop phy-
sicians to carry with them the necessary means for examination and
treatment (microscope, etc.). But if there is no way out, it does no
harm if occasionally a non-gonorrheal catarrh is taken for a case of
THE WA*R AND VENEREAL DISEASES IN GERMANY 533
gonorrhea and treated with a strong albargin or protargol solution as
is usual in attempts to accomplish an abortive cure. The keeping
secret of the first stages of a venereal disease is the only instance in
which I would consider punishment justifiable. It is understood, of
course, that the infected men, those of them who are unable to march
or may easily become so (all fresh cases of gonorrhea, chancroid and
serious forms of local syphilis) should either be sent off home or at least
to the nearest provisioned station.
I cannot close this discussion without calling attention to the fact
that now more than ever and more than in peace times the danger of
venereal infection threatens the army and the nation not from profes-
sional prostitution alone. A world war like the present which sud-
denly tears all the economic bonds of the civilized nations, cripples
numerous industries in our great cities and incidentally throws hun-
dreds of thousands of women out of employment. How are they to
support themselves? Especially when women of the propertied classes
in their effort, praiseworthy in itself, to do their share for the soldiers
and their dependents volunteer to do gratis the work that is neces-
sary for war purposes, not realizing that in doing so they are only in-
creasing the misery of the unemployed. And what is to become of the
thousands of girls who have all along been living half by prostitution
and now stand stripped of a large part of their "friends" and protectors?
The orders which the Berlin chief of police and other police authorities
after him issued were certainly dictated by the best will, and these execu-
tives had not only the moral but also the hygienic element in view, but
after some consideration we must conclude that as far as hygiene is
concerned very little can be accomplished by guarding the streets and
public inns and not much more by prohibiting female service in the
so-called animierkneipen, if, provision is not made at the same time,
for the women thus thrown out of a living. Of course they want to
live, as well as anyone else, and they will find ways of practising the
only "trade" they have learned. To secure regular work for these
girls at a time when already hundreds of thousands are turned into the
streets who have hitherto earned their bread by honest work, is quite
impossible. Without a doubt they will continue to support themselves
by the prostitution of their bodies. It will be the task of public sani-
tation to do away with the greatest possible number of these sources
of infection through supervision and careful examination of the real
vagrants as well as through interning of those who have an acute dis-
ease; but at the same time efforts must be made to get the healthy
534 SOCIAL HYGIENE
ones some useful employment or, if that is quite impossible, at least
food and shelter.
The most impractical measure in handling this problem of venereal
diseases seems to me that adopted in quite a number of cities, of dis-
charging venereal patients from the hospitals in order to make room
for wounded. The number of beds at our disposal for the latter is so
great and the supply rises to such an extent day by day that it is really
a great mistake to favor the spread of venereal diseases through the
population by such a measure. At no time have persons of both
sexes infected with venereal disease belonged in the hospital more than
at this very time. Just as we must strive not to allow our cultured
and economic achievements to be destroyed in this war, just so we must
not in our anxiety and care for our warriors who are sacrificing them-
selves, neglect for one moment the hygienic safeguarding of the entire
nation. And the venereal diseases, gonorrhea no less than syphilis,
are so great and permanent a danger to our people that every blunder,
every piece of negligence of which we are guilty today will be bitterly
avenged. So many thousands of the flower of our nation are falling
victims to the bullets of the enemy that we must guard and value the
health of the rest as a dear possession. — Deutsche Medizinische Wochen-
schrift, October, 191 4..
VENEREAL DISEASES AND THE WAR
ERNEST FINGER, M.D.
Vienna
. . . . And so venereal diseases in the war deserve full consid-
eration from a double point of view: venereal infection of the army
during a campaign and venereal infection of the civil population through
the soldiers returning from the front after the campaign, and the
danger rises relatively as the enormous drafts of fighting men cause
both these factors to assume increased dimensions. The question
becomes all the more important for us Austrians because both our
Austrian provinces in which our troops are being concentrated, Galicia
and Bukowina and Bosnia-Herzogovina, are replete with venereal
disease, and the bordering enemy countries, Russian Poland, Volhynia,
and Podolia and also Servia are counted among the most infected coun-
tries of Europe. Indeed the number of infected men who up to now
have had to be sent back to the hospitals as unfit for fighting is by no
THE WAR AND VENEREAL DISEASES IN GERMANY 535
means small. Whether a relative increase of venereal disease has
already taken place in the army cannot be determined or proved from
this fact since it is understood that, relative conditions being the same,
the enormous increase in the numbers of the army must correspond
with an increase in venereal diseases. These diseases may be divided in
respect to time and place of infection into two groups : The one group
consists of those cases in which infection took place at the time of
mobilization or on the way to the front and in which, as is usual, the
disease broke out about eight days or fourteen days later (in cases of
gonorrhea and syphilis respectively) during the campaign. Naturally
not a few of the soldiers overlooked or kept secret the first stages of
their sickness thereby making it worse, so that not a few seriously
complicated cases which arrived in Vienna in the first half of September
originated in the first two weeks of August. The psychological factor
which entered into these cases is easily understood. The high spirits of
the men at parting and at the arrival in the recruiting places, the
fighting enthusiasm, unfortunately heightened by the abuse of alcohol,
the long stay in large cities, the advance which the female element
made to the recruits everywhere and expressed in various ways, did
procurer's service. Whoever cared to gain an impression of these
conditions here in Vienna had only to visit the Praterstern and the
Prater during the first two weeks of August; here any evening numerous
groups of soldiers could be seen streaming from the Praterstern to the
Volksprater, scattering into the various saloons and inns, and if one
walked in the meadows toward the Danube one could see countless
loving couples of which the male partner was always a soldier and
innumerable prostitutes searching after partners of the same kind.
The unusually fine weather was particularly favorable to these love
adventures. Similar conditions as in Vienna must have prevailed
in the provincial capitals and large cities. The effects were not lack-
ing. According to a widespread rumor, the first hospital transports,
which on their arrival in Vienna were solemnly received at the station
by patriotic reception committees, included some whose members
owed their wounds not to the weapons of Mars but to those of Venus.
Even today soldiers are still arriving with complicated conditions and
advanced stages of venereal diseases which point to infection in the
early days of August, while others are coming in whose early symptoms
point to an infection of four to six weeks' duration, acquired, therefore,
in the first half of September, and who declare that they became in-
fected in Russian Poland. These men, then, were infected during the
536 SOCIAL HYGIENE
campaign, hence belong to the second group of our classification.
Previous experience has shown that this class of infections increase a
great deal in number as the war continues, reaching that point at which
they may become dangerous when the men return to their own homes,
if preventive measures are not adopted in time.
As far as the combating of venereal diseases in the army is concerned,
Germany and Austria can point to very substantial success through
instruction and personal prophylaxis. At the front, no doubt, the ap-
plication of such prophylactic measures, which consist of injections of
the familiar silver-albumen preparations into the urethral opening
and washings with disinfecting soaps, sublimate, lysol, etc., to be done
by every soldier as soon as possible post coitum, will meet with great
difficulties. As for instruction, lectures are probably out of the ques-
tion; nevertheless it will be possible repeatedly to admonish all the
troops units, in brief pithy sentences in the daily orders, of the dangers
which threaten the soldier in the land of friend and foe alike. It
must be admitted, of course, that in war time the psyche of the soldier
is less accessible to such instruction than in times of peace. As for
prophylaxis, it has been and is being recommended that every man
receive a handy package containing the usual prophylactics. Such a
little package would certainly not increase the burden of the soldier's
knapsack very much. Whether the man, uncontrolled and without
compulsion, will find time, place, and opportunity properly to apply
the prophylactics remains questionable. At all events it must be
admitted that in this manner at least a small fraction of the infections
could be prevented. As far as I know, however, no such measure has
been attempted this time either in Austria or in Germany.
An important means of restricting the number of infections consists
without a doubt in restricting as much as can be done the possibility
of infection. The German admjbistration, which we cannot sufficiently
admire for the consciousness of purpose with which it provides for the
smallest details, has enforced exemplary regulations in this direction.
Some of the rules laid down by the military authorities are as follows :
(1) Prohibition of the sale of alcoholic liquors to soldiers in railway
restaurants; (2) shortening as much as possible the stay of military
transports in large cities; (3) commanding troops not to leave the rail-
road platforms even in case of a long wait. But the civil administra-
tion in Germany too, in proper recognition of the needs of the situa-
tion, has ably supported the military authorities.
But the treatment of venereal diseases too must be given special care
THE WAR AND VENEREAL DISEASES IN GERMANY 537
and attention at this time. Blaschko is right when he speaks of the
impracticability of dismissing persons infected with venereal diseases
from the hospitals to make room for the wounded. Here in Vienna
this difficulty was evaded in a very happy manner. Of course here as
everywhere else even the dermato-syphilitic clinics and wards of the hos-
pitals had to give up all or most of their rooms for the accommodation
of wounded soldiers, but the health department, fully cognizant of the
importance of the question, has at my instigation responded in an un-
usually praiseworthy manner by establishing a large emergency hos-
pital with 540 beds for venereal diseases, an ample substitute for the
above mentioned loss, and used a great deal by the military and
civilians.
As for prophylactic measures on the way to the front and at the scene
of the war itself, the only thing that can be done is to let the military
and the local civil authorities cooperate in such a way as to reduce the
possibility of infection to a minimum, which means closing all brothels
and arresting and interning all registered and clandestine prostitutes.
As concerns the menace to the civil population in the form of infected
discharged soldiers returning to their homes after the war — the army
sanitary administration bears the full great responsibility and it must
absolutely be demanded that all troops before being discharged be sub-
jected to a careful medical examination and that all those found infected
be immediately assigned to proper treatment. — Wiener KlinsicheWoch-
enschrift, November, 1914-
WAR, PROSTITUTION, AND VENEREAL DISEASES
PROF. ALBERT NEISSER
Breslau
From the most varied sources comes the news that in those army
units which at home or at the front have the opportunity to get into
connection with prostitutes a very considerable spread of venereal dis-
eases is already noticeable and to a degree which seems by far to
surpass the prevalence of the evil in the Franco-Prussian War. And
this great evil deserves our most serious consideration and action.
1. In the first place the demand of the men must be combated.
This may be accomplished only by very strong warnings and admoni-
tions to the troops to be continent, and especially by instruction about
the great danger which lies in all intercourse with prostitutes. We are
538 SOCIAL HYGIENE
certainly not exaggerating when we assume that every prostitute who
yields herself to the soldiers is diseased, or at least, considering the
large number of cohabitations in which every prostitute takes part in
the course of a single day — my correspondents tell of thirty to forty
times — becomes diseased in a very short time. Direct prohibition of
sexual intercourse to the men is not to be thought of; there is too
much danger that infections will be kept secret. But we could with
far more success appeal to the honor of our troops, showing them how
disgraceful it is for a soldier to withdraw from the ranks in such a
dishonorable manner, while their comrades fight on, braving the perils
of war. It would have to be made very clear to the married men
above all how great may be the danger for their wives and children if
they do not return to them fully cured. And more than anything else
the view that continence is harmful must be combated, even when hard
to bear. The so-called want appears only when the seductive oppor-
tunity is present. If the troops continued on the firing line for weeks
longer, no man would think of sexual intercourse. The doctrine of the
"semen accumulation" is merely a convenient excuse. For experience
teaches that it is easier to remain continent when for any reason one
has had no sexual contact for weeks than when one has been practicing
it frequently. The pause dulls the libido. And in cases of unusual
stimulation ought not pollutions to take place and bring relief?
2. The greatest possible sanitation of prostitution must be provided
for, so far as efforts are unsuccessful, by arresting them. I ask myself
why this sharp but so useful measure is not relentlessly resorted to.
This method of elimination is the most effective, since sanitation, in
the case of the most prevalent venereal disease, gonorrhea, is impossible
anyway, and because, considering the enormous number of visits of
the individual females, not even a daily medical examination would
accomplish the purpose, apart from the impossibility of performing a
really good examinatiou of prostitutes.
As regards syphilis, sanitation is much more conceivable. The
capacity of all prostitutes for transmitting infection could easily be
much lowered if every single one (without bothering about a special
diagnosis) were subjected to an energetic salvarsan treatment, or per-
haps treatment with salvarsan combined with mercury. If there
should actually be one among them still uninfected with syphilis, the
treatment would surely do her no harm. Since a weekly (intravenous)
injection of salvarsan and mercury (mercinol) is sufficient to bring
about the desired effect, I believe that this convenient mode of thera-
THE WAR AND VENEREAL DISEASES IN GERMANY 539
peutical prophylaxis could be easily carried out. Of course a complete
cure will not be accomplished by this means, but the chances of infec-
tion will be so greatly diminished that from the point of view of our
troops the effect would be a great success.
If it should seem undesirable to enforce such stringent rules against
prostitution and against the soldiers, perhaps for fear that the latter
might turn their attention to non-prostituted women and girls, then,
I am convinced, there remains only the suggestion made by Lesser to
supply the troops with prophylactics, viz., condoms. For there is no
doubt that this mechanical means of protection is superior to all others
because of its convenience and easy application. To many this sug-
gestion may seem disagreeable for so-called moral or ethical reasons;
from the sanitary-hygienic point of view it is certainly the best and
most promising. Incidentally I would remind such persons that the
thing at issue is not only the present health condition of the troops,
but also the whole question of the misery connected with the diseases
that come as sequelae to syphilis, and the prevention of the injury
inflicted by syphilis upon posterity, the increase of which will be more
important than ever in the coming decades.
But I must return in a few words to the question of the treatment of
venereal diseases at the front, with special reference to the essay by
Zieler in No. 1 of this weekly and his attack upon me. I had discussed
in a short article in this weekly the question of whether and how vene-
real diseases of the fighting army could be treated at the front and had
arrived on the whole — I will not go into detail — at a positive conclu-
sion. Zieler, on the other hand, answers the question negatively, —
"that a thorough treatment of venereal diseases with acute and in-
fectious conditions within the ' zone of operations' is impossible or at
least to be advised against emphatically and that patients of such a
kind should as quickly as possible be brought to the provisioned station.
Scientific ambulant treatment in the troop is impracticable even for
syphilis, with very few exceptions, and should therefore not even be
tried."
I must of course admit beforehand that Zieler is better able to judge
the war conditions and that my theoretical peace observations may
seem worthless compared with his. Nevertheless I consider his stand-
point, if I may say so, too pessimistic. I think also that he has set
himself too high an aim. Zieler desires a " thorough" treatment, as
we strive for in peace times, while I, of course only for the war, keep
in mind the task of keeping down as low as possible the number of
540 SOCIAL HYGIENE
soldiers withdrawn from active service because of venereal diseases as
well as the duration of their withdrawal. To be sure this will leave
many cases of chronic and infectious gonorrhea. In the case of syphilis,
however, I believe a thorough treatment is quite possible, and with the
same success we attain in normal times. But the disadvantages pos-
sibly resulting from incomplete cure in cases of gonorrhea are balanced
by the very considerable military advantage of the early return of the
thousands of warriors. Of course adequate provision made by all
means must be for very careful examination by specialists before any
of the troops are discharged at the conclusion of the war, of at least
those men who during the war had any form of venereal infection, in
order to prevent the married men above all from carrying the diseases
into their families.
Now, where and how should treatment be carried on at the front?
As far as gonorrhea is concerned I agree unquestioningly with Zieler
that with cases of acute gonorrhea the best thing to do is to take them
out of the troop as soon as possible unless well-trained specialists can
devote a few days of quiet to effecting abortive cures. As far as my
knowledge goes, in a war like this in which permanent positions are
taken up, there are not seldom days in which the individual soldier
may have comparatively much rest, while with the marching and
fighting troops a gonorrhea treatment necessitating several injections
daily is out of the question. On the other hand, referring cases to a
regular hospital when there are no complications is entirely super-
fluous. Those patients, to be sure, need periods of rest without
strenuous duty, but not finely fitted hospitals. I believe the surmount-
ing of all these obstacles must be possible through the creation of a
new system adapted to our plan. As far as syphilis is concerned, how-
ever, I continue strong in my conviction that sufficient treatment can
be effected even in the marching troops and certainly in those stationed
in permanent positions.
If in the case of troops who are exposed to the dangers of infection
(in large towns with women who prostitute themselves) sanitary ex-
amination is conducted to any degree, almost all cases of syphilis can
be discovered while still in the primary stage. If they are treated
immediately, either an abortive cure is at once effected, or at least
they are certainly saved from secondary conditions which come in
for the most serious consideration because of the danger of extra-
genital infection of the other soldiers.
And is it really quite impossible to carry along the little capsules of
THE WAR AND VENEREAL DISEASES IN GERMANY 541
neosalvarsan and the small bottles of mercinol? And perhaps a liter of
distilled water, enough for at least fifty intravenous neo-injections, so
that the small portion necessary for a single injection need only be
boiled up again? Is there really no time once a week to perform the
neo-salvarsan and oleum cinereum injection, which can be done by
every practiced physician in a few minutes? Since moreover it is not
even necessary to observe the intervening time so punctiliously, whether
six or eight or ten days! And at the most, six such injections are
necessary. Thus we may have an admirable, in many cases even an
abortive cure.
As for the subjective and objective complaints, if neo-salvarsan is
used (with proper dosing and technique) they amount to nothing;
likewise the gray oil may be used with effect (if one does not confine
himself to the simple salvarsan treatment). At all events I should
think it must be possible to effect these eminently important cures as
well as the typhus vaccinations with their none too rare disturbances.
The danger of stomatitis, too, is not great enough to cause me to send
an otherwise able-bodied man to the hospital.
In short, I continue firm in my conviction that an ambulant treat-
ment for syphilis at the front is in most cases feasible. I would natur-
ally go too far if I were to extend my demand to all cases of syphilis
or the majority of the cases of gonorrhea. Zieler, however, goes too
far, I think, in denying the possibility of it so gruffly and will not
even try it out. I believe that in such adversities every factor at all
usable must be taken into account. Then the given conditions of time
and place will determine whether a certain cure should be tried or re-
jected; under certain circumstances even the number of patients will
be the determining factor.
In any event one postulate must be fulfilled: the very considerable
number of skilled specialists in the German Army who are now being
employed in interior-medical and in surgical field hospitals must be
used more than heretofore for the special task of combating and treat-
ing venereal diseases. And for the future it must be seen to that
every physician in our special branch be so widely trained as to have
complete command of the modern treatment of gonorrhea and syphilis.
Perhaps then the experience and added knowledge gained in the war
will be the means of our attaining the inclusion of the special examina-
tion in the state examinations, a thing we have been striving for this
many a year. — Deutsche Medizinische Wochenschrift, January, 1915.
542 SOCIAL HYGIENE
WAR AND VENEREAL DISEASES
PROF. ALBERT NEISSER
Breslau
Whoever is concerned in the education and instruction of the lay
public about the dangers and the significance of venereal diseases knows
how hard it is to find the proper means of an effective presentation for
the great mass of those to be instructed. If one describes the dangers
as they really are, that is in gloomy colors, in order to give a most
impressive warning, then sometimes timid and nervous persons are so
affected that serious disturbances often developing into mental diseases
result. If the instructor represents the danger of venereal infection
more mildly, the success aimed at by the instruction becomes rather
doubtful in the case of reckless youths. What then is to be done?
Of course the first and foremost fact, to be stated in the most impres-
sive manner, is that venereal diseases are actually diseases that must be
taken very seriously, but on the other hand it must be stated most
emphatically that (1) the very sad effects of which the layman hears
so much are not inevitable; they certainly may appear, but they need
not; and (2) these serious after-complications occur almost solely in
the case of patients who have had poor treatment or none.
But to make the treatment a good and successful one requires not
only a practised specialist with years of training — quackery and
nature-cure fail here completely — but also sensible patients who follow
directions and do not give their own opinion or "think" in matters
they know nothing about! And the first and most important com-
mand is : Go to the doctor as soon as possible ! The sooner treatment
can be started, the more easily and surely can the disease be cured.
What is true for peace times is all the more true for times of war.
What is the significance of venereal diseases for the army?
In the first place, thousands upon thousands are withdrawn from the
fighting army for weeks. But they are not only missed as fighters,
they also cause expense and great obstruction through their transpor-
tation back home and through the necessity of establishing hospitals
for thousands who were not wounded by the enemy! They burden
the doctors so necessary for the care of the wounded. And besides, a
person infected with syphilis who does not come up for treatment early,
perhaps from complete ignorance of his condition, or, insufficiently
treated but externally sound, remains at the front, such a syphilitic
often prevents the successful healing of a wound later on, endangers the
THE WAR AND VENEREAL DISEASES IN GERMANY 543
doctors treating and operating on him through the transmission of
poison from the blood, and endangers his comrades lying in the trenches
with him when eating and drinking utensils are used by all in common
without sufficient cleansing. Two cases of such accidental infection
from man to man have already been reported to me.
If it were only a few who meet with the fate of venereal infection no
such weight would be placed upon the withdrawal of these infected
troops. But it is always thousands and tens of thousands who in
every war are withdrawn from the fighting troops in such an inglorious
manner.
In the war of 1870-1871 there were no less than 33,538, that is, almost
an entire army corps, of men with venereal diseases in the hospitals.
What the figure will be in the present war, can of course not be deter-
mined yet; but it will certainly become very large, if I may be permitted
to judge from the reports and experience published up to the present
time. Both the garrison and training troops at home and certain of the
divisions at the front already have a large number of men ill with
venereal diseases, from which number, to be sure, those cases, by no
means rare, in which the disease was contracted in peace times must
be subtracted
But the very worst part of the venereal diseases is not the diseased
condition immediately following infection but the ailments frequently
developing in later years, when the war is long past and the old infec-
tion already forgotten, and the transmission of the disease to the
family after the return of the troops to their homes.
Certainly we are justified in asking the question: "Shall we not have
cripples and dependents enough to provide for as a result of wounds
and hardships?" Cannot the family at least be spared this misery
and the nation this enormous financial burden brought about by the
venereal diseases? And we know how often the seemingly healthy,
believing themselves really cured, infect their wives and so frequently
make healthy progeny impossible. And yet after this war there is
nothing our country will be more in need of than a growing population !
At the same time we must most emphatically call attention to the
fact that in this question of population gonorrhea is almost of greater
significance than the otherwise so terrible syphilis. It is shown that in
Germany about one-tenth of all marriages remain sterile, childless.
In no less than one-half of the childless marriages gonorrhea in the
man or the woman is the cause of this barrenness.
But all the more urgent must be the warning issued to those who are
544 SOCIAL HYGIENE
in health : Do not imagine that in refraining from intercourse with women
you are harming your health. The opposite is true ! Always remember
the danger of almost inevitable infection. Avoid alcohol as the worst
seducer to sexual intercourse! Remember the injury to yourself, your
family, your Fatherland which you may cause in acquiring such a dis-
ease. Therefore, be continent — and if you possess the good-will you
can do it — and you will remain healthy!
And without being a moral preacher I may add : Should not every
man who, inspired by the sacred love of country, went off to the war,
see clearly after quiet deliberation how greatly he compromises his
duty to his Fatherland when, following the impulse, he recklessly ex-
poses himself to the danger of becoming diseased and incapable of
fighting? Is it not disgraceful for a man to place himself outside the
ranks of his fighting comrades because of such a disease? Is not the
number of those who have fallen and been wounded before the bullets
of the enemy great enough already?
But to the sick we niay call : If you have had the misfortune to be
infected, see that you receive good treatment as soon as possible. Fol-
low the advice which physicians are able to give you so successfully
on the basis of the progress of science. Remember that after the first
diseased conditions are cured you are not yet well, that you can still
be dangerous, and that a good specialist must continue to advise you.
You have your fate in your own hands! With good and careful treat-
ment all the much feared effects of venereal diseases can be avoided
with almost entire certainty. Yes, we may almost say: There is no
disease that can be cured so surely as syphilis — provided physician and
patient do their duty.
Of course administrative measures by our military authorities can
also be of great use: —
1. Most thorough and indiscriminate suppression, confinement, and
guarding of all prostitutes; where there are brothels, closing of the same;
at the least, daily examination of the inmates by special physicians.
2. Emphatic instruction and warning of the troops as part of the
service, even with certain threats of punishment in cases of too great
carelessness. I realize that thorough success cannot be attained
through penal regulations, but perhaps an improvement of the condi-
tions. And at the front particularly the idea must be much more
forcibly presented to the soldiers: "Where there is the good-will to be
continent, venereal infection can be avoided." Perhaps it will fall
upon more fruitful ground if accompanied by an allusion to the dis-
THE WAR AND VENEREAL DISEASES IN GERMANY 545
honor and shame of being disabled because of a venereal disease as
opposed to a wound received before the enemy.
3. Establishment of special hospitals easily reached from the battle-
front, employment of the many specially trained doctors for these special
hospitals. Perhaps then the treatment of soldiers at the front with
venereal diseases will be more frequently applicable than is the case at
present. — Frankfurter Zeitung, January, 1915.
PROSTITUTION IN THE ARMIES AND THE FIGHT
AGAINST IT
FROM A REVIEW OF THE ESSAY BY HABERLING
DR. KATHERINA SCHEVEN
Dresden
We are not of the opinion that the author in these suggestions has
met the question squarely or contributes anything at all of value in
combating venereal diseases in armies. He also commits the great
mistake of seeing in prostitution only a female problem and therefore
fashions his regulations only for the prostitute. He also takes the
point of view that it is man's good right to demand the opportunity for
sexual intercourse in every condition of life — even in war — and that
it is therefore the business of the authorities to obtain healthy material
for the masculine desire and keep the sick material away, if necessary,
with vigorous measures. He seems not yet to know what has been
admitted for years at all scientific congresses, namely, that no woman
occupied in prostitution can long remain healthy, that no physician
can in a single examination determine with absolute certainty whether a
professional prostitute is well or diseased, and that therefore check-
cards — which would mean a continuous seduction of our soldiers to
sexual intercourse — are a highly dangerous institution. As has always
been the case with reglementationists of the old breed, Dr. Haberling
moves in a vicious circle. We are convinced that the only way to
successfully combat venereal diseases in a fighting army is to proceed
with severe measures against prostitution and the brothel nuisance
behind the front and as much as possible to remove from the soldier's
path all opportunity for immoral intercourse. It is ridiculous to de-
clare that sexual abstinence cannot be expected of the soldier. Things
are expected of the soldier that are a great deal more difficult than
that. Instead of brothels let soldiers' homes and recreation cen-
546 SOCIAL HYGIENE
ters be established behind the front; let the soldiers be forbidden very
strictly to meddle with women (the soldier is used to really obeying
strict commands;; let the officers be enjoined to set the men a good
example ; and let efforts be made to win over the superiors of all troop
units to the idea that it is a stain upon the honor of a soldier to with-
draw himself ingloriously from the Fatherland through a sexual infec-
tion for which he himself is responsible. In the- terrible earnest of the
present situation, while our husbands and sons in heroic self-denial are
accomplishing wonders of fortitude, while millions of hearts are quaking
and trembling in anguish for their dearest treasure, it seems like a
cruel irony upon the sacred gravity of this historical moment when from
the standpoint of our doctors the excesses of the soldiers are evalued
as something quite normal. If, considering the weakness of human
nature, they cannot be entirely suppressed, at least let us not forget
to combat them at the heart of the evil — man himself. — Der Aboli-
tionist, June, 1915.
THE WAR AND VENEREAL DISEASES
DR. A. BLASCHKO
Berlin
We have already called attention to the grave dangers which threaten
our population in the present state of war from the evil of prostitution
and the venereal diseases following in its wake. Sooner than we ex-
pected, the fears we expressed have been verified. From almost all
the larger garrisons come reports of the great number of soldiers with
venereal diseases. Everywhere in the hospitals whole sections are filled
with men who contracted their illness partly in their native garrisons,
partly in French and Belgian brothels, or from wandering Polish pros-
titutes. Among the diseased is included a large number of reservists
(Landsturm and Landwehr), whose illness is the more dangerous in
that there is much reason to fear that after their return home they will
transmit their diseases to their families. No small contingent is made
up of those men who are on leave and of convalescents who very often
acquire a venereal disease before they return to the front.
In the first two months of the war, when our troops were advancing
through Belgium and France, in strenuous forced marches, there was
little danger of a venereal epidemic. This has changed since the war
has developed into a war of positions, extended in time and space. To
THE WAR AND VENEREAL DISEASES IN GERMANY 547
be sure the soldiers in the trenches who are exposed for days and
weeks to the inclemencies of the weather and the bullets of the enemy
have other things to think of; quite different, however, are the condi-
tions behind the front. First of all there are the commissariat forces
which follow the troops in long wagon trains and must camp at all
times of the day in villages and along the road, so that they have ample
opportunity and leisure to come in contact with the population. Then
there is the lack of diversion in the way of duty, allowing the sex im-
pulse to manifest itself more strongly. Most dangerous of all, however,
are the provisioned stations or headquarters. They are usually small
or middle-sized towns where the staff headquarters and hospitals are
located and they form the midpoints of traffic between the front and
home. Here, as a rule, a gay, busy life is developed. Here war has
lost its worst horrors; here, 20 or 30 miles behind the line of battle, the
ghastly grimness of it is not so apparent. The overworked troops rest '
here temporarily and gradually, with the increased quiet and certainty
of existence, the sex impulse also asserts itself again. The reservist
quartered in some private house and his hostess whose husband is
away fighting on the enemy side gradually develop very friendly rela-
tions to one another, relations which are transferred to a successor as
soon as the troops change their stations. From the standpoint of
morality this is certainly to be condemned; from the hygienic stand-
point at least no harm, or very little harm, ensues. The dangerous
things are the brothels which are found in all small French cities and
represent the very worst center of contagion. These brothels which
regularly have no more than from three to six prostitutes are frequented
extensively by our troops, and the opinion seems to prevail that these
institutions should not only be suffered but even fostered as useful
and indispensable. In Chauny, where only one brothel with three
girls existed, which did not satisfy the "needs" of the men, several
other houses were established. And it is thought that in this way a
very useful organization has been created. Since so many women have
been deprived of their supporters and their work through the mis-
fortunes of war, all too great a number of them, sad to say, are ready for
prostitution. It is expected that through regular medical examinations
the danger from venereal diseases may be overcome. But how is this
possible, even with daily examinations, since for every brothel girl
there are thirty or forty visitors, any one of whom may be infected
with a chronic gonorrhea? And what is done with these girls when
they are found sick? They are confined in a room guarded very care-
548 SOCIAL HYGIENE
fully by a member of the garde civique, but to remove them entirely
out of the province of the soldiers does not seem possible.
In an essay by Haberling entitled "Prostitution in the Army and
How to Combat It," the author suggests that whenever a number of
cases of venereal disease occur in a place, a list of all public prosti-
tutes be immediately sent to the commandant of the troops stationed
there. Medical examinations should be repeated every eight days at
least, all those found sick interned under military observation and those
found healthy 'receive cards, as evidence, with the signature of the
commandant and a list of the days of examination. The soldiers are
then to be directed to visit only prostitutes who can show such cards.
I have already called attention to the fact in an article in the Deutsche
Medizinische Wochenschrift that these suggestions are partly very
practical and partly absolutely dangerous. Considering the difficulty
of proving the presence of gonococci in the case of a girl infected with
gonorrhea, even by means of a microscopic examination (and in war
times such things are certainly not done very exactly), the hygienic
value of the check-card is after all quite problematic. More dangerous
still is the direction which positively refers the men to association
with professional prostitutes, since this would often enough be re-
garded as encouragement or provocation, and as pointed out before,
the check-card offers a most doubtful protection. If we are to take the
stand that sexual abstinence in the enemy's country is an impossibility
with our soldiers, then let us at least not be satisfied with half-way
measures, but in the first place examine every brothel girl daily and
then, above all, the soldiers visiting the brothels. If it seems unde-
sirable to use the doctors for such examination work, then the sub-
ordinate members of the sanitary force may be entrusted with this task
which is none too fine but also none too difficult.
Furthermore, all these places must be supplied with adequate means
of protection. The soldiers must be in their quarters early — and this
should be the rule in the enemy's country as well as at home — and
above all report to the proper regiment doctor at the slightest sus-
picion of an infection in the sex organs. The keeping secret of a vene-
real disease in its initial stage is the only case in which I would consider
punishment justified.
I personally, in opposition to many of my colleagues, am of the
opinion that in a time which demands so many sacrifices of everyone,
the demand of abstinence from sexual intercourse even for the soldier,
who truly needs his strength elsewhere, is not an all too rigorous de-
THE WAR AND VENEREAL DISEASES IN GERMANY 549
mand. Only then could we prevent so great a number of soldiers from
being made incapable of fighting at this early stage through venereal
disease.
At home, however, the danger is almost greater than out in the field.
Officers and men on leave and convalescent wounded, as we are told
in a request of the "New Fatherland League" to the commander-in-
chief on the borders, conduct themselves in the streets and public inns
in a manner certainly not compatible with the spirit of the time. All
these men, of whom a part are minors and another part composed of
married reservists, succumb to the seduction of professional prosti-
tution the more easily because in a metropolis they are without con-
nections and must frequently dispense with proper companionship.
Naturally, not much can be attained through prohibition, although the
recently issued order not to extend leave after 8 p.m. has perhaps
helped a little. (In practice this order does not seem to be very
strictly obeyed.) The "League" also suggests that a proper form of
entertainment be devised for the soldiers. This does not mean boring
tea-parties, but social affairs on a large scale, as artistic evenings, theater
parties, humorous plays, and dances in civic societies. It is believed,
too, that such societies would be glad to cooperate in this cause.
The military authorities certainly deserve credit for their efforts
justifiable in themselves, to make life happier during the short furlough
for the soldiers who have suffered much at the front *through priva-
tions of every sort or from wounds. But it must be seen to that these
amusements assume a form which does not endanger the health of the
men. To allow the soldiers going out for the second time a "free
night," as is done in Frankfort-on-the-Main, according to the Kor-
respondenzblatt fur die Evangelische Konferenz in Baden seems to us at
all events a dangerous risk. All too easily the momentary danger to
the fighting trim of the army from venereal infection as well as the
constant danger for the entire nation, is overlooked. The question is
by all means worthy of the most serious consideration. — Mitteilungen
der deutschen Gesellschaft zur Bekampfung der Geschlechtskrankheiten.
WAR AND VENEREAL DISEASES
Chief Physician Dr. H. Eicke recommends the following measures to
prevent venereal diseases in the war: —
A. Measures against prostitution.
1. Examination of all public women, to be repeated once each
week.
550 SOCIAL HYGIENE
2. All those found sick to be interned.
3. Brothels to be placed under medical supervision. They make
medical control easier and prevent secret prostitution. In the brothels
themselves provision would have to be made for prophylactic treat-
ment perhaps by installing a sanitary corps right on the premises which
would also have to control the troops more closely.
B. Measures affecting the troops.
1. It should be the duty of every soldier to report for prophylactic
treatment to a person in charge of such work as soon as possible, at the
latest on the morning following, after sexual intercourse. The person in
charge to preserve secrecy.
2. Every soldier who contracts a venereal disease as a result of dis-
obeying the order given under (1) to be punished.
3. Those also to be punished who cannot give the name of the person
infecting them.
4. Weekly hygienic inspection combined with instruction by the
military doctor.
5. Keeping secret a venereal disease to be punished in every case.
6. Prophylactics to be held ready in the soldiers' quarters as has
happened hitherto.
7. The following memorandum to be distributed among the soldiers : —
•
COMRADES!
It is important now to call your attention to dangers which threaten you as
men. For months you have been in the enemy's country and a long time will
pass before you see home again. Most of you, no doubt, have had sexual inter-
course before the war and now that you have had to abstain so long a time, the
impulse is asserting itself again. No doubt loose women and girls offer them-
selves to you who make a business of the prostitution of their bodies. As a
result of their calling they are all sick and transmit to you, if you associate
with them, diseases like syphilis and gonorrhea, treacherous diseases which not
only unfit you for fighting for weeks and months, but which you even transmit
further to your families and which in a twelvemonth may even bring you to the
insane asylum. Each one of you must exert sufficient strength of wilf to keep
away from these females. If you always avoid excess of alcoholic drinks which
heat your blood and perhaps cause you to forget your good resolutions you will
be less likely to fall into temptation. It is not true that even months of sexual
continence harm you in health. Only those who follow the advice given here for
their good will remain healthy. Of course many of you find it very hard to
control the sex impulses and many believe, in youthful thoughtlessness, that
because they have hitherto remained healthy they are immune to such diseases.
To these men we also appeal; these too we want to advise. Above all, then, go
THE WAR AND VENEREAL DISEASES IN GERMANY 551
only to women whom you know to be under medical supervision. But even
with them safety measures must not be disregarded. Painful cleanliness is ab-
solutely essential. Wash, and wash again! Above all do not fail to report
immediately, without shame and without fear of any punishment, to your quar-
ters, where further safety measures can prevent a still possible infection. Let
all, however, take this exhortation to heart once more. Abstain now from sexual
intercourse, then you will surely remain well and preserve your health for the
great tasks of the time. And thus you will earn the gratitude of your country
and your family.
— Medizinische Klinik, No. 24, 1915.
DISEASES IN THE WAR
PROF. W. SCHOLTZ
[From a lecture delivered before the "Verein fur wissenschaftliche Heilkunde
zu Konigsberg," March 22, 1915.]
As regards the frequency of venereal diseases among our troops I
wish at the outset to oppose the frequent exaggerations on this score.
Naturally with the present army of millions the total number of soldiers
with venereal diseases is rather large, but the percentage figure of in-
fections is probably by no means serious and according to all prognos-
tications will not exceed the peace figure very much. This certainly
holds true here in the east. In the west the conditions may be a
little less favorable but even there a serious massing of venereal disease
seems to exist principally in detached troop divisions like garrisons in
large conquered towns, provision trains, and similar army divisions
which operate mostly behind the battle line.
As to this part of the east, particularly according to the statistics of
my hospital, the number of venereal infections within the range of
operation for the standing army (as much of it as is stationed here) is
really very low. By far the greater number of infections occurs in the
garrisons in which the troops receive their training, which means espe-
cially here in Konigsberg itself. Moreover it should be remembered
that not all the cases are attributable to the war but that a not insig-
nificant part of the diseased troops entered the army already infected.
After all this we may assume that the percentage during the war in
the army will not exceed the percentage in peace by very much. This
was the case also in the war of 1870-1871. At that time, too, the
percentage of men ill with venereal diseases was about the same in
peace as in war — a little over 4 per cent per year. Since meanwhile
the percentage in peace time has fallen considerably and amounts to
552 SOCIAL HYGIENE
only a little over 2 per cent for the year, we may hope that in the
present war it will fluctuate between 2 per cent and 3 per cent (the
percentage among students at the large universities) to 16 per cent
(business men) to 8 per cent (workmen, in metropolitan districts) ; it is
quite certain that the present war of the nations, with its armies of
millions of men, will effect a decrease in the number of persons
having venereal diseases within the entire male population. Consider-
ing further immediate compulsory treatment and the interning of all
the diseased persons in hospitals, the necessary conclusion is that the
war must lead to a far-reaching sanitation of the male population.
Then we need not only not fear an increase in venereal disease in the
total population, but as a result of the sanitation of the unmarried male
element which is being accomplished during the war, we shall even be
in the happy position after peace is made to apply practical measures
to bring about a decrease of venereal disease in the entire nation.
Seriously high, however, and considerably higher in percentage than
in peace times, is the number of infections among married men alone,
for according to my statistics and those of other authors, fully one-
third of the infected troops are married men. Since just the opposite
is true in peace times, the percentage of cases among the unmarried
in the war assumes an even more favorable aspect as opposed to peace
times than appears above. And the married do not come into con-
sideration as a factor in the progressive spread of the scourge within
the nation.
This important fact of the far-reaching sanitation of the male popu-
lation must be taken immediate and full advantage of even during the
war and particularly at the close of the war, for the good of the entire
nation. Now or never is the time for far-reaching and really effective
attacks upon venereal diseases.
The necessary measures for the accomplishment of this purpose should
be, according to my view : —
1. Completing the sanitation of troops at the time of discharge in
such a manner, that at the very beginning of peace negotiations when
it is customary to dismiss part of the troops, or at least when they
are easily dispensed with, all soldiers formerly infected with a venereal
disease should be given another careful examination in special hos-
pitals (in cases of syphilis also examination for Wassermann reaction)
and in case a complete cure has not been effected, given a second treat-
ment. Further, all the remaining troops which are to be discharged
should be examined by the army doctors for venereal diseases and, in
THE WAR AND VENEREAL DISEASES IN GERMANY
case of infection or suspicious symptoms, hospital examination and if
necessary hospital treatment should be given. Very particular im-
portance and care should also be attached to the examination or treat-
ment of married men.
2. Instruction concerning personal prophylaxis through compulsory
application of the same throughout the entire army during the war.
3. Prevention of widespread renewed infection of the male popula-
tion toward the end of the war and after the conclusion of peace: (a)
Through the earliest possible energetic measures for the sanitation of
prostitution. Such energetic action is without doubt made easier dur-
ing the war; it would have to begin at the latest when peace negotia-
tions are begun, (b) Through measures aimed against extended excesses
on the part of the discharged troops, since with the return of the troops
to their homes illegitimate intercourse, as is well known, often assumes
very great proportions. (Distribution of circulars, admonitory addresses
to the troops upon their discharge, etc., etc.) — Deutsche Medizinische
Wochenschrift, June, 1915.
DR. KURT MENDEL
Garrison Physician in Chauny
[In reply to an article in the Deutsche Medizinische Wochenschrift by Prof. A.
Buschke, directing phj^sician of the Dermatological Military Ward of the Rudolf
Virchow Hospital in Berlin.]
Buschke states in his article that, according to the results of inves-
tigations in his hospital, several soldiers had been infected in a brothel
in the city of Chauny in northern France, and continues as follows: —
"Since, as I have been told, there also exists a large hospital in
Chauny no doubt quite a number of soldiers have been and are still
being infected. I have therefore informed the medical division of the
war department of the facts; through this channel the matter may
be brought to the attention of the army chief concerned who may
then have the brothels closed or else order them to be regularly super-
vised for purposes of sanitation. At all events this will open the way
to choking up the sources of venereal infection in the enemy's country.
Infection occurring otherwise is due to vagrant prostitution in which
case of course nothing can be done."1
1 This reasoning has remained unintelligible to me. — K. M.
554 SOCIAL HYGIENE
As I have been acting as garrison physician in Chauny since Sep-
tember 28 and therefore feel in a measure responsible for the sanitary
institutions here, I take the liberty to make the following reply to the
statements quoted above: —
It certainly did not require the admonitions of Buschke and his
notices to the war department to call the attention of the commandant
or the responsible physicians here to the dangers our soldiers run dur-
ing their stay here. The following explanations will show, moreover,
that long before the present writing everything has been considered
and every action taken to prevent as much as possible the further
spread of venereal diseases.
Let me say in the first place that a possible order of the war de-
partment to the army commandant here "to have the brothels closed
or else regularly supervised for purposes of sanitation" would remain
without effect because since the beginning of the war a brothel no longer
exists in Chauny; at that time it was deserted by its inmates and the
key of the public house turned over to the Mayor's office. In two
houses of the city, to be sure, sexual intercourse later developed into
a brothel-like activity. These places, however, were very carefully
watched by the sanitary squad from the beginning and as soon as it
could be proved that they were the source of infections they were
closed; the women living there who were diseased were interned, to-
gether with all other Frenchwomen found to be afflicted with venereal
disease, in a special building where they were guarded and given
treatment.
Finally, in the case of every soldier reporting sick or found diseased
in the medical inspection, I searched most thoroughly for the source
of infection, found it almost without exception, and permanently in-
terned the transmitter of the disease in order to prevent further
contagion.
That we have devoted special attention to the prophylaxis of vene-
real diseases from the beginning is shown by the following presenta-
tion sent in by me to the military authorities on November 5, 1914.
I quote the following sentences from it here because of their more
general interest : —
The means for preventing the further spread of venereal diseases recom-
mended for our garrison and tried in other places seems insufficient to me: the
establishment of brothels in which it is attempted by the aid of regular medi-
cal examinations to intern only uninfected women is dangerous, for through this
means the soldiers are actually directed toward intercourse with prostitutes,
THE WAR AND VENEREAL DISEASES IN GERMANY 555
sexual intercourse, particularly extra-marital intercourse of married soldiers,
approved, as it were: the isolation of all women infected with venereal diseases
is an impossibility because their number is too great and certain proof of their
being diseased would be possible only through daily examinations; supervision
of those houses in which particularly much sexual intercourse is practised, say
by a sanitary squad whose duty it would be to examine the visiting soldiers for
venereal diseases (a method that is applied in China), would prevent the spread
if the diseases for only a comparatively small number of cases, aside from the
fact that by this method many who are in reality infected would pass through
as healthy; regular examinations of the troops by physicians cannot be conducted
frequently enough really to prevent the spread of venereal diseases to any con-
siderable degree; recommending the use of condoms, medicine-droppers, or simi-
lar things, by the men, experience has shown to be of no great avail, espe-
cially as the use of these means of protection is abhorred by many because of
the lowering of the intensity of sexual pleasure, nor does their application by
any means afford a sure protection against venereal infection.
The best means of checking energetically the further spread of venereal dis-
eases seems to me to be the demand of complete sexual abstinence of the soldiers
in the field. The war demands so many and such great personal sacrifices and
the individual, as the previous history of this war has shown, offers these sacri-
fices so gladly and willingly, that the demand of abstinence from intercourse
with prostitutes or loose females for the length of the war seems absolutely prac-
ticable and attainable. The troops in the spirit of voluntary sacrifice will add
this to the rest as a further measure of self-denial, especially when they realize
that their own personal good is concerned; the army would be able to retain a
great many soldiers who are otherwise disabled for weeks by venereal infection;
the serious later complications of diseases, which, as experience shows, every
previous war has carried in its train, will be prevented; and the women of our
native land remain safe from infection and its disease-bringing effects.
Against making such a demand of complete sexual continence objection is
often raised that by this means concealment of an acquired infection would be
encouraged. Against this possibility I believe regular medical examination
would afford sufficient protection. The infliction of punishment in cases of men
who are, upon examination, found infected with a venereal disease and whose
time of infection is determined, will serve as a further effectual deterring factor
against the practice of sexual intercourse during the war.
I accordingly recommend that sexual intercourse be prohibited in this garri-
son, attention being called to the great prevalence of venereal diseases in
this town, as well as to the dangers which lie in venereal infection for the
soldier himself, for the army, for the women of our land, and that punishment be
threatened in case of venereal infection discovered in the weekly medical exami-
nations of the troops.
Should this demand, however, be rejected as too rigorous it may at least be
requested that a weekly warning be issued to the soldiers in which attention is
called to the prevalence of venereal diseases here and emphasis is placed upon
the danger to which every man indulging in sexual intercourse here exposes
himself.
556 SOCIAL HYGIENE
This letter was turned over to the consulting health specialist and
the higher authorities who made it the basis of detailed discussion.
For obvious reasons they did not decide on the prohibition of sexual
intercourse; they have, however, given the entire matter the closest
attention.
Contrary to the opinion of Buschke in his concluding sentence, I be-
lieve on the ground of my experience here that in war-time particularly
much may be accomplished against vagrant prostitution — and that is
chiefly the kind that concerns us here in Chauny; because in enemy
country merciless isolation for the entire duration of the war of all
persons once found diseased is very practicable.
In spite of such measures, without the prohibition of sexual inter-
course, no one can prevent venereal diseases from continuing to assume
great proportions, especially in the provisioned garrisons, — not even
Professor Buschke with his fine appeal to press and war department
composed at the native hearth. — Deutsche Medizinische Wochenschrift,
January, 1915.
REPLY TO THE ABOVE REMARKS
/
DR. A. BUSCHKE
Berlin
[In his reply Buschke, who quotes a letter sent to him by the sanitary division
of the war department containing substantially the same facts Mendel gives
concerning conditions in Chauny, acknowledges being mistaken about the source
of infection of his patients and continues: — ]
On the whole my further anamnestic investigations of the infections
of soldiers with venereal diseases here in the public dermatological
hospital under my supervision have somewhat modified my views about
the brothel question. For it appeared that the greatest number of in-
fections occur not in brothels but as a result of vagrant prostitution,
which, in the main, accords with our peace experience. But if this
vagrant prostitution is hard enough to get at in peace times, surely
in war times difficulties might arise which are not always as easily over-
come as Dr. Mendel represents, albeit his activity deserves all
credit. I find that on the basis of the very facts before us I am bound
to agree with those who see in well-supervised brothels — if possible by
specialists — the best prophylactic measure; hence it seems best to me
to keep the existing brothels in the enemy's country open and well
THE WAR AND VENEREAL DISEASES IN GERMANY 557
controlled. It is a well-known fact that in former wars the military
authorities have even gone so far as to place medically controlled pros-
titutes at the disposal of the Army. That, of course, is out of the ques-
tion for us and the above mentioned measure must be recommended
as a substitute. Besides that, wherever possible, compulsory disin-
fection could be enforced among the soldiers and in the brothels, —
that is, wherever this is at all possible under the difficult conditions of
war. As is known, this plan has been worked successfully in the navy
in peace times and I am told that even now it is being tried in several
places in the land army. As a matter of course the soldiers should also
be kept back from sexual intercourse as much as possible through in-
struction calling attention to the dangers of venereal diseases and
through circulars such as the German Society for Combating Venereal
Diseases has already distributed.
I must take issue very decidedly with Dr. Mendel's view that sexual
intercourse should be forbidden the soldiers under threat of punish-
ment. If Dr. Mendel knew the extensive literature on the subject,
which as non-specialist, and at the front besides, he can naturally not
be expected to, he might not have made this suggestion to the military
authorities. In the excellent and exhaustive essay by Haberling on
Prostitution in the Armies, and the Fight Against It we find the follow-
ing sentence: "The thousand-year-old evil of prostitution in its rela-
tion to armed might, as we have here presented it, proves to us clearly
that punishments, no matter of how cruel and barbarous a kind, have
never been able to effect an essential limitation of prostitution. This
principle has now been finally discarded." It was right, therefore,
that the military authorities, who in this as in all other fields have shown
the greatest intelligence and most thorough knowledge, did not accept
Dr. Mendel's suggestion. Even under the much simpler hospital con-
ditions here, where it is our duty to keep the soldier with a venereal
disease away from the public, it is only with difficulty that the soldiers
are deterred by punishments from leaving the ward by forbidden ways,
at night, etc. Punishments, according to my experience, make almost
no impression; we must strive rather so to adjust the methods of con-
finement in this institution as to make it as hard as possible for the
soldiers to get away. How much harder would this be at the front!
On the whole, however, the detailed discussion which is being de-
voted to venereal diseases in the war is fully justified, not only be-
cause of its immediate significance for the fighting army but also and
especially for the time after the war, considering the great influence
558 SOCIAL HYGIENE
venereal diseases have upon sterility and the quality of the progeny
which is to replace the terrific human losses we are suffering in this
war. From this point of view it is very worthy of thanks that Dr.
Mendel has told us of his experiences, even though we cannot agree
with his conclusions.
WAR AND VENEREAL DISEASES
DOCENT DR. E. KLAUSNER
[Lecture delivered before Medical Society of Prague, January, 1915.]
. . . . We clinicians far from the scenes of war were interested
first of all in the question of the extent to which the present war was
influencing the sexual-hygienic conditions of our city — both the mili-
tary and the civil population, or that part of it that concerned us as
the working material which we handled in the ambulatoriums of the
clinic.
Now, though the fact that venereal diseases, which are very preva-
lent even in normal times, have increased, cannot always be estab-
lished conclusively, for even in peace times a sudden explosive-like
increase of one or the other of the venereal diseases may be noted, yet
I believe on the basis of long years of study of the sexual-hygienic condi-
tions in Prague I may assume a certain right to report certain clinical
observations which concern such marked fluctuations in the appear-
ance of venereal diseases and such characteristic changes in the sexual-
hygienic conditions even during the very first months of war, that they
seem to me decidedly worth relating — the more so because as far as I
know there have been no reports thus far of observations relating to the
influence of the present war upon the sexual health of the civil popu-
lation living far from the seats of war.
The first fluctuation by way of increase could be observed in the
month of August, 1914, when thousands of reservists were assembled in
Prague for mobilization purposes. Passing the barracks during this time
and the parks lying near them one could see these places peopled all day,
but especially in the evening hours, by a great number of females in
most of whom one could recognize the familiar faces of the suburban
prostitutes of Prague striving in an unequivocal manner to use the
high spirits of the soldiers to their own advantage. The pouring in
of the clandestine prostitutes from the periphery of our city naturally
resulted in more extensive intercourse between these persons and the
THE WAR AND VENEREAL DISEASES IN GERMANY 559
civil male population. And so it is quite clear that in consequence of
these conditions the number of patients in the ward assigned to the
treatment of prostitutes mounted rapidly, often assuming such pro-
portions that for lack of ward space for the prostitutes brought in it
was necessary almost daily to discharge some of the females admitted
the day before, where the cases were chronic and slightly infectious.
Especially noticeable in conjunction with the great number of cases
of secondary syphilis among the prostitutes brought in was the in-
creased number of fresh luetic infections among the male civil popu-
lation, a fact which could be established with certainty, since in the
months of September and October several cases with primary effects
were often found in a single day among the patients of the ambula-
torium, so that the clinic was at this time treating a large number of
freshly infected syphilitics, while in recent previous years weeks often
passed without bringing the clinic one case with a primary infection.
As for the two other venereal diseases, chancroid and gonorrhea — in
these two, especially in the latter, a distinct increase took place.
This picture of the sexual-hygienic conditions in Prague changed
quite suddenly within the next few months when the greater part of the
troops had left the garrison and also the number of young male indi-
viduals of the civil population had decreased considerably as a result
of the call to war service. The number of patients in the ward for dis-
eased prostitutes which in normal times amounted to forty or fifty
and which as already related had mounted to a maximum just the
month before, now dropped rapidly, finally sinking to a minimum
never known before in the course of the last thirty years. The obvious
explanation of this remarkable decrease is the decrease in the mascu-
line material which clandestine prostitution in particular counts upon.
The situation thus created for the prostitutes may best be illustrated
by the fact that during this period a great many of these girls came
to the ambulatorium without cogent reason and actually begged to be
admitted while in normal times these females avoid the ambulatorium
altogether. The needy condition of the clandestine prostitutes also
caused many of them purposely to have themselves arrested by the
police, as they declared when brought in, for the sake of finding shelter
in the ward.
The aspect of things changed again in the last two months when a
large number of recruits were concentrated in Prague for training and
at the same time a great many wounded and convalescent soldiers were
being quartered in our city. Immediately a rapid increase in the
560 SOCIAL HYGIENE
number of patients in the prostitutes' ward could be noted and at the
same time the number of venereal patients was raised by the addition
of many infected men, especially soldiers, in the clinical ambulatoriums.
It was at this time, moreover, that the auxiliary hospital for the treat-
ment of soldiers with venereal diseases was established, which, as I
was able to determine, had an unusually large number of patients in
these days. The most serious condition resulting from the spread of
venereal diseases among the soldiers was the marked increase of infec-
tion of married women upon the return of their husbands from the front.
Isolated cases of this kind were observed at the time of mobilization
and in many women with florid secondary syphilis I was also able to
determine anamnestically that the date of infection coincided with the
period of mobilization. The quartering of very many reservists living
in Prague itself in the barracks naturally encouraged a freer life and the
sanitary conditions pictured above, with clandestine prostitution coil-
ing itself about the barracks particularly, further increased the possi-
bility of venereal infection of the women by their husbands. But re-
cently, through the return of the men from the front, the cases of con-
jugal infection with syphilis and gonorrhea have increased to a very
marked degree. This most lamentable fact brings about a danger not
to be minimized, the danger of the endemic spread of venereal diseases;
for it is possible that through the infected husband the disease, in most
cases quite florid and because of the unusual circumstances naturally
untreated, may be endemically transmitted — even by extra-genital
means — to the remaining members of the family in particular and the
environment of the infected man in general. Such cases we have re-
cently observed in the clinic; in one of them, for example, mother and
child were infected with gonorrhea by the returning husband. To
what extent venereal diseases prevail among the soldiers in the two
different theatres of war I cannot say with any degree of certainty
from the quality of our infected material. Yet I must make mention
of the fact that the infected soldiers from the southern theatre of war
uniformly tell about the great prevalence of venereal diseases in the
army of the south.
(Among the usual suggestions for prophylaxis, etc., Dr. Klausner
recommends: Limitation of leave for soldiers in hospitals and conva-
lescent homes; regular examination of these men for possible presence of
venereal infections. Careful examination of all soldiers who go to
their homes for rest and care, and relentless transfer of all those in-
fected with venereal diseases to one of the hospitals mentioned.)
THE WAR AND VENEREAL DISEASES IN GERMANY 561
IN DARKEST BELGIUM
THE FIGHT AGAINST PROSTITUTION
[From an article by the War Correspondent Paul Schweder.J
A very "liberal" legislation and the same sort of police regulations
make it very hard for the girls to free themselves from the hands of the
"enterprisers." On such ground the moral views of the community
must be of a very lax nature. Growing industry and rising commerce
have done their part in making conditions worse, and the three great
world's fairs in Brussels, Lie*ge, and Ghent, all in the last decade, with
their concentration of people streaming in from every land, have hardly
exercised a morally elevating influence.
And so our troops marching into Belgium found beside the general
lack of discipline some very miserable conditions in the field just
spoken of. Hence it was one of the first and foremost tasks of our
army authorities and the general government instituted for Belgium
to create a change as much as possible, not only in the interest of our
soldiers but also in the interest of the Belgian natives themselves.
By a mobilization of doctors the government worked hand in hand
with the German morals police. Privy Councillor Prof. Pannwitz,
the well known leader in the fight against tuberculosis, was given
charge of all hospitals in this territory and Crime Commissioner Dr.
Gebhardt, of Leipsic, was appointed supervisor of the morals police,
with headquarters at Brussels. A number of criminal officers from
Berlin, Hamburg, Leipsic, and Munich were sent to him as assistants.
Thus, within recent weeks, a systematic organization for combating
the bad moral conditions in Belgium especially in Brussels, has been
established.
The German General Government has received much valuable aid
in its work from the women. Just as the success of tjie fight against
tuberculosis could not have been attained without woman's coopera-
tion, so in combating the bad moral conditions in Belgium, especially
venereal, diseases, it has been deemed indispensable. The early prudish-
ness has long since given place to the more intelligent view that here a
very necessary work must be done for the preservation of our army
and hence of our nation. In general it has been observed that prosti-
tution in enemy country has increased during the war. Neediness and
lack of employment, supplemented by a certain careless view of life
of the people are probably the main reasons for this condition. The
562 SOCIAL HYGIENE
first thing done was to provide thorough hospital treatment for the
diseased girls. Then, when experience led to the discovery that a
great number of prostitutes established themselves wherever large
bodies of troops were collected, all those girls not belonging in the
city in question were sent back to their homes by the hundred.
Most attention was paid to clandestine prostitution which plays the
greatest part in Belgian cities. This is clearly shown, for example, by
the fact that in Brussels only about a hundred and fifty girls report
regularly for control, while every visitor knows that hundreds people
the streets. With the aid of the Belgian authorities began the task of
clearing the streets of prostitutes, and it was done by means of the
socalled Copenhagen system. The infected girls are taken to hospitals
where they lie entirely separated from those already under control.
It has been rightly said that among the former there are many girls
who have been driven to this course by seduction, need, and unem-
ployment and that most of them can still be led back to their former
honest occupations.
For this purpose a committee of Brussels ladies of high rank has been
formed to work hand in hand with the military doctors and the govern-
ment. The undiseased girls, among those arrested, who have not been
under control before, are sent home with a warning. Only after three
successive warnings and after it is found out certainly that external
circumstances are not the cause of the immoral mode of life, are the
girls entered on the list. Before this point, however, the voluntary
work of the Brussels ladies sets in. They make efforts to save the girls
by visiting them in their houses, obtaining employment for them, and
trying to awaken their latent honor.
Now as to the ways of preserving our soldiers from danger, experience
has shown that educational books and brochures are not of much avail.
Hence other courses have been tried. Thus trustworthy persons were
posted at the (Depots who instruct the arriving soldiers in a comrade-
like manner concerning the moral and physical dangers confronting
them. Usually a sanitary guard is also stationed at the depots which
distributes brief memorandum booklets. Further the soldiers are
fittingly instructed in the mess-rooms by means of lectures. Successful
work is done in cooperation with the sanitary troops by our army
chaplains.
After these regulations it may be expected of the intelligence of our
soldiers that it will be possible to attain conditions which will make an
injury to the strength of our army impossible. — Berliner Zeitung am
Mittag, March, 1915.
THE WAR AND VENEREAL DISEASES IN GERMANY 563
We abolitionists, too, will not deny our approval to these measures
of our authorities, for we are no such sticklers for our principles as to
demand that in a land like Belgium and in war times at that, reglemen-
tation should be done away with at a stroke. That it is carried out in
a more humane manner than heretofore and is connected with thorough
rescue work with the aid of women is one great advance compared with
the former conditions prevailing in Belgium. — Der Abolitionist, April,
1915.
VENEREAL DISEASES AND WORKINGMEN
In the Wiener Medizinische Wochenschrift Dr. Moritz Oppenheim
has published the results of his experience in the Ambulatorium fur
Haut und Geschlechtskrankheiten des Verbandes der Genossenschafts-
krankenkassen in Wien during the period from October 1, 1914, to
September 30, 1915. From a comparison with peace years there ap-
pears to be a considerable increase in the number of cases of venereal
diseases. The cases of infection among the workers below twenty
years of age have doubled, but the age of the infected boys has fallen
too, for even fifteen-year-old youngsters required medical attention.
The author explains these conditions by the "high war wages, night
work frequently in company with young female workers, seduction by
prostitutes on the way home at night, heightening of sexual excitability
through night work, richer food as a result of the better pay, and
alcoholic excess." The greatest weight is probably to be laid upon
night work, for the higher pay, which at all events is given only in iso-
lated places of business, has long ago been equalized by the rise in the
cost of food. But there are two other factors which play an important
part : first, the conscription of boys of nineteen and since also of eighteen.
(In reality they are even younger, since the calendar year is considered.)
The juvenile worker who is called out in "defence of the fatherland"
believes he is already a man and owes it to his manhood to practice
sexual intercourse. Connected with this is also the matter of alco-
holic excess at the time of drafting. This mode of excess is even so bad
that in many places the serving of liquors at the time of drafting is for-
bidden. The second element, however, which applies in all ages, is
the depraving of morality. The entirely changed living conditions, the
daily uncertainty of affairs, the severing of family ties, the mixture of
the population, need and worry, easy war-earnings — all these things
have depressed the general morality and have brought about a moral
564 SOCIAL HYGIENE
irresponsibility which has seized upon all classes of the population;
they are responsible for the indiscriminate promiscuity of sexual
intercourse which is the cause of the growth of venereal diseases.
Among those between the ages of twenty and thirty there has been
an absolute decrease, but only an absolute one, for as the author em-
phasizes, these are the very years which are most subject to military
draft, especially in the year under consideration, for the calling of the
reserves began in February, 1915, with those classes. Therefore fewer
workmen of those ages were at home and considered in these statistics.
In the more advanced ages the number of the diseased is swelled again.
In the years above forty it doubles, and above fifty the absolute number
is even tripled. This may no doubt be explained by the fact that in
the absence of a sufficient force of the younger workers more of the
older classes were used, and then also by the fact that with the younger
people gone to the front it became easier for the older ones to establish
sexual connections.
The women, for obvious reasons, seldom visit the Ambulatorium,
but even in their case the number has doubled. Most of those dis-
eased are between the ages of twenty and twenty-five years. — Volks-
zeitung, February, 1917.
VENEREAL DISEASES AT THE FRONT
DR. W. FISCHER
[This is a collective review of essays appearing previous to March, 1915, on
the combating of venereal diseases in the war. Almost all the preceding articles
are included in the discussion. The concluding paragraph follows:]
Reviewing briefly the contents of the essays considered, the number
of which alone gives some idea of the importance assigned to venereal
diseases in the war, we find that there are in the main three cardinal
questions with which the authors concern themselves.
The first is the question of , prophylaxis. The demand of absolute
sexual continence which is raised in different quarters bears no pros-
pect of realization and success. One must simply reckon with condi-
tions as they are, not as they should be.
The second point concerns the treatment of the already infected
soldiers. Neisser's suggestion to carry out the therapy at the front,
i.e., in the troop, should be rejected for two reasons, it seems to me:
first, for the sake of the diseased man himself, and then because of the
THE WAR AND VENEREAL DISEASES IN GERMANY 565
danger of infection for those about him. The soldier in the troop
cannot be so sharply guarded as to make it impossible for him to trans-
mit his disease through further sexual intercourse to the female popu-
lation and thus indirectly harm his own comrades. Hence dispatching
all men infected with venereal disease back behind the front and strict
isolation in special hospitals is very necessary. Of course for diagnosis
and therapy a skilled and specially trained medical corps is needed.
The military authorities in charge of this branch could perhaps see to it
even more than heretofore that the proper persons are employed in
these places. The creation of dermatological consulting bodies of the
kind already existing for surgery and internal medicine therefore ap-
pears very pressing. Within recent months extensive measures of this
kind for the sanitation of prostitution have been adopted especially for
Belgium.
And finally, as the third point, the anxious question concerning the
future of our people when a large part of our troops come home in-
fected. " We need many and healthy descendants!" cries Abderhalden.
"The entire future of our people rests upon them." In this struggle
of the nations it is not the young men alone who had to go forth to
defend the might and honor of the Empire; the married men too, who
have already founded families, have been called to the colors and
partly in the enemy's country, partly in large garrisons towns are ex-
posed to the temptations of prostitution which is flourishing every-
where. Certainly circulars and instruction are helpful but who is
ready to declare that these means can limit the evil to a noticeable
extent? Of the danger in store for the home population after the war
from the discharged troops, Finger speaks very forcibly, showing at the
same time how this evil may be warded off. He places all responsibility
upon the military authorities, demanding that all troops be carefully
examined before being discharged and all those found infected be held
for treatment. At the same time the way must be cleared for co-
operation with the sick funds and the national insurance. Thus Finger
shows that in his care for the present he has not lost sight of the future !
The pecuniary sacrifices which such a measure demands of the state
are without doubt enormous, yet it may be the only way to preserve
our people and the coming generation from perhaps unsuspected dangers.
Let us hope that in this vital question, too, the splendid organization
of our state, which demands respect even of our enemies, will not fail
us. — Zeitschrift fur Bekampfung der Geschlechtskrankheiten, May, 1915.
566 • SOCIAL HYGIENE
THE SPREAD OF VENEREAL DISEASES IN THE ARMY AND
ITS PREVENTION
ANNA PAPPRITZ
If the essays which have been appearing under this title in the
medical journals were to be collected they would make an imposing
volume. Unfortunately the authors have brought out no new points
of view; they only keep recommending the already familiar prophy-
lactic measures, on the one hand personal phophylaxis for the soldiers
themselves, and on the other the most stringent control of prostitution
in the provision stations and the cities occupied by our army in the
enemy's country. The effect is almost tragi-comic when one reads
these regulations and considers how impossible it is to follow them at
the front. The soldier who hardly has the opportunity to change his
underwear and to observe the most necessary rules of cleanliness is to
be made to perform manipulations upon himself which not only de-
mand an enormous expenditure of tune and care, but also necessitate
a regular traveling drugstore of salves, droppers, cotton, and other
things. Besides that, our doctors, who are working day and night to
the point of utter exhaustion in the service of our wounded, are to
undertake a daily control of brothels so careful that almost twice the
present staff of doctors would be necessary. How this prophylaxis
actually works out is described by Professor Blaschko in the Mitteil-
ungen of the German Society for Combating Venereal Diseases (De-
cember, 1914). The very same sentiments are expressed in an article
by the present garrison physician of Chauny, who considers the estab-
lishment of brothels as well as the recommendation of protective means
dangerous.
If the picture which Professor Blaschko draws of the institution of
brothels in the west is sad enough, conditions must be actually horri-
fying in the east, where, as I have heard, the female population is com-
pletely infected through the Russian armies. And yet there too brothels
are being instituted for our soldiers, as the following letter from the
Frankfurter Zeitung indicates. In No. 21 of January, 1915, Dr. Fritz
Wertheimer writes in a report from the Polish theater of war: "All
physical and spiritual pleasures are taken care of by the commandant
at the headquarters station; his subordinate executive is a major, an
officer's substitute. Since he has now become the head of a new
business he is called in confidential circles by the title of commissioner
of morals. Concerning the gay side of such headquarters activity
THE WAR AND VENEREAL DISEASES IN GERMANY 567
he will no doubt publish memoirs at some future time. With the
recommendation of the perusal of this work, I take the liberty of pass-
ing over this delicate subject to the respectable pleasure of the baths.
. . . ." The revolting cynicism with which this wretched business
is treated here is quite characteristic of the masculine attitude toward
this serious question.
But not only at the front but at home as well the dangers which this
system holds for our troops are very great. I quote the following note
from the Hamburger Nachrichten of October 11 : " A complaint has come
to us from circles connected with domestic missions, stating that recently
on a Saturday night it was determined by count that over three thou-
sand men had business in the closed streets of our city." In this con-
nection the admonition is given to keep to a decent mode of life in the
present hard times and to turn the money sacrificed there to nobler
uses. Further strong disapproval is expressed of the custom of serving
alcohol in these places throughout the night.
From these facts it is obvious that the suggestions made in the numer-
ous articles in the medical press not only bring nothing new, but have
already shown themselves to be without effect. It would therefore
be much more effective in my opinion instead of discussing these ques-
tions solely in the professional journals to publish popular educational
articles in the daily press as Professor Neisser has done in the Frank-
furter Zeitung. But a single warning in one daily is not sufficient;
this educational work must be carried into the entire press, including the
smallest local sheet, and then only will it have an effect upon the
general public and perhaps also influence the authorities.
How difficult it is for our efforts to obtain a hearing with the latter is
shown by the answers which follow upon all requests of the kind.
Among others the German Federation for the Protection of Juveniles
has in conjunction with the German Society for the Combating of Vene-
real Diseases directed petitions to the Prussian, Saxon, Wurttemberg,
and Bavarian ministers of war in which attention is called to the con-
tinued spread of venereal diseases in the army, warning given of the
danger of brothels, and the following demands were made: —
1 . To direct regiment commanders and hospital heads to instruct the
officers and men subordinate to them, especially those not yet of age,
concerning the dangers of illegitimate intercourse.
2. To forbid all military persons to visit brothels.
3. To allow evening leave to persons in the hospitals and to troops
on' furlough only when they seem trustworthy ; to control evening leave
as much as possible, and not extend it beyond 11.30.
568 SOCIAL HYGIENE
4. To demand immediate notification of a venereal infection and
location of the place of infection.
A petition of the League of German Women's Clubs to the Minister
of War was answered as follows: "The receipt of your communication of
November 13, 1914, is hereby acknowledged with the most sincere
thanks for your efforts in behalf of the advancement of the military
and public health. The recruited men are instructed about venereal
diseases and their danger and also the circular published by the Medical
Division of the War Department entitled "Beware of Excesses" is given
them. Hence the War Department considers further measures affecting
the individual soldier, particularly the distribution of two more circulars
offered by the division, as unnecessary."
The above named societies received a similar answer. Plainer than
this courteous denial is the practice which continues to move along in
the old rut, a practice that must fill us with grave concern and with
deep sorrow when we are forced to look on at the havoc venereal dis-
eases are working with the health of our troops. — Der Abolitionist,
March, 1915.
THE TREATMENT OF VENEREAL DISEASES AFTER THE
WAR AND PHYSICIANS' FEES
DR. H. SCHONHEIMER
Health Councillor, Berlin
In a most exemplary manner our army authorities are working to
render soldiers with venereal diseases harmless through timely cure
and isolation. Ye^ it is apparent that it will be impossible to prevent
infection being carried back into the land. We physicians have ample
opportunity to observe to what an extent these poisoned darts are pene-
trating our country and those of us who carry on a gynecological prac-
tice see almost daily how the happiness of many a marriage is being
destroyed by this scourge.
We are very pleased to note, therefore, that everywhere preparations
are being made to combat this evil. We consider as one of the most
effective means to this end the advisory posts for persons with vene-
real diseases. They can be productive of much good, especially if their
peculiar mode of activity and active propaganda really attract suf-
ferers and dispel all distrust on the part of the people. It is their
business to see to it that every person afflicted with a venereal dis-
THE WAR AND VENEREAL DISEASES IN GERMANY 569
ease places himself under medical care as soon as possible, and that he
does not quit it until successfully cured. We physicians must see to
it that these advisory posts are established and carried on only as such,
and do not develop into places for treatment. Because treatment —
on that point we are all agreed — must not be taken out of our hands.
But if we consider timely and thorough treatment as lying in the
public interest, then public organizations must be made to bear the
cost of this treatment. For a large part of the returning participants
in the war the sick funds seem to be the right authorities. Whether
they really are, is questionable. For they are so constituted that their
primary interest lies in making and keeping the sick person able to
work again. This aim attained, any efforts of the managers beyond this
point will be slight. At any rate we cannot expect that they of their
own accord will urge their members to continue treatment. I cannot,
therefore, regard it as a happy solution of the problem when the work-
men's sick funds in many places are made regular centers of organiza-
tion for the treatment of diseased men returning home from the war,
while other institutions are only supplementary to these, concerning
themselves with the treatment of those who do not belong to work-
men's sick funds. For from the point of view of public health the es-
sential thing is to prevent the spread of disease at its source, namely,
the individual diseased body, not merely to restore the individual to
his work and his daily occupations.
It seems much more practical, therefore, that, as is planned in Berlin,
the national insurance companies should take the organization of medi-
cal treatment in hand and the sick funds pay a fitting contribution for
being released from any of the burden. For the national organizations
are far more interested than the sick funds in the permanent and com-
plete removal of the evil. Besides this, they are much better prepared
financially, at least in the strong industrial districts, to undertake the
initial risk.
But who is to Comprise the second party, i.e., treat with the physi-
cians for the party bearing the costs? Since physicians are agreed that
all doctors willing to do the work must be permitted to take part in the
treatment, the first body that occurs to us as being representative of the
profession is the united body of the various associations of physicians
or their presidents. Accordingly, the president of the association of
physicians in Berlin has cooperated to create a commission to come to
an agreement with the president of the national insurance company.
Thus far this plan has not shown itself to be a very happy one, for in the
570 SOCIAL HYGIENE
negotiations the tendency has been to determine too precisely the
officers who shall have jurisdiction and to deprive them of the very
support which the associations themselves created with such care for
the purpose of strengthening the position of the doctors ; I refer to the
committees for making agreements, whose logical agents of super-
vision and appeal are none other than the presidents of the chambers.
It would be much more practical to organize a commission out of the
entire body of physicians, its agreement to be subject to the approval
of the agreement committee or the president of the association.
But what of the conditions to be agreed upon? As thorough and
intensive treatment as possible must be the rule, guaranteeing the per-
manent removal of the evil and the danger of infection connected there-
with. The first requisite, then, is that there shall be no form of
single payment plan such as has unfortunately been in vogue all
through the historical development of the sick funds. While I do not
in the least mean to deny that many physicians would give individual
and intensive treatment even under the single payment plan, still I
believe in most cases it will be impossible to combat human nature.
This sort of fee in its very nature is simply the equivalent for mass
services; the single payment plan simply means treatment by rote.
Such a procedure would without doubt defeat our aim. If real, thor-
ough treatment is to be the rule, only payment for individual services
can be permitted.
Secondly, however, the fee must be sufficient and proportionate to the
importance of the treatment. Here, too, mediocre payment results in
mediocre services. Physicians will willingly perform the many separate
operations a,nd manipulations (massages, injections, etc.) if they
. may expect fitting recompense for the complete treatment.
The important thing now is to get started and to start rightly, for the
institution, in itself an excellent thing, will be followed by others. It
will soon become apparent that the treatment of men with venereal
diseases will not be sufficient; the infected married 'women, non-pro-
fessional prostitutes, and finally even professional prostitutes will have
to be given attention if the evil is to be rooted out. And finally, there
are other diseases besides venereal diseases, the combating of which is
very essential to the well-being of the community. All this will be dqne
with the cheerful cooperation of the physicians but must not be paid
for with their economic ruin. — Deutsche Medieinische Wochenschrift,
October, 1916.
THE WAR AND VENEREAL DISEASES IN GERMANY 571
The German League of Evangelical Religious Blue Cross Societies
has published a pamphlet for the combating of immorality among the
soldiers from which the following facts are taken: —
We have received written information from a German city to the effect that,
among 10,000 inmates of the hospital there, seven hundred are ill with venereal
diseases, that is seven out of a hundred. Similar reports have been sent us from
other German cities where there are large hospitals: everywhere large divisions
of the hospitals had to be devoted to soldiers who were affected with such dis-
gusting diseases — sexual ills.
The Magazine of the German Evangelical Society for the Advancement
of Morality says : —
While several cities, conscious of the great responsibility, closed the mu-
nicipal public houses immediately at the time of mobilization, or visiting the
same was strictly forbidden the soldiers by the military authorities, grave com-
plaints and accusations come from others — from those cities in which the city
government deems it incumbent upon it to allow the existence of brothels for the
immoral pleasure of the masculine world. We have trustworthy reports that in
such brothel cities in the days of mobilization and likewise in the following weeks
of the concentration and training of troops, the crowds of recruits, reservists
and Landsturm men filled the brothel streets, while lightly wounded and con-
valescent men had themselves driven in cabs and autos to the brothel.
At the entrance to the brothel streets our sailors could be seen standing elbow
to elbow in hundreds and even thousands. Reports from young Christian non-
commissioned officers and soldiers have corroborated my vision.
A minister who in his metropolitan district is very much distressed
because of the existence of the brothel evil which is suffered, not to say
encouraged, by the municipal authorities, writes as follows: —
Conditions are worse than ever in the two brothel streets, particularly when
the saloons are closed in the evening or when new troops are recruited. In one
hour on a Saturday evening 397 men and on the following Sunday 450 men were
counted who turned into these streets. That certainly tends to decrease our con-
fidence in the happy issue of the war. But it is even more depressing to see
wounded men entering or leaving the wicked houses. The command has been
issued prohibiting the visiting of these places, but it is not enforced. The
answer to all requests to the city authorities and to the quarters of high com-
mand is always: "We cannot close the immoral streets because of sanitary
considerations (!!)" and empty promises are made to prevent excesses in future.
(Here is the sore spot : the tolerance of the authorities toward sexual
excesses. A terrible mistake even in peace times, it becomes a menace
in times of war. The only means of saving the situation is to close all
public places of immorality and prohibit to our troops all intercourse
with prostitutes of any kind. — ED.) — Der Abolitionist, April, 1915.
572 SOCIAL HYGIENE
MILITARY MEASURES AGAINST THE TREATMENT OF
VENEREAL DISEASES BY CHARLATANS
The continued acceptance and publication of impure advertise-
ments of quacks and persons making a business of "curing" venereal
diseases has caused the commander-in-chief in the border districts to
call attention to the public danger of such advertisements and to forbid
their publication.
All newspapers appearing in the city of Berlin and the province of
Brandenburg are hereby forbidden to accept and publish advertise-
ments in which: —
1. Persons offer to treat diseases or ailments known as venereal
diseases, including the conditions following them.
2. Objects or method of treatment are recommended which are sup-
posed to serve for the relief or healing of such diseases.
This order does not apply to advertisements of duly approved
physicians.
Berlin, November 23, 1914
The commander-in-chief in the border districts
[SIGNED] VON KESSEL, General-Oberst (Major-General).
DECREES OF THE BERLIN CHIEF-OF-POLICE,
AUGUST, 1914
1. It is expected that shortly soldiers will be quartered in Berlin
and vicinity. In the interest of public health it is therefore urgently
ordered that all means be taken to restrain prostitution. The execu-
tive officers of the national police district of Berlin have received orders
to keep particularly close watch upon registered prostitutes and all
females suspected of professional licentiousness. Incidentally they
are to watch those females who conduct themselves after the manner of
prostitutes in public places (streets, halls, etc.) so openly and provok-
ingly as to offend the moral feelings of their fellow-citizens. In future
all such persons shall without consideration and without regard for
person be arrested and given over to the proper authorities for tempo-
rary imprisonment and eventual infliction of probationary supervision
by the "morals police." Considering the intellectual level of the
metropolitan population, full understanding of the fact can be counted
upon that in such serious war times when the defensive power and
THE WAR AND VENEREAL DISEASES IN GERMANY 573
capacity of the nation is the highest consideration, extraordinary meas-
ures must be taken.
2. The present exigencies of war-time demand in the interest of pub-
lic health and public order a particularly energetic combating of the
dangers of prostitution. I have therefore directed my executive officers
to attack the system of prostitution without mercy. The registered
prostitutes have been forbidden by me to enter any public halls or inns.
Appreciation of this order on the part of proprietors is counted upon
and it is expected that they for their part will supplement the activity
of the officials and under no circumstances allow prostitution to show
itself in their places in any form. Should this appeal to the moral
sense and public spirit of the proprietors fail of its effect, I shall be
forced against my wish to use special police measures. This order has
been printed on white cards and posted visibly in all halls, cafe's, and
hotels in Greater Berlin.
3. The so-called Animierkneipen, which are considered by most inn-
keepers the plague-spot of their business, are hereby ordered to dis-
charge all their waitresses and buffet-mamsells within twenty-four
hours. Otherwise these places will have to be closed. About seven
hundred places of this kind, generally distinguished by a red lamp,
come into consideration. It is understood that this order is not di-
rected against inns in which (as in South Germany) women are em-
ployed, nor against the female employes of the large restaurants and
cafe's.
(Similar orders were issued in all the larger German cities. Every-
where at the time of the passage of our troops and recruits all brothels
were closed; registered and secret prostitutes, the latter on their way
from their rounds, were rounded up and held, and so our soldiers to a
great extent escaped the possibility of infection. — Sexualprobleme,
September, 1914-}
OVER FOUR HUNDRED ANIMIERKNEIPEN CLOSED!
The prohibitive order of the Berlin Chief-of-police concerning the
employment of female help in the Animierkneipen has resulted in the
extinguishment of something like four hundred of the familiar red or
blue lanterns.
Since the female service here has ceased and also because of the
hard times, the company resorting to these places became constantly
574 SOCIAL HYGIENE
smaller and smaller, so that many of them thought it best to suspend
business. The number of waitresses out of employ as a result of the
law is figured at approximately a thousand. Close police observation
prevents circumvention of the law by the employment of the former
waitresses as "female companions." This has been frequently at-
tempted, but the landlords and landladies concerned were strictly
cautioned against continuing the practice. — Sexualprobleme, November,
1914.
BOOK REVIEWS
THE PHYSICAL BASIS OF SOCIETY. By Carl Kelsey. New York:
D. Appleton and Company. 1916. 406 p. $2.00.
This volume is in purpose and in effect a collection of facts bearing
upon sociology, to be used as introductory material for a course in
sociology. They are loosely organized in themselves and theoretical
interpretation of them is almost wholly lacking. For a course in sociol-
ogy or even for the preliminary basis of such a course, there is over-
emphasis, perhaps, on detail, notably in the chapter on Control of
Nature.
As is to be expected under such a title, the book begins with a chap-
ter of facts concerning Earth and Man, goes on through Mutual Aid, and
Struggle for Existence, Control of Nature, Evolution of Man, Heredity
and Society, Race Differences, Sex Differences, Influences of Society
upon Population — and ends with the two chapters, Social Institutions
and the Nature of Progress. The least valuable chapters from the stand-
point of comprehensiveness and workable theory are the last two on
Social Institutions and the Nature of Progress. Chapter III, Control
of Nature, is a very valuable summary of a mass of details in the three
fields, physical materials, food plants and domestic animals, and
disease. The section on control of disease does not deal at all with
venereal disease except for a mention of Ehrlich's 606 as an example
of the use of a specific in the warfare against disease.
In the chapter on Sex Differences, although some of the recent
material which seems to signify the necessity for a revamping of our
older notions of sex differences is admitted, yet on the whole, the
Ellis-Thomas view is held to: that man consumes energy more rapidly
than women, is more variable, better fitted for feats of strength and
bursts of energy than women. What this problem needs is accurate
investigation of such matters as Katabolism in individuals of the two
sexes, doing similar or identical work, living under similar conditions,
eating and exercising alike in quantity and kind.
F. F. B.
575
576 SOCIAL HYGIENE
MENTAL CONFLICTS AND MISCONDUCT. By William Healy. Boston:
Little, Brown and Company, 1917. 330 p. $2.50.
No longer is it a mere hypothesis or an experimental assumption
that in some individuals undesirable conduct is fundamentally path-
ological. This volume, a distinct contribution to the psychology and
pathology of anti-social behavior, is a case-book covering a wide range
of clinical types of misconduct, profitable alike to the experienced
worker with delinquents, to the investigator orienting himself in the
technique of the subject, and to the parent or teacher who is called
upon to deal with misdoers. It furnishes us an intensive study of
that type of misdemeanor whose causation is to be found in mental
conflicts originating in certain prior experiences and resistance to them.
The author's penetration into the dynamics of the problem has
brought to light the following general principles, briefly stated: (1)
The existence of an irresistible, impelling drive toward behavior in
direct variance with the conscious wishes and desires of the wrong-
doer. (2) A direct relation between emotion-provoking experiences
of childhood and delinquencies of adolescence or even major offenses
of adult life. (3) Much delinquency arising from repressed emotional
disturbances centering about sex experiences and ideas. (4) The
efficacy of mental analysis in liberating and diverting energy stored
up in such complexes. (5) The application of this method to problems
of abnormal social attitudes and disordered behavior, but its necessary
inapplicability to cases of constitutional inferiority, toxic or traumatic
abnormalities, mental aberration consequent upon disease, or to adoles-
cents of hypersexual tendencies.
Chapter III discusses methods of therapeutics and prophylaxis of
mental conflicts. Exploration into the genetics of the difficulty is
useless without reeducation, and prevention is impossible without
changing the character of instruction. No reader of the case histories
here presented can avoid the conclusion that frankness between parents
and children is most emphatically called for. Conflicts arising from
illicit sexual experience, secret sex knowledge, or the shock of unsus-
pected information covering facts of parents' identity are clearly
shown by analysis and confession to result in stealing, running away,
exhibitionism, destructiveness, sadism, masochism, poisoning, and
other vicious offenses.
The concluding chapter affords terse answers to questions on the
significance of a variety of factors in the genesis of mental conflict.
BOOK REVIEWS 577
The author is convinced that neurotic symptoms are not ordinarily
present in cases of misbehavior, that inherited predisposition is not
indicated by the histories, nor are the offenders of the "shut-in" type
of attitude. They do, however, seem to be hypersensitive and of
more than average intellectual ability. With such, the substitution
of new interests, and establishment of new ways of reacting to certain
stimuli, proves most gratifying.
A thoroughly, satisfying impression derived from the book is the
candid open-mindedness of the writer, his judicious survey of psycho-
analysis and his rational independence of any one dogmatic school of
thought.
M. C. G.
Columbia University.
THE SEXES IN SCIENCE AND HISTORY. By Eliza Burt Gamble. New
York: Putnam, 1916. 407 p. $1.50
This book contains much interesting information concerning prim-
itive customs governing the relations of the sexes. Its main conten-
tion, that woman is the equal of man, is supported by some of the best
recent scientific opinions, although the author seems unaware of that
fact. There is a tone of controversy, as well as of sex antagonism
throughout the book, which makes it sometimes unpleasant reading
to the lover of justice. The achievements of men are held as of little
real value, being purely materialistic, and thus, owing to the ascendency
of the male since history began, the present time is made to appear as
one of great degeneracy, the remedy for which will be found in an
overturning of society in which marriage as we know it, will be abol-
ished and woman's instinctive altruism will inaugurate an era of pure
morals. In this new time that is coming, only robust women will
attempt to bear children, and men will return to the innocence of
primitive times by submitting to the will of the women in sex relation-
ships, as it is known that the males of lower species always do with
their females.
This is a long look ahead, yet there are men today advocating some
such return, without underestimating the peculiar excellences of their
own sex or the necessity of the struggle for existence represented by male
egoism, before the larger altruistic outlook could become possible for
either men or women. Certainly none of them would concede Mrs.
Gamble's claim that woman has an exclusive monopoly of the pro-
gressive principle and all the altruism.
578 SOCIAL HYGIENE
In regard to the character of society under the matriarchate, a
return to which is recommended, Mrs. Gamble is strangely inconsis-
tent. At times she calls this order a "gynecocracy," declaring that
woman was then supreme, and at others she is equally emphatic in
her claim that the matriarchal government was a pure democracy,
in which altruism and brotherhood were the dominant characteristics
and class rule was unknown.
Similar inconsistencies mar the discussion of other matters, and
occasionally facts which would invalidate the argument are ignored,
rendering the book an unreliable guide. Nevertheless it is an interest-
ing work and stimulating to thought.
H. B. B.
RATIONAL SEX ETHICS. By W. F. Robie. Boston: Badger Press,
1916. 356 p. $3.50.
Though finding many things to approve in this book, the present
reviewer must regard it in some respects as neither rational nor ethical,
only amazingly sexual.
Among the commendable features are the following : the recognition
of the grave social menace of venereal diseases; the rejection of all
forms of promiscuous intercourse; the importance of preparing chil-
dren for adolescence and parenthood; the value of modern religion in
meeting the issue; the avoidance of the coitus interruptus in marital
relations; the importance of advising individuals rather than lecturing
to audiences; and the rejection of all quack literature and remedies.
Highly objectionable is the permission of "auto-erethism" (i.e.,
masturbation), the vulgar frankness with which details of the sex
life are presented, and the method of arriving at the so-called ethical
conclusions.
One of a dozen statements concerning auto-erethism is: "If the
patients were married the problem was settled, if single or widowed, a
solution was found by removing the stigma of sin, vice, or immorality
from occasional auto-erotic relief when attempts at sublimation were
inadequate" (p. 271).
If I quoted passages to prove the obscene character of the book,
which prints in minutest detail the erotic confessions of normal and
abnormal men and women, it would not be proper for this magazine
to circulate through the mails. Never has my mind had such a prurient
bath, and I have heard Forel lecture and read Krafft-Ebing. First, I
BOOK REVIEWS 579
regretted having agreed to review the book, and then that I could not
review it without first reading it.
The method of arriving at the result that masturbation is not in-
jurious is that the middle-class persons, selected for their virtue, who
answered a questionnaire, admitted the practice but denied any in-
jurious effects. Did they not then lose self-respect? Were they not
uncomfortable in the presence of the opposite sex? Did they not ex-
pend the vital fluid that the physical system would largely have ab-
sorbed? Did they not stimulate unnaturally the secretion of semen
by mental masturbation before the act? What would a masturbator
call an injurious effect? And this in the name of biological and Spen-
cerian ethics !
The ideal method is also the best; absolute continence until mar-
riage, involving purity of act, word, and thought. Impurity of thought
is weakness in the central citadel of the soul. There is no sex necessity,
say many reputable physicians, including Professor Howell at Johns
Hopkins. If not, permission to defile soul and body is neither rational,
nor ethical; not rational, for the reason, by re-directing attention,
should control instinct; not ethical, for self -defilement is against con-
science. Right physical and mental regimen reduces surplus semen
to a minimum, and this surplus finds nature's relief in sleep, when, as
Hawthorne says, the conscience sleeps.
The author was born in 1866. The preface was written at 43 (1909),
yet for some reason the book was not published till 1916. The author
is a physician, superintendent of Pine Terrace, and is one of President
G. Stanley Hall's pupils. He uses and approves Freudianism, in a
modified form. Woman suffrage is rejected as inimical to woman's
function. The book is loosely and unsystematically written. On
page 325, line 2, "peform" appears instead of "perform." Man is
here presented not so much a rational animal capable of self-control
with a sense of right to be respected at all costs, but a kind of barn-
yard cock with one hen, without respect even for the period of gestation.
H. H. H.
New York University.
THE MASTER PROBLEM. By James Marchant. New York: Moffat,
Yard and Company, 1917. 371 p. $2.00.
The Master Problem is a survey of the social evil in its manifold
aspects. The author has drawn copiously upon recent investigations
and studies for his facts and conclusions. Not the least among these
580 SOCIAL HYGIENE
have been the reports of recent vice investigations in the United States.
The author has also availed himself of the publications of the Bureau of
Social Hygiene, and to Mr. Flexner's study of prostitution in Europe
and especially to his discussions of the problem of regulation, he is
indebted for much of the solid material he presents.
The book is divided into six parts. The first, entitled "The Situa-
tion Abroad," is a digest of reports presenting the extent of the traffic
in the United States and South America. Reliable statistics are not
presented for the Far East, but the author quotes various extracts
descriptive of the life of the prostitute in China, Japan, and the Indies.
Unfortunately the features that really differentiate the forms that
prostitution takes in the west and in the east are inadequately presented.
Regulation is discussed in parts two and three, but nothing new is
added to the subject. The author describes briefly conditions in
Europe, including Great Britain, but does not succeed in presenting
clearly the situation which actually exists in the countries, such as
France and Germany, where nominal regulation is in vogue, and in the
Scandanavian countries, in which a policy of repression, aiming towards
abolition, is pursued. Some historical matter is introduced relative to
the activities of Mrs. Josephine Butler and Mr. W. T. Stead in England,
but the whole subject is presented in an unattractive manner and one
is tempted to assume that the author has included much material
merely to add to the bulk of the volume.
Part four is on the whole the most satisfactory section of the book. It
summarizes, in a brief manner available to the busy reader, recent leg-
islative activity dealing with the social evil and summarizes in con-
venient form the legislation of Europe and America.
In part five, the author discusses the causes predisposing to vice.
He attempts to combat the idea of economic necessity as a spur to
prostitution, but his refutation is no more convincing than is the claim
of the advocates of' this theory. In a very casual manner, he dis-
cusses the effect of pornographic literature, etc., upon social conceptions
of morality, but the biological and psychological factors that enter into
the problem have escaped him entirely. In the last chapter of this
part the preventive and rescue work of individuals, private organiza-
tions, and reformatories are discussed, and a plea is made for higher
standards of morality in the individual.
In part six, the author grapples with the problems of the declining
birth rate and the changing conception of the status of the family.
These have a very important, though indirect, relation to the problems
BOOK REVIEWS 581
discussed in the previous pages, but Mr. Marchant views them from
the. religious standpoint, and not in the scientific manner which dis-
tinguishes the research of modern social workers.
On the whole, the book adds little of value to the literature on
prostitution, for it lacks the patient investigation and scientific treat-
ment which are found in the more recent books on the subject and marks
a return to the undesirable sentimental method of viewing the problem.
The absence of an index is a serious handicap to the earnest reader.
B. M;
THE SEXUAL CRISIS: A CRITIQUE OF OUR SEX LIFE. By Grete
Meisel-Hess. New York: Critic and Guide Company, 1917.
345 p. $3.00.
Dr. Meisel-Hess was reared in the conservative middle-class atmos-
phere of a German educational institution but later, in the freer thought
of Berlin, suffered a somewhat violent reaction. This is evident in
her presentation of The Sexual Crisis. The book, however, is a re-
markably incisive analysis of the underlying problems of sex. Al-
though the reform measures which she advocates may seem, to those
acquainted with the problems at first hand, too radical, nevertheless
the careful consideration and lofty idealism exhibited throughout make
the book a contribution worthy of note. It must be remembered, too,
that the book is more of a protest than a carefully considered plan of
reform.
The author presents clearly the difficulties of the sexual life of our
time, and paints a vivid picture of the shortcomings of marriage as it
exists. The marriageable age is being pushed forward further and
further. The healthiest and highest types of individuals, through
economic pressure, tend less and less to propagate their kind, while
drunkards, syphilitics, and defectives are allowed to marry without
being obliged to disclose the infirmity. The wealthy find ways of
preventing offspring while the poor continue to multiply in abun-
dance. Our present sexual order produces misery, disease, and prosti-
tution on the one hand, and total sexual starvation, neurasthenia, and
perversion on the other.
The author's treatment of the double standard of morals, sexual
hypocrisy and lies, perversion of love in prostitution, and the intense
sexual misery all around us is well worth reading and pondering. Those
of us who hold that the marriage institution must not only be preserved
at all costs, but that no form of sexual life outside of it can be counte-
582 SOCIAL HYGIENE
nanced by society, must at least take these shortcomings into considera-
tion and present an adequate program for the attainment of a rational
sex life within marriage and the proper preparation and control pre-
ceding it, before we can give an unequivocal answer to Dr. Meisel-
Hess's contentions.
Furthermore, the author is not endeavoring to destroy the marriage
institution itself. On the contrary she says very emphatically that
"marriage as the permanent sexual association of one man and one
woman. ... is and must remain the ideal." She is simply
protesting against existing evils and offers some valuable remedial
suggestions. We agree with her that more emphasis should be placed
on eugenic marriages, that practical measures should be found to help
woman attain to a greater freedom of choice, that some sort of mother-
hood protection (endowment or insurance) should be provided, and
that men and women should learn to enter the marriage relation with
higher motives than are too often manifest today.
But all these suggestions and many others are already being worked
out through the social hygiene movement without giving sanction to
sexual relations outside of marriage.
J. R. M.
CIVILIZATION AND WOMANHOOD. By Harriet B. Bradbury. (Present
Day Problem Series.) Boston: Richard G. Badger, 1916. 229 p.
$1.00.
This book is introduced to us as one treating of the condition of
women in all the greatest civilizations, going back briefly to those pre-
historic times of which our knowledge is chiefly by inference, and
tracing human development in this connection down to the present
time, with its unsolved problems and its forward look. The central
thought of the book may be said to be the natural evolution of all the
finest phases of civilization from those primitive affections growing out
of family relationships, the importance, consequently, of a lofty con-
ception of home life, the sex relation, friendship and social ties, and the
inevitable connection between religous thought and social judgments.
It traces the effect upon woman's character and the home of the re-
ligious ideals of Buddhism, of Confucianism, of Mohammedanism, and
of the various forms under which Christianity has appeared through
the Christian centuries. It shows the disintegrating effect of contempt
for woman and the enlarged possibilities in social evolution where
woman is so free and so respected that she can engage in business and
BOOK REVIEWS 583
all other activities on an equality with man. And the author makes
the statement that "the home life, whatever its character, determines
the character and accordingly the progress or the stagnation of a race,"
and it is to elucidate this principle that Civilization and Womanhood
has been written.
It is an ambitious task which has been undertaken, and we ques-
tion whether in setting forth her ideas to the public the author has
done justice to her subject.
The historical chapters contain a good deal of interesting material.
Throughout the book a great variety of topics is discussed. Although
scientific aspects of many social problems are touched upon, one
does not get the impression of any really fundamental grasp of the sub-
ject on the writer's part. On many debatable questions her statements
are dogmatic and largely an expression of personal opinion, often of
a sentimental kind. The repeated use of the word "physicist,"
apparently to indicate a practitioner of medicine, appears to us
objectionable.
With the main conclusions of the author regarding our present prob-
lems of the evolution of women in the home and in the larger life of the
community, we are heartily in accord. They appear to us liberal and
sane, and they sound a needed note of warning concerning those
dangers which may be lurking in the future, dangers economic and
dangers physical, a heritage from mistakes in our social customs re-
garding women. S. D. H. D.
WOMAN: HER SEX AND LOVE LIFE. By William J. Robinson, M.D.
New York: Critic and Guide Co., 1917. 411 p. $3.00.
"The task I have put before myself in this book," says the author,
"is to give our girls and women sane, square, and honest information
about their sex organs and sex nature, information absolutely free from
luridness, on the one hand, and maudlin sentimentality on the other."
In reading the book one cannot help being impressed with his sincerity;
and, from the viewpoint of the psycho-pathologist and physician, he
has probably succeeded in his intention. Such commelit and criticism
as the reviewer makes will be from the point of view of the intended
consumer, a married woman without pretense to special scientific
training in this field.
There are many things which commend the book to the careful con-
sideration of women. Dr. Robinson realizes the harmfulness of sex
misinformation; and he is right in emphasizing the greater importance
584 SOCIAL HYGIENE
of proper information for woman, because her sex life involves greater
"social, economic, and physical consequences."
He has to an unusual degree been able to make comprehensible to the
average woman the terminology of his subject, through simple defini-
tions and illuminating examples. In his presentation of a subject he
begins with the normal and then adds the variants. Moreover he is
thoroughly concise and loses no time in getting right to the questions
that are in the average woman's mind. He interprets well the infor-
mation which she requires. For instance his chapter on "Who may
marry" is a remarkably complete and simple presentation of a diffi-
cult problem. His description of the anatomy of the sex organs is
admirable in its clearness and in its scientific and unsentimental spirit.
In discussing intercourse and its accompanying problems, Dr. Rob-
inson writes entirely from the standpoint of the medical practitioner
and the man. He considers it his mission to destroy error, mysticism,
and superstition, and so far as utter frankness ahd truthful presenta-
tion of his own viewpoint are concerned, he succeeds. It is not incon-
ceivable, however, that women, as such, have something to contribute
to the discussion.
The chapter of advice to girls in which he gives them to understand
the risks they assume in entering into illicit relations might be read
by any girl of maturing or matured age because of its earnestness,
soundness, and wisdom. But when he deals with the subject of intra-
marital intercourse he does not reckon fully with the aesthetic reactions
of woman or with her intellectual and spiritual demands and increasing
independence.
With regard to what he considers the normal expression of the mari-
tal relation I have no objection to offer. From his wide and intimate
experience he doubtless is in a position to define normality. It is in
discussing the variants that the author seems to lack insight into the
woman's point of view. This is especially true of his attitude on the
problem of "frigid" women with whom he classes a quarter or a third
of all. women. To avoid the unhappiness that this might cause in
married life the author recommends that such a woman should deceive
her husband as to her real feelings.
It seems to be established that men as a sex are physically more
passionate than women by instinct or by social inheritance, and yet
even the passions of men are admittedly subject to fluctuation, or per-
haps better yet, express themselves in cycles. No one lives perma-
nently at the crest of the wave either spiritually or physically. If a
BOOK REVIEWS 585
marriage be based on fundamental intellectual and spiritual as well as
physical congeniality there should be no cause for alarm in the tempo-
rary ebb of physical passion in either husband or wife. In the chapter
. on the single standard of morality, the lack of a spiritual element is
obvious.
The chapter on race limitation deserves commendation. It is the
best discussion of its necessity that the reviewer has seen. The illus-
trations are varied and particularly well chosen.
One would be loth to put this book in the hands of a prospective wife
in spite of its many excellencies, because it is too pathological and too
exclusively physical in its approach. One seldom finds a girl, in
society, industry, or profession, who, when about to marry, does not
feel some spiritual expectancy, not necessarily sentimental. And no
one who does not understand and appreciate this spiritual appeal can
successfully write on "Woman: her sex and love life."
One serious fault is noticeable, affecting structure and style as well
as matter: the chapters, which are commendably short, though rather
boldly titled, are in several cases addressed to and written for differ-
ent readers. For example, the excellent style of painstaking defi-
nition in the chapters presumably for the uninformed girl, is abandoned
for the free use of technical and even Latin terms in chapters
for mature married persons, couples in danger of divorce, women at
the menopause. Pedagogically the book thus condenses and accen-
tuates the dangers found in sets of "sex books" supposed to be read at
successive ages. -This would not be so bad if it were not that oc-
casionally the advice given is inconsistent. To warn girls against
illicit relations and their penalties, and then more or less to condone
them in the unmarried male creates a dilemma. In a book containing
so many practical details, it is a surprise to find nothing said of the
emotional and physical effects of most modern dancing on girls or
boys — a more serious matter than many to which pages are devoted.
S. W. E.
MOTHERHOOD AND THE RELATIONSHIPS OF THE SEXES. By C. Gas-
quoine Hartley. New York: Dodd, Mead, and Company, 1917,
402 p. $2.50.
On starting to write this book, the author remarks, she found it
necessary to decide "whether the primary interest should rest in the
eternal instincts, passions, and typical character of womanhood, or in
586 SOCIAL HYGIENE
woman's actions and characters as affected by the unusual conditions
of the time" in which the work was undertaken. As she anticipated,
the decision was by no means a simple one, which probably accounts
for the alternating assurance and uncertainty in regard to the role of
women in society that dominate the work.
The book was written under the stress and strain of emotion pro-
duced by the present war which has given a tremendous impetus to the
gainful employment of women and has enlisted the services of many
who have carried on industrial and commercial pursuits without
pecuniary compensation. The author views this movement with
great apprehension. She sees it primarily in the light of the condemn-
ing facts of infant mortality and morbidity contained in recent official
reports. She reflects upon it from the standpoint of a society in which
for some years to come women will far outnumber men. Her con-
clusions, briefly stated, are a plea for a restricted separation of function
for men and women, whereby men shall be primarily breadwinners and
incidentally fathers, and women shall be primarily mothers and inci-
dentally nothing else.
In line with this view the author makes a perfectly consistent argu-
ment for the removal of the stigma from illegitimate children, and
for the open approval of "irregular" sex relations. While we are to
continue to hold monogamic marriage as the highest and most desirable
form of parentage, the quality of motherhood is after all the most
important thing, and motherhood of a high order is not incompatible
with polygamy.
The book is divided into five parts consisting of an introduction
dealing with the position of women before and during the war. This
is followed by a review of "the maternal instinct in the making,"
which is concerned with parenthood among insects, beasts, and birds.
Then comes a series of chapters on the mother in the human family,
primitive and modern. The closing part contains three chapters on
sex education. The plea in the later chapters for greater frankness
in sex relationships and for a more wholesome and healthier attitude
toward sex is by far the strongest part of the book.
Intermingled with it is much that will make the more progressive
students of the sex problem extremely impatient. They will rightly
think we have long passed the time when a woman of the author's
standing can talk seriously of self-sacrifice as the "supreme joy and
privilege of the female." They will ask practical and troublesome
questions of one who looks for "a regeneration of woman's instincts
BOOK REVIEWS 587
through consciousness." They will not be satisfied with being told
that "woman is the keeper of redemption" and "it is her work to lead
man back to the gate of his being." Such phrases indicate fairly the
vague, somewhat mystical quality of the author's approach to the
problem of the position of women. On the whole it is distinctly re-
actionary as regards the way by which we are to advance to "a sane,
complete, and profitable life" for men and women.
E. J. H.
THE HEALTHY MARRIAGE. By G. T. Wrench, M.D. New York:
Hoeber; 1917. 298 p. $1.50.
Viewed from the layman's standpoint this book may have value
in its detailed explanation of the marriage relation, its difficulties, and
opportunities, and in the emphasis on the normality of the process of
child-bearing. It is, however, verbose and full of unnecessary dis-
cussion of details not connected with the subject — such as electric
light, advertisement in dress and personal arts, amusement, and em-
ployment. Dr. Wrench's views on the proper occupations for women
are certainly not adapted to the need of the woman of the present day
whose intelligence will resent his suggestion that the greatest degree
of inspiration and satisfaction may be found in needlework, even
though its results be ugly, because of the pleasure and pride which a
women will take in her own handiwork as an expression of personality.
Women have developed so many channels for the expression of per-
sonality in which mental effort and spiritual growth are involved
that it is difficult to imagine a return to the needlework of covering
cushions for her drawing room as a means of development.
A description of what the nurse and physician may or may not do
at the time of childbirth seems unnecessary and tiresome. The con-
demnation of the use of alcohol at the time of marriage and during
pregnancy is timely, but one wishes to eliminate the chapter expressing
the opinion that alcohol in moderate quantities is defensible. The
writer, after stating the objections to moderate use of alcohol of such
men as Forel and Professor Kraepelin, states that he is inclined to
agree with Matthew Arnold that "wine used in moderation seems to
add to the agreeableness of life — for adults at any rate — and whatever
adds to the agreeableness of life adds to its resources and powers."
Prostitution and alcoholism alike exist through their seeming power
to add to the agreeableness of life but it surely cannot be said that
they add to its resources and powers.
588 SOCIAL HYGIENE
Altogether the writer has contributed a few practical suggestions
enmeshed in a labyrinth of elaborate and tiresome detail the value of
which is open to question. The book is not suited to the needs of
American men and women in search of practical and direct truth.
V. H. P.
•THE SEXUAL DISABILITIES OF MAN AND THEIR TREATMENT AND
PREVENTION. By Arthur Cooper. New York: Hoeber, 1916.
Third Edition, 227 p. $2.50.
Based on the observation and experience of the author's years of
practice as a physician and surgeon, this little book is intended for the
use of the "student who becomes a practitioner with little knowledge
of matters which receive but scanty attention in the medical schools."
But the layman, seeking information along this line, will find the book
equally valuable because of its non-technical language and practical
teachings.
The third edition has been enlarged by the addition of several chap-
ters on "The Prevention of Sexual Disability," including one on vene-
real diseases. This is too brief to be very satisfactory, and lays little
emphasis on the importance of continence in young men which, aside
from its moral value, is the greatest safeguard against the infection of
venereal diseases.
J. F. M.
THE STUDY OF THE BEHAVIOR OF AN INDIVIDUAL CHILD; SYLLABUS
AND BIBLIOGRAPHY. By John T. McManis. Baltimore: War-
wick and York, Inc., 1916. 54 p. $.75.
Man has always been interested in the processes of growth and de-
velopment, whether it be the development of a written language from
the simplest picture symbols, or the growth of the acorn into an oak.
Much time and study has been spent upon the evolution of races'
and of species, perhaps because examples of such evolution are com-
paratively few but the development of individuals is so commonplace
that we are only beginning to see that this too is a phenomenon worthy
of study and that "the development of a human being, of a personality,
from a germ cell is the climax of all wonders, greater even than that
involved in the evolution of a species or in the making of a world."
Realizing how important it is for a teacher to recognize the stages
of this development and the bearing of a child's heredity and environ-
ment upon his actions, Professor McManis has prepared this outline
BOOK EEVIEWS 589
for the use of his classes, to encourage them in the study of individual
children rather than imaginary cases.
Under the various topics of study, which include physical and home
conditions, mental ability, plays, instinctive and group activities,
motor ability, and moral characteristics, the author has given a brief
explanation of what is to be covered by that particular topic and of
its relations to child life in general, and has supplemented this by
suggestive questions and a short bibliography.
Although the student is expected to be accurate and scientific in
his investigations, great emphasis is laid upon the sympathetic relation-
ship that must exist between the student and the child if the desired
results are to be obtained. "By way of caution," says the author
in the chapter on "Outside Interests and Activities of the Child," "re-
member that if you are to keep friendship between yourself and the
child uppermost, you will need to respect most fully his rights in such
matters as companionship; but on the other hand, the closer and more
frank and honest you are with him, the more valuable will be your
insight into his realm of confidence and intimacies. He will quite
readily discuss important matters with people he trusts."
The study is an interesting attempt to combine the methods of the
scientist with the spirit of the child lover and should prove a help to
all who are trying to improve the conditions of children through a real
understanding of their needs.
J. F. M.
NOTE AND COMMENT
Moral Conditions on the Streets of London. Experience is a most
thorough yet harsh teacher. In the present war our government is
avoiding many of the difficulties encountered by the other nations at
war by profiting by their bitter experiences. As an example, it is
interesting to note that London is now wrestling with the problem
which we, through the Commission on Training Camp Activities,
hope to forestall by measures directed toward promoting sobriety,
abolishing the temptations of vice, and substituting wholesome recrea-
tion and constructive education.
There was held on June 27th in London a meeting under the chair-
manship of the Rt. Hon. and Rt. Rev. The Lord Bishop of London
for the purpose of discussing "The Moral Conditions of the Streets
of London." A pamphlet distributed to those who attended, set
forth the attitude of the National Vigilance Association under whose
auspices the conference was called.
From much of what has been written in the papers, and spoken on public
platforms, it would appear that London has since the war given alarming evi-
dence of moral degradation. In the opinion of the Association responsible for
organising this Conference such statements are exaggerated.
While the moral condition of London undoubtedly calls for the serious consid-
eration of all moral and social reformers, there is nothing of such an abnormal
character as to justify certain extreme statements which have been made; in most
instances in good faith, but on incorrect information. As an Association we
have tried impartially to investigate the matter with the result that we feel
that the condition of the streets of London is in reality better morally, than in
pre-war times We do not think further investigation is necessary.
The facts are only too well known. In our opinion the time has arrived for sin-
cere reformers to devote themselves to the consideration of remedies.
The Lord Bishop of London who opened the meeting called atten-
tion to the improved conditions of London in the past fifty years, and
especially commended the Royal Commission on Venereal Diseases
which has been attacking the problem from the medical angle. Men-
tion was also made of the good effects achieved through moral suasion
addressed to the better nature of the men in the ranks through educa-
tional lectures and other addresses. His suggestion that the penalties
590
NOTE AND COMMENT 591
imposed on the brothel keepers must be made more severe and strin-
gent was met with enthusiasm and it was urged that the temptations
and pitfalls engendered by the disreputable music halls be swept away.
But it was maintained that the most difficult question was that of
dealing with the thousands of girls in the streets. "Sir Edward Henry
has taken up 13,000 girls from the streets, and I believe he would say
that there has not been much good done by taking them up." To
help solve the problem women patrols were recommended and the
speaker agreed with Mr. Coote of the National Vigilance Association
in believing "that we ought to make it hotter for foreign souteneurs
who come over here and practice their calling. It is a monstrous
thing that we should allow London to become (as Mr. Coote says)
the moral dustheap of Europe."
Sir Edward Henry, K. C. B., Chief Commissioner of Police, offered
evidence that a searching investigation had been made as to the charge
"that overseas forces had become conspicuously disorderly, and that
much drunkenness and immorality were observable All
official statistics belie this statement — the general opinion being that
the restriction in the hours of sale and the prohibition of treating
have greatly promoted sobriety The statement which has
gained currency that this neighbourhood is characterised by the drunk-
enness and immorality of the persons resorting thereto, is an unjusti-
fiable exaggeration and has no foundation of fact to support it."
Clubs and recreation centers for men in khaki, where they assemble
with their fellows, as well as other convenient places where men and
girls may meet under proper and kindly supervision, were commended
not only as a war measure, but as a lasting benefit as well.
Lieutenant-General Sir Francis Lloyd denied that soldiers were not
being looked after while on furlough from the trenches and cited some
of the attempts being made to make the soldier comfortable. He
pointed out that during 1916, 1,169,655 men slept in beds that were
prepared for them; that there is an organized system of meeting the
men at railroad stations; that there are special institutions; also buffets
(canteens) for the men and that numerous clubs have generously
opened their doors to the men in uniform. "There is one point about
it which I may mention — the difficulty of coordinating voluntary serv-
ice. These services are being run by keen and enthusiastic people,
and it is sometimes difficult to coordinate them, although we are anxious
to do so." His denial of the charge of excessive and unusual drunken-
ness is equally emphatic and convincing though it was admitted that
592 SOCIAL HYGIENE
in a free country there was bound to be a certain percentage of men
who would not and could not be restrained from indulging their de-
sires for liquor and vice.
But I appeal to you that the soldier is not as bad as he is painted, and that
under the stress and great difficulty — because it is difficult when you have been
working in dirty wet trenches with bullets flying about, it is difficult when you
have been in training somewhere in Great Britain under very bad conditions,
as a civilian who is not used to knocking about — it is difficult to come to London
with all its pleasures and temptations, and if you are a virile soldier, not to
"have a go" of some sort. Remember that they are just human creatures.
We want to be "To their virtues ever kind, to their faults a little blind," and to
take the second view of those faults before one says "It is all evil." It is not
all evil; things are getting better; and the state of London is far better than it
was. And may it go on, and may it still get better and better.
When the Soldiers Come to Town. Mr. Elwood Street tells, in a
recent issue of The Survey, what is being done to meet the social prob-
lems arising in connection with the coming of soldiers for training to
three cities in South Carolina, — Charleston, which still holds to its
segregated district; Columbia, which has abolished its district by city
ordinance; and Spartanburg, where public sentiment has never toler-
ated a vice district. In each of these towns there is great activity on
the part of Y. M. C. A.'s, Y. W. C. A.'s, women's organizations, and
other agencies to provide for the recreation and welfare of the troops.
Spartanburg, in brief, expects the new army to be made up of normal, clean
young men, neither better nor worse than the average. It does not fear their
"virility." It rather suspects they will enjoy the same things the average young
man out of uniform enjoys, and it intends to provide those things just as far as
possible.
It remains, of course, to be seen whether cynical Charleston or dubious
Columbia or hopeful Spartanburg is right. Much depends on the cooperation of
the military authorities. South Carolina's pessimists point to their many
mulattoes and say Sherman's men on their triumphant march did their best to
"whiten the dark belt." The pessimists quote with remarkable consistency
stories of conditions on the Mexican border last year which would indicate an
interest of military authorities there in efficiency rather than morality. The
optimists point to the wholesome faces of the sailors on the streets of Charles-
ton and of the National Guardsmen mobilized in all three cities.
St. Louis Public Health League. A unique experiment of combining
the several forces laboring in the interests of public health, which prom-
ises great success, is being tried in St. Louis. Recognizing that in
union there is strength, eight agencies interested in the physical well-
NOTE AND COMMENT 593
being of the public of that city have combined or correlated their
efforts and have formed a clearing house known as the St. Louis Public
Health League. The individuality of each society is not disturbed,
but the league seeks to do that which the component societies could
not do alone.
For instance, a health exhibit has been prepared by the league,
each society supplying its unit. The placards are uniform in size,
workmanship, color, arrangement, etc., with just enough difference to
distinguish each unit from the others. The league is also distributing
at the places where the exhibit is displayed and among patients dis-
charged from some of the larger hospitals, a small envelope containing
a set of leaflets of different colors. Each component society has
supplied the text for its particular leaflet consisting mainly of in-
structions concerning the particular phase of public health in which it
is interested.
The league is financed by distributing the expense among the va-
rious organizations represented and a certain amount is paid into the
treasury by the various societies each month. While of recent origin,
the league is well under way and has under consideration a number of
plans which promise to be of great value. The component societies
making up the league are the following: St. Louis Tuberculosis Society;
Society for the Prevention of Cancer; Pre-natal Care and Social Service
Department of Washington University; Visiting Nurse Association;
Missouri Association for the Blind; Missouri State Social Hygiene
Society; and, in an advisory capacity, the St. Louis Medical Society
and St. Louis Health Department.
The advantages of this arrangement are: a closer affiliation of
public health organizations; the possibility of doing in combination
what could not well be done separately; no duplication or over-lap-
ping, but a correlation of effort; a decided saving of expense.
Training Camps must be Clean of Vice. — Sons and brothers are going
out of thousands of honorable and honored households of the United
States to give their services, their lives it may be, to the defence of the
nation. They are answering the nation's call. Already, and justly,
there rises from these households a demand that the nation, in return,
shall at the very least provide for these, its soldier boys, every possible
safeguard against the moral pitfalls that have proverbially beset the
pathway of the man-at-arms. It is none too early to arouse the
authorities to the need of safeguards of this sort In
594 SOCIAL HYGIENE
short, it is clear that the forces of immorality are seeking to intrench
themselves in or around every station or camp where the young men
who are going forth to serve their country are likely to be assembled
in any considerable numbers for instruction, for practice, or in actual
performance of duty.
Strange as it may seem, city and town authorities are not, as a rule,
alert to exercise their power of prevention in this situation. However
much local officials may have bestirred themselves to secure the taking
up of their district allotment of Liberty bonds, or to swell the contri-
butions to the Red Cross, too often they forgot their opportunity to
contribute to the support of the war by closing a resort or refusing a
license to some craftily placed saloon.
The same officials, who may be emphatic in their demand for sani-
tary conditions at military camps, are not always equally emphatic in
their willingness to insist on moral sanitation as one of the prerequisites.
Civilian bodies, women's clubs, and many medical or sanitary experts
are giving attention to this phase of the matter, and there are indica-
tions that the national government will not fail to act in cases where
the state and local authorities are derelict. But the demand for com-
plete extinguishment of immoral influence about camps or in the neigh-
borhood of military or naval stations should be taken up by every well-
meaning man or woman who has at heart the welfare of the country,
its soldiers and the great cause which they are now seeking to defend.
To see that the boys and men in the United States service have de-
cent surroundings while in camp or awaiting their call to positive ac-
tivity is only one way in which the non-combatant population of the
country can "do its bit" in the war; to assist, even passively, in giving
aid or comfort to the forces that would tend to demoralize the boys
who have come from their homes to offer themselves for the service of
their nation is little short of treachery to that nation, and should be
dealt with by those summary methods that are always in keeping with
war.
For war is the great adventure of this day and generation. The
nation that wages it should pause for no toleration and no quibbling
when the end to be achieved is efficiency, based on what is right.
The families that have given up their boys are no "slackers" in the
nation's hour of need. Shall the nation be a "slacker" in its response
to the demand of those families that their boys shall have proper moral
protection? — Providence, R. I., Tribune.
NOTE AND COMMENT 595
Camp Mothers and Policewomen in New York. Since August 1st,
New York City has been seeing what sort of work can be done by
women police officers.
When the soldiers and sailors began to be concentrated in large
numbers here, the Mayor's Committee of Women on National Defense
urged Police Commissioner Woods to appoint policewomen for the
further protection of young girls throughout the city. He agreed to a
trial of the plan, provided it were approved by the various social and
civic organizations of the city and by the War Department's Com-
mission on Training Camp Activities. The Mayor's Committee
promptly engaged two well-qualified women who were given the au-
thority of special patrolmen. The Evening Post thus summarizes their
first month's work: —
In August Mrs. Cook, in Brooklyn, interviewed 60 girls, sent 31 home, inter-
viewed 76 soldiers and sailors, reported one case to the police, reported 5 saloons
to the police, as well as one moving-picture house and one case of soliciting,
and patrolled 14 districts. The Navy Yard district was patrolled every day,
different hours of the day being chosen. Mrs. Douglass, in Manhattan, inter-
viewed 274 girls, sent 185 home, took home 27 girls, and reported 12 to social
agencies. She also interviewed 166 soldiers and sailors, and patrolled 47 districts.
Although having the power of arrest, neither of the two policewomen
has used it. Their work supplements that of the regular patrolman
who represents the majesty of the -law; their chief concern has been
prevention, rather than punishment and cure after offense. Weak
girls they have taken out of danger, exceptionally bad resorts they have
reported to the police; and they have helped both girls and men to
find wholesome recreation in each other's company and in proper
surroundings.
Their month of probation is now at an end, and upon their reports
will be based a request to the Police Department to include in the
budget for the coming year an appropriation for at least six police-
women.
" Letters urging this action have already been sent to Commissioner
Woods by the New York Probation and Protective Association, the
Committee of Fourteen, the Y. W. C. A., the American Social Hygiene
Association, the Church Mission of Help, the Association of Jewish
Women, the Association of Day Nurseries, the Association of Neigh-
borhood Workers, the Women's City Club, the New York Social
Hygiene Society, the People's Institute of New York, the Brooklyn
596 SOCIAL HYGIENE
Juvenile Probation Association, and the Fresh Air Federation. The
War Department Commission on Training Camp Activities also
urges the plan."
The interest of the press is further indicated by this editorial from
the Tribune: —
CAMP MOTHERS
Police Commissioner Woods could not do a better piece of war work than to
appoint women police officers to patrol parks, navy yards and armories, as urged
by the Mayor's Committee of Women on National Defence.
Such a measure is not unprecedented. Eighteen months ago England officially
appointed camp policewomen, after women volunteers had successfully demon-
strated that their services were invaluable. That immoral conditions will pre-
vail in army camps has long been an axiom of war, but England, first by "cor-
dially recognizing" the volunteer policewomen and then by appointing them as
officers, has raised the standard of her army life an appreciable degree.
There is no question that women officers can do this special protective and
preventive work better than the average policeman. Aside from any sentimental
generalizations about woman as a natural protector of the race, and apart from
superfeministic claims for her superiority over man in every capacity, experience
has shown that in this kind of work women are more successful than men.
"Camp mothers" have unlimited opportunity for good; "camp fathers" would
not get very far, one fears.
The Mayor's Committee of Women on National Defence has investigated for
New York City and has found that conditions among the soldiers and sailors and
young girls are far from ideal. They have demonstrated also that without
arrest, without publicity, many cases' of immorality can be prevented. New
York should have their services as part of the city administration.
The new city budget does not go into effect until January 1. Up
to that time the Mayor's Committee of Women will continue to pay
the salaries of these two officers who are #t present "showing" New
York.
The National Education Association, at its meeting in Portland,
Oregon, devoted two sessions, arranged by the American Social Hygiene
Association, to the consideration of social hygiene, one on "Sex Educa-
tion and the Public Schools" under the chairmanship of President
W. T. Foster, of Reed College, Portland, Oregon, and one on "The
Community and the Camp" at which Rt. Rev. Walter T. Sumner,
Bishop of Oregon, presided.
To this meeting Dr. Charles W. Eliot addressed the following letter: —
NOTE AND COMMENT 597
Asticou, Maine,
30 June, 1917.
The great war inevitably increases the destructiveness of the evils which the
social hygiene associations in this country have been combating for a few years
past. I have lately been told by a well-informed French national official that
tuberculosis, alcoholism, and venereal diseases are killing and disabling month
by month more French people than the actual fighting is killing and disabling.
Defense against tuberculosis is only an incidental part of the work of the social
hygiene associations. Their main object is to prevent the ruin which follows
upon sexual vice; but inasmuch as alcoholism and sexual vice are almost always
closely associated, social hygiene societies have found it necessary to contend
against both the saloon and the brothel, or in broader terms against the free sale
of alcoholic beverages and prostitution. Their means of attack on £hese wide-
spread evils are chiefly educational, by spreading information about them, and
stimulating public opinion to demand effective legislation against them.
The great war in which the United States has now joined with all its might in
defense of democracy and national liberties, and in support of the sanctity of
international contracts, inevitably increases the danger to the community from
alcoholism and venereal disease ; because it exposes multitudes of young men to
temptations which hardships and perils intensify, and the entire population to
infection from returning soldiers discharged from the armies because useless and
diseased. Hence the social hygiene associations should turn their attention
during the war to the protection of the soldiers summoned hastily from their
homes into training camps in this country, and into cantonments near the fight-
ing lines abroad. They should make immediate provision for giving instruction
to all the new levies through the Medical Corps, the agents of the Young Men's
Christian Associations, and their own employees, as to the far-reaching con-
sequences of both alcoholism and venereal disease, and for providing wholesome
means of comforting and refreshing the troops after hardships, nervous strain,
and intense fatigue. Under such terrible conditions many men are liable to
turn in their ignorance to alcohol as a restorer; and alcohol leads them into still
graver evils.
The social hygiene associations can also aid in maintaining the efficiency of
the American armies by advocating effective administration of effective laws
prohibiting the manufacture and sale of spirits. Indeed, several of the associa-
tions have already performed this duty.
The medical and sanitary authorities now welcome the cooperation of the
social hygiene associations on economic as well as moral grounds; and public
opinion is so thoroughly aroused to the necessity of preventive measures that
we may reasonably hope that the American armies, while on American soil, will
be better protected than armies have heretofore been in any part of the world.
By contributing in this fundamental way to the national defense the social
hygiene associations will gain strength to do their regular work better in peace
times.
'Instruction to Soldiers. In lesson number 7 of a series prepared by
the War Department and printed in the Official Bulletin for the benefit
598 SOCIAL HYGIENE
of men selected for service in the national army as a practical help in
getting started in the right way, it is pointed out that the soldier owes
it to himself and his country to keep in good health by observing rea-
sonable precautions and by avoiding excesses.
A part of the lesson deals with the questions of illicit sexual inter-
course and venereal disease: —
It is frequently assumed by well-meaning critics that illicit sexual intercourse
and venereal diseases are more common in the Army than in civil life. This is
probably a mistaken impression, due largely to the fact that statistics of these
diseases are- collected in the Army, whereas the corresponding figures for civilian
life are incomplete. In the new Army the evils of sexual immorality will be
reduced to a minimum. The men will find their time and energy so fully occu-
pied that they will have fewer temptations and dangers of this type than in
everyday civil life.
One of your obligations as a citizen-soldier is to conduct yourself in such a
way as to create and spread the true impression — namely, that the National
Army is made up of men too much in earnest in the great task assigned to them
to indulge in lewdness and vice.
The only sure safeguard against venereal disease is to avoid illicit intercourse.
A clean life is the best guarantee of sound health. To maintain a clean life,
keep away from those things which tend to promote sexual excitement and de-
sire, particularly obscene conversation, reading matter, and pictures.
The moral reasons which should impel every self-respecting man to avoid
debasing himself by sexual vice are well known to every man who joins the
National Army and need not be recounted here. In addition to the moral
reasons there rests upon every soldier the especial duty of avoiding everything
that may unfit him for active and effective service. This obligation in the
present crisis is even greater and more urgent than in normal times. The soldiers
of the National Army will be expected and required to maintain especially high
standards of conduct and to honor the uniform they are privileged to wear.
A Great Public Health Problem. There is perhaps no public health
problem more important or one more difficult of solution than
that of the control of venereal disease. Unlike other infections,
syphilis and gonorrhea are, in the public mind, inseparable from
sexual immorality, and, therefore, up to a very recent date, regarded
as wholly unsuitable for discussion except at medical meetings
and in scientific journals. Happily for the human race this attitude
of aloofness is now fast disappearing, largely as the result of public
health education conducted by a number of social hygiene organiza-
tions, and a few city and state departments of health. Thinking
persons are awakening to the fact that these two diseases, world-wide
in distribution, are daily causing so much domestic sorrow, illness, and
NOTE AND COMMENT 599
so many deaths, that the prudish plea of indelicacy can no longer be
tolerated as an excuse for failure to take action against their ever-
increasing spread. The ignorance of the public of the ravages of these
diseases, familiar to every physician of experience, is astonishing. . . .
The State Department of Health inaugurates an educational campaign
against the spread of these diseases, to the end that the people of the
state of New York shall have full knowledge of well-established facts,
and so order their lives and the lives of their girls and boys that the
victims of ignorance may be reduced to a minimum. The moral fac-
tors involved in this campaign must be left to other agencies, whose
cooperation the Department of Health gladly welcomes, while adhering
strictly to its proper function of suppressing disease, regardless of its
origin. — New York State Department of Health Monthly Bulletin.
Reporting of the Venereal Diseases in New Jersey. Public Health
News, the monthly bulletin of the Department of Health of the state
of New Jersey, in commenting upon the new law approved March 29,
1917, says in part: —
The act contains some novel provisions, the principal one being the require-
ment that these diseases be reported directly to the State Department of Health
instead of to local boards, to whom other communicable diseases are now re-
ported. It is probable that the reason for this requirement lay in the belief
that the records of names and addresses of these cases (which the State Depart-
ment is not permitted to divulge except to the prosecutors under certain condi-
tions) would be less likely to become public property than if they were reported
to the local boards
Few of the other contagious diseases have the possibilities of causing physi-
cal damage and mental affliction that these have, yet up to the present time
no adequate measures have been taken by this State to control or suppress
them. Now, however, the first step looking toward their control has been made.
In order that a disease may be successfully combatted its presence must be known.
This is a fundamental principle which has been found applicable to all the other
communicable diseases and it will be found applicable to gonorrhea and syphilis.
Cases which are unknown are dangerous to the public at large because they may
at any time infect others. Under intelligent supervision and treatment, the
danger of infecting others is markedly diminished. Of course, there is now and
then a sufferer from one or the other of these diseases whose conscience is so
dulled that he cannot be trusted not to infect others after he has been fully in-
formed of the danger of so doing, but the great majority of the sufferers
from these diseases, when fully informed regarding the danger of infecting
others, will take the. necessary precautions to prevent the spread of such
infection.
600 SOCIAL HYGIENE
The act also provides for free diagnostic service to reported cases and for
the furnishing of remedial agents at cost. The diagnostic service in the case
of smears from suspected cases of gonorrhoea has been furnished without cost
by the State Laboratory of Hygiene to physicians in the state for many years.
Complement fixation tests for gonorrhoea will be made in the near future, and
Wassermann tests for syphilis are now being made without charge when properly
collected specimens are sent by physicians from persons who are residents of this
state
Some delay will necessarily elapse before the Department is ready to furnish
the remedial agents provided for in the section above referred to
The Department is preparing circulars on these diseases for distribution by
physicians to their patients. It is of the utmost importance that persons affected
by these diseases shall have accurate and complete information regarding the
modes of transmission and the necessity for proper treatment. It is also of
great importance, if these diseases are to be controlled and if the information
obtained from reports of cases be fully utilized, that adequate provision be
made for the treatment of all cases by competent practitioners as long as such
treatment is necessary.
Provision should be made for clinics, at which free treatment can be had by
indigent cases of both sexes, under such conditions as will insure the return of
these cases to the clinics until discharged. Measures are also needed which
will prevent the treatment of these cases by quacks, and will also prevent the
sale of remedies advertised to cure them. Attempts at self treatment are com-
mon, and are dangerous because they are ineffective. It is vitally important,
if these diseases are to be cured, that they be properly treated in the earliest
stages and that treatment be continued until a cure is effected. This usually
takes much longer than the patient believes should be the case. These are all
subjects about which legislation should be had in the near future. A beginning
in the control of these diseases has been made. If the work is to be really effec-
tive, the present legislation requiring the reporting of these diseases should be
supplemented by statutory requirements regarding treatment.
Kansas Makes Venereal Diseases Notifiable. — The Health Depart-
ment of the State of Kansas has by authority of an act passed Febru-
ary 28, 1916, enacted rules and regulations for the control of communi-
cable diseases including gonorrhea and syphilis and declaring them to be
notifiable to the Department. The reports are to be made within
forty-eight hours after diagnosis on blank forms provided by the De-
partment and must include in addition to the serial number, "the type
and stage of such disease; the color; the sex; the marital state; and the
occupation of the person affected with the disease; and a statement as
to whether or not the nature of the occupation or place of employ-
ment of the person afflicted with such disease makes him or her a
menace to the health of any other person or persons." The name
and address of the patient are not reported.
NOTE AND COMMENT 601
It also becomes the duty of the medical attendant to give the patient
a circular of detailed instructions relating to his malady. Attached
to this circular is the notification blank and on both instruction and
notification blanks appear corresponding numbers.
Below is a reproduction of the card used in reporting cases of
syphilis.
GROUP II.
K? RETURN OF NOTIFIABLE DISEASE.
Date 191
Disease Type or stage „
Patient's age ; sex ; color ; married — single — widowed —
divorced. (Draw circle about word indicated.)
Occupation Is occupation or place of employment such as
will make patient a menace to the health of others? If so, what measures
are or have been advised? -
Date of onset. 191 Complicating diseases (such as
alcoholism, tuberculosis, etc.) „
Was diagnosis confirmed by laboratory finding? If so, which?
Did you give patient circular of instructions bearing above serial number?
Address of reporting physician
Signature of physician „
Tear off this slip. Instructions are to be given to patient.
(Name of patient not required. Report confidential. Mail to State Board of Health, Topeka, Kan.)
7-185
Syphilis in the Austrian Army. In a recent issue of the Wiener
Klinische Wochenschrift (XXIX, No. 51), Hecht, an Austrian army
surgeon, states that in his corps records are now kept of every man
with venereal disease, and a certain mark opposite the name of a man
on the register indicates that in no circumstances is he to be granted
home leave. This restriction of home leave had previously been en-
forced for typhoid carriers. Hecht adds that no one seems to class
the venereal diseases with infectious diseases, but he is convinced
that this neglect to apply the measures that have been found reliable
with other infectious diseases will avenge itself sooner or later. He
estimates that the number of syphilitics in the Austrian army now
must certainly be several hundreds of thousands, and complains that
they are being treated in hospitals, while sound and healthy men are
being shot down in their stead. This actually places a premium on
602 SOCIAL HYGIENE
*
sexual infection, for the healthy have no chance of a few months'
respite in the hospitals from the fighting. The effect likewise is to
spare the syphilitics while the sound get killed off. He makes the
very reasonable suggestion that the diagnosis should be the signal for
sending the man to the front. This would have a deterrent effect; at
present many prefer to take their chances with syphilis rather than
with the enemy's shells. Hecht thinks it might be possible to form
special companies of syphilitics as soon as the ulcers have healed over,
so that the treatment could be conveniently continued and applied
on the firing line, while infection of other troops would be prevented.
Neisser long insisted that courses of salvarsan and mercury could be
given perfectly well in the trenches. Hecht declares that it is im-
possible to reiterate too often the frightful danger for the populace
from syphilitics in the primary phase. Since the war began, a total
equivalent to sixty divisions have been temporarily withdrawn from the
fighting for venereal diseases. In conclusion, Hecht insists on the
necessity for enlightening the public in regard to the danger of venereal
disease in candidates for matrimony. — Medical Officer, London.
A South African Report on Venereal Disease. Under date of August
28, 1916, a special report by the Medical Officer of Health of Johannes-
burg on the prevention and treatment of venereal diseases was issued,
based in large part upon the work of the Royal Commission of Great
• Britain.
The prevalence of venereal diseases in Johannesburg, as well as else-
where, is difficult to ascertain and as the Medical Officer of Health says :
"No exact or even approximately accurate information is available,
and probably it is no greater than in other large centers of population
in the Union. But there is, nevertheless, reason to believe that this
prevalence is very real and alarming, and also that it is increasing,
especially amongst whites, partly because of the reluctance and tardi-
ness of sufferers to secure skilled treatment, and partly because suffi-
cient facilities have not hitherto existed either for diagnosis or treat-
ment Figures cannot be taken as even approximately
representing the prevalence of venereal disease in Johannesburg, partly
because many cases are treated by private medical men, many others,
as pointed out by the .Royal Commission, consult 'unqualified persons,'
and there are probably some (particularly syphilis) which, not being
recognized at an early stage, are entirely neglected."
NOTE AND COMMENT 603
Facilities for diagnosis and treatment at the time of making the
report were available but needed developing.
Under the old Volksraad Law No. 12 of 1895, Section 36, provision
is made that every contagious syphilitic shall "have himself treated
and healed by a doctor" as well as notification amongst colored per-
sons, monthly medical examination of colored persons, and for the pro-
vision of hospital accommodation for whites and colored.
Under the Transvaal Local Government Ordinance 1912, Section 72
(10), municipalities may make by-laws for preventing the outbreak and
spread of infectious and contagious disease, and for compelling the
segregation and treatment of sufferers therefrom in suitable hospitals.
The Medical Officer of Health very strongly recommends the de-
veloping of facilities and enforcing the methods under the existing laws
and believes "that the careful organization of well-considered scientific
measures against venereal disease should lead rapidly to a great reduc-
tion in the number of cases and a corresponding alleviation of untold
misery, and that our population may thereby soon be largely freed
from one of the greatest physical scourges with which humanity is
afflicted."
The recommendations are that the government guarantee 75 per
cent of the expenditure involved and that a comprehensive scheme
covering free diagnosis, free treatment by special clinics both for white
and colored out-patients and a relatively small but extensible number
of beds, free supply of remedies which will include not only salvarsan
but all other medication and supplies needed. He further recom-
mends a strong effort to obtain through the Medical Association the
full cooperation of the private medical practitioner, by encouraging
him to avail himself of the free diagnostic facilities of the laboratory
and the educational advantages of attendance at the clinic, as well as of
the- consultative services of the Medical Officer, by the gratuitous issue
of salvarsan to practitioners as indicated in the preceding paragraph,
and by advising well-to-do applicants for treatment to obtain it through
their own medical adviser, in consultation, if desired, with the Medical
Officer, and in the last recommendation he urges that the utmost
publicity be given to the facilities provided.
DR. FRANKLIN MARTIN, MAJOR M.R.C., MEDICAL MEMBER ADVISORY COMMISSION,
COUNCIL OF NATIONAL DEFENSE
Dr. Martin through the committees and sub-committees of the General Medical
Board is directing a nationwide campaign for informing the medical profession
of the government's program for combating the venereal diseases, and securing
the active cooperation of physicians in applying it to civil communities as a
national necessity.
604
SOCIAL HYGIENE AND THE WAR
FRANKLIN MARTIN
Member of the Advisory Commission, Council of National Defense
Some one has said this war is now being fought by the Euro-
pean nations with the salvage from the battle lines. This is
probably literally true in the sense that medical science
is promptly repairing and returning to the trenches enormous
numbers of men who in previous wars would have been per-
manently retired. It has also been said that if we do not succeed
in reducing the number of derelicts from this world war to the
lowest terms the civil life of the nations will be wrecked after
peace has been declared. This again is literally true because
the exhausted nations will be able to carry only a limited load
of non-producers. There is a third statement which may be
made — that America's influence on the outcome of the war will
depend largely on the physical efficiency of her men both abroad
and at home in her shops and fields. Summed up in terms of
medical administration these mean competent medical service
for the military forces, adequate provision for the rehabilitation
or reeducation of the crippled, and protection for the health of
the civil population.
These are problems for the physician and the sanitarian. If
success is to be achieved they must recognize that there are
enemies behind as well as in front of the army. The triple
alliance of alcohol, prostitution, and venereal diseases is one of
the most dangerous of these enemies behind the lines. A soldier
in the hospital with syphilis and one there because of a battle
wound are both out of the fighting and a drain on the nation's
resources, but the former is the more serious loss because his
illness was preventable and his acquiring of it did not register
a blow against the enemy before he fell. Furthermore he may
become a carrier of his disease to many others in the course of
years and be a lifelong burden to society.
605
606 SOCIAL HYGIENE
The man who through ignorance and the temptations of
commercialized prostitution becomes infected with venereal dis-
ease before he reaches the front, is a challenge to our effec-
tiveness and sincerity in preparing for this war; the man who
knowingly exposes himself to infection has failed in his duty as
a Soldier; the woman who yields to illicit sex relations is not as
loyal to her country as we have a right to expect her to be.
This is not a time for temporizing with abstract morals, nor on
the other hand with conditions of immorality. Secretary of
War Baker has well said, "Our responsibility in this matter is
not open to question. We cannot allow these young men,
most of whom will have been drafted to service, to be sur-
rounded by a vicious and demoralizing environment, nor can
we leave anything undone which will protect them from un-
healthy influence, and crude forms of temptation."
It is the business of the nation to help win this war. "From
the standpoint of our duty and our determination to create
an efficient army, we are bound, as a military necessity to do
everything in our power to promote the health and conserve
the vitality of the men in the training camps,"1 and to continue
in Europe successful activities of this character during the
period for which the men will be abroad. The General Medical
Board has recognized from the beginning that the control of
the venereal diseases constitutes one of the serious problems
of the war. Its early efforts to aid the government in develop-
ing a practical program have been outlined in a previous article
in this series. That program as approved by the Council of
National Defense and put in operation by the several depart-
ments concerned may be summed up under measures: —
(a) For the protection of health and moral standards; (6)
For dealing with prostitution and alcohol; (c) For preventive
and therapeutic treatment of venereal diseases; (d) For general
education of the public; and (e) Various special measures neces-
sitated by war conditions.
1 Letter from Secretary of War Baker to the governors of all the states and
the chairmen of State Councils of Defense.
SOCIAL HYGIENE AND THE WAR 607
The secretaries of War and Navy have created commissions
on Training Camp Activities to deal particularly with the first
of these measures. The recreational, entertainment, lecture,
and social activities encouraged and directed by these commis-
sions are fairly well understood by the public, strongly organized,
and well supported. State and local volunteer agencies are
aiding this phase of social hygiene work. Probably upwards
of $5,000,000 has been raised for these purposes by such organ-
izations as the American Playground Association, Young Men's
Christian Association, the Knights of Columbus, the American
Library Association, the Young Women's Christian Association
and others equally important but more limited in their fields of
activity. The concerted efforts of these and many other or-
ganizations to combat vice by making community entertain-
ment and social acquaintance more interesting and attractive
than the companionships and amusements of commercialized
vice districts is without precedent in the control of venereal
diseases, and deserves every encouragement. There is no doubt
but that such activities make for better comradeship, better
courage and better health and thus warrant the time and effort
devoted to them independently of their influence on the reduc-
tion of prostitution and the venereal diseases.
The administration of the law authorizing the establishment
about all military camps of zones from which prostitution and
liquor are excluded by federal authority, constitutes the chief
means of attacking these two important factors in the control
of venereal diseases. The commissions on Training Camp
Activities with the cooperation of the American Social Hygiene
Association, the Bureau of Social Hygiene, Probation and
Traveler's Aid Societies, the Committee of Fourteen, the
Watch and Ward Society, and other law enforcement bodies,
are doing excellent work in promoting community action in
combating these evils. The new note in this campaign is that
these activities are being directed with due regard to the whole
program thereby avoiding the age-long controversy over en-
couraging prostitution by measures for control of venereal
disease vs. the repression of prostitution at the expense
608 SOCIAL HYGIENE
of spreading these diseases. For the first time in modern war-
fare a nation has undertaken seriously to grapple with this
problem as a war measure.
The treatment of venereal diseases properly falls under two
heads: "early treatment" or measures taken after exposure to
infection but before the disease develops, and medical treat-
ment, or measures taken after infection occurs. Both syphilis
and gonorrhea are caused by organisms which may readily be
destroyed by the proper application of chemicals to the surface
of the injured mucous membranes or skin through which the
infection finds entrance to the body. Aside from cleanliness
and sexual continence, which combined are an unfailing safe-
guard, there are no practicable preventive measures generally
applicable except the early treatment of these exposed surfaces
with such chemicals.2 The necessity for following careful in-
structions and thoroughly applying this treatment within a
very few hours (eight as a maximum) after exposure to infec-
tion, and the public fear of condoning sexual license even in-
directly have greatly limited this phase of treatment. There
now seems to be an opportunity to place the detection and early
treatment of venereal diseases on the same basis as the detec-
tion and early treatment" of cliphtheria, meningitis, and other
dangerous communicable diseases, and to do this without con-
doning sexual license or lessening responsibility for proper conduct
and liability to any penalties which society may be able to
devise, for the protection of our moral standards. The so-
called prophylactic packet prepared to be carried and applied
by the individual immediately before, or immediately after
exposure to infection has not proved practicable as an adminis-
trative measure in the army; and in the navy is considered an
undesirable method which has been discontinued as a general
requirement. It seems apparent from a study of the limita-
tions and objections to this method of preventing infection
2 I.e., Early treatment administered in regimental infirmaries under instruc-
tion comprising soap and water, bichloride solution 1/2000, 2 per cent protar-
gol, and calomel ointment (generally referred to in the post as "prophylactic
treatment.")
SOCIAL HYGIENE AND THE WAR 609
that its value is limited to special cases in which the physician
or medical officer may determine to advise its use.
The program published elsewhere in this number of SOCIAL
HYGIENE3 presents the details of the War Department's plan
for medical control in cooperation with agencies for social
control. The navy has similarly taken steps to deal effectively
with this medical problem. The scientific knowledge of diag-
nosis and treatment gained during the past ten years has
revolutionized the public health aspect of these diseases. The
present war provides the opportunity to apply this knowledge
on a vast scale both to soldiers and civilians. The extent to
which this application may be accomplished depends largely
on the education of the public to understand and support the
necessary measures. The American Social Hygiene Associa-
tion has laid an excellent foundation in the past few years upon
which to build a broad educational campaign. Many other
agencies are contributing to this work, but the emergency is
such that the General Medical Board has provided further as-
sistance through its committee on state activities which is
informing all state and county medical committees and societies
regarding the government's program, and through its sub-com-
mittee on venereal diseases which is working out the details of
community plans for action in each extra-cantonment area. A
special sub-committee on civilian cooperation has been formed
to aid in organizing local support for carrying these plans into
effect. This committee is cooperating with the section on
venereal diseases of the Surgeon General's office and the com-
missions on Training Camp Activities of the War and Navy
Departments. Its chairman is devoting his entire time as a
volunteer to the committee and as director of public information
of the American Social Hygiene Association.
The United States Public Health Service has included syphilis
and gonococcus infections among the major epidemiological
3 See pp. 455 to 463, this number of SOCIAL HYGIENE. This has also been
reprinted under the title, "Method of Attack on Venereal Diseases," and may
be obtained on application to the American Social Hygiene Association, 105
West 40th Street, New York City.
610 SOCIAL HYGIENE
problems to be worked out in the civil sanitary districts which
the Service is establishing about the cantonments. Through
the cooperation of the Surgeon General of the army, an officer
of the sanitary corps is being added to the personnel of each
sanitary unit for this purpose. The United States Hygienic
Laboratory is studying such details as the provision of an ade-
quate supply of salvarsan at low cost to civilians. Assistance is
also being given in statistical studies, attempts to secure mor-
bidity reports, and in public education.
The United States Navy includes the combating of venereal
diseases in the work of the bureau of medicine and surgery,
this work being assigned to the officer in charge of infectious
diseases. The medical measures are correlated with other
measures of the navy department for protecting the men from
prostitution and alcohol. Everything is done that may re-
duce the number of infections after exposure occurs, or mitigate
the severity of the diseases in those for whom early treatment
fails. There has been much confusion in the public mind re-
garding the order of Secretary Daniels discarding the so-called
prophylactic packet (or self-treatment preparation which the
sailor was expected to apply immediately before or following
exposure to infection). It has been assumed by many that
Secretary Daniels barred all efforts to prevent infection, and
limited the medical staff to curative measures after the symp-
toms developed. What the Secretary really did was to an-
nounce that every man should be credited with the will power
and judgment to remain continent while on shore-leave until
he had proved himself unable to live up to this standard. After
every resource in this direction fails, the Secretary has been
and is in favor of immediate and continued effort to combat the
diseases to which the sailor has exposed himself. The full text
of the Secretary's letter is appended together with the copy of
a letter recently sent to the Governor of Louisiana.
It is understood that these articles on Social Hygiene and the
War are intended to chronicle progress, through the assembling
of letters, resolutions, and other documents giving evidence
that the government's program is being carried out. The
SOCIAL HYGIENE AND THE WAR 611
following are selected for this purpose. No effort has been
made to arrange or comment on them, but those interested in
the social hygiene movement will find them encouraging and
worthy of study.
The General Medical Board Sends a Letter to the State Committees,
Medical Section, Council of National Defense
To the State Committees of the Medical Section, Council of National Defense :
During the present war there is for the first time an opportunity to secure full
cooperation between military and civil forces in applying the medical, social,
moral and economic knowledge which has been demonstrated to have a bearing
on combating the venereal diseases. Public opinion will now support a sound
program which on the one hand recognizes these diseases as dangerous and
communicable, and on the other zealously safeguards the moral standards that
society has built up.
This program is directed first toward the environment to remove so far as
possible opportunities and temptations for sexual license and to substitute at-
tractive recreation and social acquaintance of men with women and girls under
home influences. It is directed secondly toward individuals both in military
and civil life to secure through education and appeal to loyalty their self-control
and guidance of others. It is directed lastly toward minimizing the disease and
misery resulting from failures along the first two lines of effort, through the
establishment of advisory and treatment facilities for venereal diseases, pro-
vision for the care and protection of illegitimate children and their mothers, and
the rehabilitation or control of women who practice prostitution, and the dis-
cipline of men who contribute to the delinquency of girls and women. Leader-
ship in law, medicine and ethics is essential in every community which proposes
to cooperate with the Government in carrying out this program.
The medical aspect of combating the venereal diseases is clear and the meas-
ures to be adopted are practicable. Syphilis and gonorrhoea must be dealt with
on the same basis as that for other communicable diseases. This means that
infected persons must be reported to the health authorities, and must be so in-
structed and controlled that they will not infect others. When ways and means
are devised to meet these cardinal requirements, all the other essentials for com-
bating the venereal diseases can be readily provided. The reporting of these
diseases does not necessitate declaring the name of a patient if. the physician is
willing to assume full responsibility for proper treatment and the protection of
the public.
In cases where the physician will not take this responsibility the health officer
must exercise supervision, but the public need not know the identity of the in-
dividuals thus controlled.
In order that the physician and health officer may properly perform their
duty, they must be clothed with authority and equipped with proper facilities.
The authority required is a law or ordinance making syphilis and gonorrhea
reportable; the facilities required cover laboratory diagnosis, salvarsan and
612 SOCIAL HYGIENE
other drugs; ambulatory and hospital treatment and clerical and follow-up
service to ensure continuous treatment and the obedience to instructions for
protection of the associates of the patient. Since a large percentage of those in-
fected cannot pay for treatment or will not readily consult a private physician,
free diagnosis and advice, public dispensaries, and follow-up service by health
departments are necessary.
The General Medical Board of the Council of National Defense believes the
combating of venereal diseases to be one of the most important medical prob-
lems of the war, and it has, therefore, devoted time and effort to aiding the Gov-
ernment in outlining the policy which has been adopted. It now directs its
Committee on State Activities to inaugurate a vigorous campaign for the re-
porting of these diseases and for their proper treatment. Its Sub-committee
on Venereal Diseases is charged with the working out of administrative details
for placing the comprehensive program in operation. The active cooperation of
your State and County Committees is sought. Correspondence upon conditions
affecting the establishment of local measures is requested. If desired a repre-
sentative of the Committee will visit your state for the purpose of aiding you in
promoting this important work.
By separate post a series of pamphlets relating to the subject is being sent
you. Sincerely yours,
THE GENERAL MEDICAL BOARD,
COUNCIL OF NATIONAL DEFENSE.
Committee on State Activities:
EDWARD MARTIN, Philadelphia, Chairman,
JOHN D. McLEAN, Philadelphia, Secretary,
JOSEPH C. BLOODGOOD, Baltimore,
JOHN YOUNG BROWN, St. Louis,
KARL CONNELL, New York City,
GEORGE W. CRILE, Cleveland,
RICHARD DERBY, New York City,
JOHN M. T. FINNEY, Baltimore,
JOSEPH M. FLINT, New Haven,
WILLIAM J. MAYO, Rochester,
STUART McGuiRE, Richmond,
LIEUT.-COL. ROBERT E. NOBLE, M. C., U.S.A., Washington,
CHARLES H. PECK, New York City,
HUBERT A. ROYSTER, Raleigh,
FREDERICK T. VAN BEUREN, JR., New York City,
FRANKLIN' MARTIN, Ex Officio,
S. F. SIMPSON, Ex Officio.
The State Medical Society of Pennsylvania Adopts Resolutions
Preparatory to an Active Campaign Against Venereal Diseases
»
WHEREAS, the State Medical Society of Pennsylvania is deeply concerned
in all that pertains to national efficiency and health conservation; and
WHEREAS, venereal infections are among the most serious and disabling dis-
eases to which not only the soldier and sailor but men, women, and children in
civil life are liable; and
SOCIAL HYGIENE AND THE WAR 613
WHEREAS, they constitute a grave menace to success in the war in which we
are engaged; and
WHEREAS, the Congress of the United States, the President, the secretaries
of War and Navy, the Council of National Defense, and other governmental
agencies have adopted a general policy for combating the venereal diseases;
and
WHEREAS, a great responsibility rests upon the civil population and particu-
larly upon the medical profession for participation in carrying out adequate
measures for giving effect to the Government's policy;
Therefore, be it resolved that the Medical Society of the State of Pennsylvania
pledges the support of its members to the following basis for a program of civil
activities adopted by the American Medical Association: —
1. That sexual continence is compatible with health and is the best preven-
tion of venereal infections.
2. That steps be taken toward the eradication of venereal infections through
the repression of prostitution, and by the provision of suitable recreational
facilities, the control of alcoholic drinks, and other effective measures.
3. That plans be adopted for centralized control of venereal infections
through special divisions of the proper public health and medical services.
4. That the hospitals and dispensaries be encouraged to increase their facil-
ities for early treatment and follow-up service for venereal diseases as a measure
of national efficiency.
5. That the members of the medical profession be urged to make every effort
to promote public opinion in support of measures instituted in accordance with
these principles of action in the control of venereal diseases.
Be it further resolved that the Commissioner of Health of Pennsylvania be
requested to take such steps as may be necessary to secure the proper reporting
of venereal diseases for the purpose of securing adequate advice and treatment
for all infected persons and carriers.
Be it also resolved that the Bureau of Medical Education and Licensure of the
State of Pennsylvania be requested to use all possible legal measures to secure
the admission of persons afflicted with venereal diseases into the hospitals of
this state.
Be it also resolved that all measures proposed shall be in accord with policies
of the Government for the repression of prostitution and alcohol and the safe-
guarding of moral standards which society has decreed.
In adopting these resolutions, the Medical Society of the State of Pennsyl-
vania records its belief that it is now possible to place the venereal diseases upon
a scientific basis as dangerous infectious diseases which may be combated by
health departments with the full cooperation of the medical profession and the
public at large.
614 SOCIAL HYGIENE
The California State Board of Health and the State Military Wel-
fare Commission under the Auspices of the Governor and the
State Council of Defense Begin a State-wide Attack
CALIFORNIA STATE BOARD OF HEALTH
BUREAU OF ADMINISTRATION, SACRAMENTO
August 16, 1917.
[Sent to County Supervisors]
DEAR SIR:
Officers of the Navy and of the Western Department of the Army have called
to the attention of the state authorities the need for vigorous and immediate
measures for the prevention of venereal diseases in soldiers and sailors stationed
in California. They call to our attention the fact that it takes $10,000 to place
one man at the front in Europe and that a vast amount of government funds will
be wasted and army efficiency lost if something is not done at once to prevent
venereal diseases in the troops now in California or about to arrive. The pre-
sentations of the Army and Navy, the State Military Welfare Commission and
the State Board of Health to Governor Stephens resulted in the appropriation,
from emergency military funds, of $60,000 for the maintenance for two years,
under the State Board of Health, of a Bureau of Venereal Diseases. This Bu-
reau will organize this work and exercise general supervision over it according to
the enclosed plan. The Governor, as well as the military authorities, recognize
the seriousness of the situation and have placed upon the Board the grave respon-
sibilities of carrying on the work.
Aside from the need for the efficient cooperation of health officers and other
county officials, the supervisors will be called upon to provide proper and ade-
quate hospital facilities for the treatment of persons who are under isolation for
syphilis or gonorrhea. Preliminary steps have already been taken by several
counties, but in most instances the provisions are as yet totally inadequate. I
therefore urge the Board of Supervisors of which you are a member to set aside
in the budget, which is now being prepared, sufficient funds to provide addi-
tional beds, wards, or even pavilions, according to the population of the county,
to meet any reasonable demands which the health authorities may make in con-
nection with the isolation of persons who cannot otherwise be prevented from
spreading venereal diseases.
I am informed that on September 4 the budgets are made up for the coming
year and that they cannot be changed thereafter without difficulty, I therefore
urge that this matter be given immediate consideration and due provisions be
made for participation in the important work of preventing venereal diseases.
Respectfully yours,
W. A. SAWYER,
Secretary.
SOCIAL HYGIENE AND THE WAR 615
MEASURES FOR THE PREVENTION OF VENEREAL DISEASES IN SOLDIERS AND
SAILORS STATIONED IN CALIFORNIA
The state will cooperate with the army and navy in reducing venereal diseases
in the men stationed in California to a minimum. To do this it will be neces-
sary to prevent these diseases in the civil population near army and navy posts,
and to extend the work as rapidly as possible throughout the state.
To carry on this work it was recommended to Governor Stephens on August
13 by the Military Welfare Commission that a Bureau of Venereal Diseases be
established under the State Board of Health and that $60,000 be appropriated
from war emergency funds for its support during the next two years. The dele-
gation which laid the plan before the Governor included Mr. Warren Olney, Jr.,
and Dr. Millbank Johnson of the State Military Welfare Commission, Colonel
Lynch of the United States Army, Lieutenant James E. Miller of the United
States Navy, and Doctors George E. Ebright and Wilbur A. Sawyer of the State
Board of Health. The plan met with the hearty approval of the Governor and
work will be begun immediately.
The functions of such a Bureau have been tentatively outlined as follows : —
DIRECT CONTROL
1. To secure the reporting of cases of syphilis and gonococcus infection, to-
gether with the probable sources of infection, by physicians and by the medical
officers of the army and navy.
2. To investigate, with the assistance, of local officials, any suspected foci of
infection and to isolate infectious persons whenever it is necessary to prevent
their spreading disease.
3. With the cooperation of cities and counties to care for the men and women
isolated on account of venereal disease in public isolation hospitals until the
patients are no longer infectious.
4. As far as possible to secure the medical examination for venereal diseases
of male and female prisoners and other appropriate groups, and to provide for
their isolation and treatment so that they will not spread disease when released.
5. Through the operation of this plan to prevent the heretofore common
evil of one community "passing on" to another its undesirables, thereby multi-
plying foci of infection.
6. To focus on this subject the social forces necessary to give former prosti-
tutes, after they have been put into good physical condition, an opportunity to
enter into productive occupations under conditions fair to themselves and to
the community.
PUBLIC OPPORTUNITIES FOR DIAGNOSIS AND TREATMENT
1. To investigate all clinics or hospitals treating venereal diseases and to
bring into existence adequate day and evening clinics and opportunities for
hospital treatment for syphilis and gonorrhea.
2. To make a list of accredited clinics in which venereal diseases are treated,
accrediting only those which reach high standards in staffs, equipment and
results.
616 SOCIAL HYGIENE
3. To purchase and issue, without charge, to approved public hospitals and
clinics, salvarsan or approved substitutes, for use in making cases of syphilis
non-infectious in the shortest possible time.
4. To arrange with city laboratories to give free diagnostic tests for syphilis
and gonococcus infections, and to encourage the more general use of the free
Wassermann tests and other tests available at the Bureau of Communicable
Diseases.
EDUCATIONAL
1. To issue printed pamphlets, cards and placards of information relative to
the prevention of venereal disease, and to cooperate with the army and navy and
other agencies in giving talks to appropriate groups.
2. To cooperate with the Military Welfare Commission in the suppression of
prostitution as the principal source of venereal diseases, but avoiding confusion
of the campaign against venereal diseases with the movement against vice as a
strictly moral issue.
3. To oppose any local plan for licensing prostitution or issuing certificates
of health to prostitutes, by showing that this is in conflict with modern methods
of control of venereal diseases, and to substitute the above program, which is
entirely consistent with the suppression of prostitution.
RULES AND REGULATIONS FOR THE CONTROL AND SUPPRESSION OF VENEREAL
DISEASES
1. All city, county and other local health officers are, for the purpose of the
control and suppression of venereal diseases, hereby designated and appointed
inspectors, without salary, of the State Board of Health of California, under
the provisions of Section 2979 of the Political Code.
2. All city, county and other local health officers are hereby directed to use
every available means to ascertain the existence of, and immediately to investi-
gate, all suspected cases of syphilis in the infectious stages and gonococcus in-
fection within their several territorial jurisdictions, and to ascertain the sources
of such infections.
3. In such investigations said health officers are hereby vested with full
powers of inspection, examination, isolation and disinfection of all persons,
places and things as in said statute provided, and as such inspectors said local
health officers are hereby directed:
a. To make examinations of persons reasonably suspected of having syphilis
in the infectious stages or gonococcus infection. (Owing to the prevalence of
such diseases among prostitutes all such persons may be considered within the
above class.)
6. To isolate such persons whenever in the opinion of said local health officer,
the State Board of Health or its Secretary, isolation is necessary to protect the
public health. In establishing isolation the health officer shall define the limits
of the area in which the person reasonably suspected or known to have syphilis
or gonococcus infections and his immediate attendant, are to be isolated, and no
persons, other than the attending physicians, shall enter or leave the area of
isolation without the permission of the health officer.
SOCIAL HYGIENE AND THE WAR 617
c. In making examinations and inspections of women for the purpose of ascer-
taining the existence of syphilis or gonococcus infection, to appoint women
physicians for said purposes where the services of a woman physician are re-
quested or demanded by the person examined.
d. In cases of quarantine or isolation, not to terminate said quarantine or
isolation until the cases have become noninfectious or until permission has been
giren by the State Board of Health or its Secretary.
Cases of gonococcus infection are to be regarded as infectious until at least
two successive smears taken not less than forty-eight hours apart fail to show
gonococci.
Cases of syphilis shall be regarded as infectious until all lesions of the skin
or mucous membranes are completely healed.
e. Inasmuch as prostitution is the most prolific source of syphilis and gonococ-
eus infection, all health officers are directed to use every proper means of sup-
pressing the same, and not to issue certificates of freedom from venereal diseases,
as such certificates may be used for purposes of solicitation.
/. To keep all records pertaining to said inspections and examinations in
files not open to public inspection, and to make every reasonable effort to keep
secret the identity of those affected by venereal disease control measures as far
as may be consistent with the protection of the public health.
The War Department Announces a Program of Social Hygiene for
Soldiers to Safeguard their Morals and Health
THE SURGEON GENERAL'S OFFICE HAS AUTHORIZED THE FOLLOWING STATEMENT
ON THE SOCIAL HYGIENE PROGRAM OF THE WAR DEPARTMENT IN
RELATION TO OTHER AGENCIES
In its popular interpretation, social hygiene has been used as a phrase to refer
inclusively to all efforts for protection of the population from prostitution and
venereal disease. Prostitution in its various forms affords the chief opportunity
for disseminating the venereal diseases and promoting sexual promiscuity.
Neither the military nor the civil authorities have been able effectively to com-
bat this medical social evil alone. The assembling of troops in the vicinity of
civil communities has always introduced a difficult social problem on the one
hand and on the other has attracted the promoters of organized vice, who have
established the commercialized activities known to increase the supply and de-
mand for prostitution. The civil authorities within whose jurisdiction these
practices were carried on were inexperienced in dealing with the situation, and
the military authorities had no legal power under which to take action.
CAN SECURE COOPERATION
During the present war there is for the first time the opportunity to secure
full cooperation between military and civil forces in applying the medical,
social, moral, and economic knowledge which has been demonstrated to have a
bearing on the repression of prostitution and the reduction of the prevalence of
618 SOCIAL HYGIENE
venereal diseases. Public opinion will now support a sound program, and suf-
ficient authority has been secured through legislative and administrative action
to promise important results.
MEASURES PROPOSED
The paramount national issue is the winning of the war, and every resource,
both military and civil, must be applied toward this end. The social hygiene
program has, therefore, been centered administratively on the protection of the
military, naval and other Governmental forces. The success attained, however,
is equally to the advantage of the civil population. So far as these adminis-
trative measures relate to the United States Army they may be grouped under
five headings:
1. Army Medical Department. Military measures for combating the venereal
diseases.
2. United States Public Health Service. Epidemiological measures for the
control of venereal diseases in the civil sanitary districts.
.3. War Department Commission on Training Camp Activities. — (a) Law en-
forcement measures in the department zones. (6) Recreation measures in the
department zones.
4. Civil Authorities. Law enforcement, recreation, facilities for treatment of
venereal diseases and protection and control of women and girls.
5. Non-official agencies. Social hygiene activities of volunteer organizations
recognized for special services.
Each of these groups includes a variety of activities carried out by widely
different agencies that have been available at the moment of necessity and
having proved useful have continued to function.
THE ARMY MEDICAL DEPARTMENT
The Medical Department of the Army is limited in its strictly official
capacity to measures for the prevention and treatment of venereal diseases in-
side the military encampments. Unofficially the Surgeon General and his staff
are in full accord and cooperation with the agencies to which reference has been
made. A section has been organized to devote its attention to this problem,
with an officer in charge of laboratory investigations, one in charge of medical
work, and one in charge of educational and environmental measures and socio-
logical studies. These officers will have the cooperation of the officer who is in
charge of sanitary inspection, and the officer who directs the division of training
camps. While the creation of a special section is new it should be stated that
the work has been carried on by the Army for many years. The activities of
the section may be summarized under the following headings:
1. Educational work adapted so far as practicable to the individual needs
and responsibilities of the men and officers, and conducted through personal
interviews, group talks, illustrated lectures, exhibits, pamphlets and library
reference books.
2. Prophylactic stations for minimizing the number of infections developing
after exposure, and for personal advice and warning directed toward lessening
the number of future exposures.
SOCIAL HYGIENE AND THE WAR 619
3. Diagnosis and treatment facilities for cases of syphilis and gonococcus
infections which develop in spite of efforts to prevent them.
4. Enforcement of penalties against those who ignore advice and instruc-
tion to avoid sexual intercourse and venereal disease.
5. Epidemiological studies of the venereal diseases to discover any new meas-
ures which may be applied.
PUBLIC HEALTH SERVICE
The United States Public Health Service has been charged with the respon-
sibility for health conditions in civil sanitary districts surrounding military
establishments. The work will be done in cooperation with the State and local
authorities and with the American Red Cross through an advisory board. The
venereal diseases, as dangerous communicable diseases, are included in the
program. The following are the principal lines of activity to be undertaken in
relation to these diseases:
1. Promotion of public opinion in support of the social hygiene program
agreed upon.
2. Survey and standardization of dispensary and hospital facilities for ve-
nereal diseases.
3. Cooperation with private practitioners minimizing the dissemination of
infections.
4. Extension of laboratory, clinical and advisory service for venereal diseases
in communities under civil auspices.
Efforts along each of these lines will simplify and render more effective the
Army measures.
COMMISSION ON TRAINING CAMP ACTIVITIES
In order to deal effectively with social hygiene in all its phases the Secretary
of War has created the commission on training camp activities to carry out the
law enforcement regulations promulgated by him under the authority of Con-
gress and the President. This commission has also been charged with important
activities in furnishing recreation for the troops. Under these two divisions the
commission's work as it indirectly bears on the control of venereal diseases may
be summarized as follows:
A. Law enforcement measures.
1. Elimination of commercialized prostitution in the cantonment zones.
2. Repression of clandestine prostitution.
3. Control of alcohol and other aids to prostitution.
4. Combating of gambling, use of drugs and other harmful practices.
B. Recreation measures.
5. Social and educational activities of recreation huts in the canton-
ments, and of recognized agencies in the cantonment zones.
6. Theatrical and other entertainment programs.
7. Athletic contests, tournaments and games.
8. Reception tents for visitors.
9. Libraries of popular books and other facilities provided under the
direction of the commission.
620 SOCIAL HYGIENE
CIVIL AUTHORITIES
It is recognized that neither the measures within the military establishments
nor the supplementary measures in specified zones can achieve the largest suc-
cess without full cooperation of civil authorities in enforcing equivalent meas-
ures in all communities accessible to the personnel of the military forces. The
carrying out of the following program, which has been inaugurated in many
cities and towns, is of great importance to the Army and to national efficiency:
1. Enforcement of laws and ordinances against prostitution and alcohol.
2. Establishment of proper facilities for advice and treatment of persons
infected with venereal diseases.
3. Provision of attractive recreation and entertainment for the leisure hours
of the population. .
4. Moral protection and education of women and girls.
NON-OFFICIAL AGENCIES
The complicated interlocking of military and civil interests in the protection
of soldiers and civilians from vice and disease affords an opportunity for many
useful activities of volunteer agencies. This is particularly true in the field of
social hygiene. In the interest of efficiency and avoidance of confusion and
duplication of effort a small number of such agencies have been recognized as
clearing houses for military-civil work of a very large number of organizations in
their respective fields.
This Letter Was Sent by the Secretary of War to the Mayors of
The Cities and the Sheriffs of the Counties in the Neighborhood
of All Military Training Camps
WAR DEPARTMENT
WASHINGTON
August 10, 1917.
MY DEAR SIR:
In anticipation of the military training camp soon to be opened in your neigh-
borhood, I am sending herewith a copy of the regulations recently issued on the
question of the suppression of prostitution and the sale of alcohol to soldiers in
uniform within a given radius of military posts and camps. These regulations,
which are based on sections 12 -and 13 of the recent Army Law, do not, I believe,
need comment, and I am confident that their enforcement will help create a
wholesome environment about the military camps.
There are one or two matters, however, in connection with the enforcement
of the regulations, to which I would like to call your attention. In the first
place, the purpose of these regulations is to put into effect sections 12 and 13
of the Army Law recently passed, so that the Army itself can cooperate with
the local authorities, if necessary, in their enforcement. The regulations do
not in any way lessen the necessity for police vigilance on the part of local au-
thorities. The presence of large bodies of troops rather increases the respon-
SOCIAL HYGIENE AND THE WAR 621
sibility of those whose duty it is to preserve local order, and I am confident that
the War Department can rely on you to the utmost to see that the regulations
are rigidly enforced.
In the second place, while we have fixed a five mile radius about the camp,
in which prostitution is strictly to be put down, the War Department will not
tolerate evil resorts of any kind within easy reach of the camp, even though such
resorts lie without the five mile zone. If places of bad repute spring up out-
side the five mile limit, but fairly accessible to the camp, I shall not hesitate to
insist upon their elimination. Of course, it would be possible to extend the
zone, and I shall not evade the responsibility in case of necessity. At the same
time, if the zone is drawn with too large a radius, there is danger that the number
of soldiers required to police it will be beyond the ability of the Commanding
Officer readily to furnish. In such a case, therefore, it might be easier and
cheaper to move the camp to a more desirable locality; provided, of course, that
clean conditions could not be secured through any other course.
Finally, let me say that the War Department will not tolerate the existence
of any restricted district within an effective radius of the camp. Experience
has proved that such districts in the vicinity of army camps, no matter how
conducted, are inevitably attended by unhappy consequences. The only prac-
tical policy which presents itself in relation to this problem is the policy of ab-
solute repression, and I am confident that in taking this course the War Depart-
ment has placed itself in line with the best thought and practice which modern
police experience has developed. This policy involves, of course, constant
vigilance on the part of the police, not only in eliminating regular houses of
prostitution, but in checking the more or less clandestine class that walks the
streets and is apt to frequent lodging houses and hotels.
I have appointed a Commission on Training Camp Activities to advise with
me on matters of this kind, and through this Commission I shall keep constantly
in touch with conditions about all our army camps. If you have any questions
relating to the enforcement of the enclosed regulations, I trust you will not hesi-
tate to get in touch with me or with Mr. Raymond B. Fosdick, Chairman of the
Commission. Meanwhile I am sure the country is looking to us to cooperate
effectively in this matter and to make the surroundings of our camps worthy of
the fine spirit of the nation which entrusts these young men to us to be trained
for service in a great cause.
Very truly yours,
[SIGNED] NEWTON D. BAKER,
Secretary of War.
REGULATIONS ISSUED BY THE PRESIDENT AND THE SECRETARY OF WAR, BEARING
ON SECTIONS 12 AND 13 OP THE ARMY LAW
Bulletin No. 45 WAR DEPARTMENT,
Washington, July 25, 1917.
1. Under authority of Section 12 of the act "to authorize the President to
increase temporarily the military establishment of the United States," approved
May 18, 1917, the following regulations are established by the President :
622 SOCIAL HYGIENE
"No person, whether acting individually or as an officer, member, agent,
representative or employe of a corporation, partnership or association, or as an
agent, representative or employe of an individual, shall, in or within five miles
of any military camp, except as hereinafter provided, sell or barter, directly or
indirectly, either alone or with any other article any alcoholic liquor, including
beer, ale, or wine, to any person, or give or serve any such alcoholic liquor to any
person, except that this prohibition against serving or giving alcoholic liquor
shall not apply to the serving of wines or liquors in a private home to members
of the family or to bona fide guests therein other than officers or members of
the military forces; and no person, whether acting individually or as a member,
officer, agent, representative or employe of any corporation, partnership or
association, or as an agent, representative, or an employe of an individual
shall send, ship, transmit or transport in any manner or cause to be shipped,
transmitted or transported in any manner, any alcoholic liquor, including beer,
ale or wine, to any place within five mile^ of any military camp, except for use
in his home as hereinbefore authorized; Provided, That where the existing limits
of an incorporated city or town are within five miles of a military camp, the
prohibition upon the sale, barter, gift, service, sending, shipment, transmission
or transportation of alcoholic liquors imposed by this regulation shall not apply
to any part of the incorporated city or town distant more than one-half mile
from said camp."
2. Under authority of Section 13 of the Act "to authorize the President to
increase temporarily the military establishment of the United States," approved
May 18, 1917, the keeping or setting up of houses of ill fame, brothels or bawdy
houses within five miles of any military" camp, station, fort, post, cantonment,
training or mobilization place being used for military purposes by the United
States is prohibited.
By Order of the Secretary of War:
(250.12, A. G. O.)
[SIGNED] TASKER H. BLISS,
Major General, Acting Chief of Staff.
Official:
[SIGNED] H. P. MCCAIN,
The Adjutant General.
Two Letters from the Secretary of the Navy
NAVY DEPARTMENT
WASHINGTON
February 27, 1915.
To all Commanding Officers.
Subject: Venereal disease in the Navy.
1. The Secretary desires to call the attention of all commanding officers and,
through them, of all medical officers and others concerned, to the subject of the
prevalence of venereal disease in the Navy; the methods employed in dealing
with these diseases; and especially to arouse renewed interest and activity in edu-
cational prophylaxis in this connection, looking to the careful and intelligent
SOCIAL HYGIENE AND THE WAR 623
instruction of the entire naval personnel in these matters, to the end that no
man shall be subject to the loss of health and efficiency through ignorance of
the serious and sometimes fatal results that may come to those so contami-
nated, and to all connected with him.
2. During the last statistical year this class of disease has caused four deaths,
138 discharges for disability, and 141,378 sick days. The total damage to the
service may be shown by the statement that venereal disease caused the loss to
the service of 456 men for the full period of this year. One ship in the Far East
reports that 44 per cent of the crew have become infected with venereal disease
of some kind during the cruise. Nearly every medical report that comes in
states in substance, "venereal disease continues to give a greater damage rate
than any other factor." This condition is not unusual, but has been equally
true for many years past, nor is it intended in any way to intimate that venereal
disease is more prevalent in the Navy than in other services or in civil communi-
ties from which it comes.
3. The Council on Health and Public Instruction of the American Medical
Association states that these diseases are "the direct or indirect cause of one-
eighth of the hospital practice in New York City;" also, that "of the deaths
from disease of the female reproductive organs, 80 per cent are due to gonorrhea
alone;" again, a committee of the New York County Medical Society makes the
appalling statement that "200,0*0 people infected with venereal diseases are
walking the streets of New York." It must also be remembered that 'a large
number of permanent disabilities and fatalities occur both in civil life and the
Navy from far reaching complications that are often attributed to other causes,
and not recognized as the direct result of venereal infection, such as chronic
rheumatic troubles, kidney, heart, brain and other diseased conditions that
often follow the original venereal infection, but which may not terminate for
months or years.
4. The expense entailed is worthy of consideration, not alone on account
of the time lost, but for the medicaments and appliances required to care for
these unfortunates; for instance, argyrol for 1914 cost $10,800; protargol, $8,929;
one single invoice of salvarsan (the demand for which is increasing day by day)
was $17,000. The total expense for these purposes from all sources would prob-
ably show a large part of the medical department appropriation, as well as the
Naval Hospital Fund, to be involved. The above is presented simply to show
the importance of the subject, and the necessity for every one to do all in his
power, both by precept and example, to help toward a better condition of things
in this regard. Neither yellow fever, nor cholera, nor plague, nor any of the dread
scourges of the world compare with the disastrous results of this constant, ever-
present evil. The fact that these diseases are not inherent in the Navy, nor in
any way necessarily incident to life in the service makes it particularly reprehen-
sible that such conditions should continue to exist if they can be legitimately
controlled.
5. I desire to call attention to the fact that by far the largest part of our
personnel is young (under 25), many of them absolutely ignorant of anything
pertaining to sex hygiene, and particularly to the types and manifestations of
venereal disease, how it is contracted, or the terrible results that almost invari-
ably follow. These young men are especially entrusted to our care, often from
624 SOCIAL HYGIENE
the best of homes, where they have been most carefuly surrounded with moral
and physical safeguards. Their parents and friends, naturally, expect from
this great branch of the Government service every safeguard and incentive that
will protect their sons from evil and disaster of this kind.
6. Having endeavored to present to you a mere outline of some of the impor-
tant features of this question, I want to review the various procedures at present
in use in the Navy to protect our personnel from this source of contamination,
and to care for them when once infected. The Medical Corps has always been
deeply interested in this question, and I fully realize that as a whole its members
have made unusual, persistent and interested efforts to control and wipe out
this source of moral and physical pollution. Especially during the past five or
six years have strenuous efforts been made to control these diseases, both med-
ically, as a problem in preventive medicine, and by teaching as well. Also I
know that many of our best officers of line and staff have given thought and en-
deavor in various ways to aid in improving conditions. Notwithstanding all
these efforts, the fact remains that little, if any, impression seems to have been
made in ameliorating conditions, and the statistics seem to show a sameness that
is almost disheartening.
7. The procedures attempted and authorized in the Navy in connection with
venereal disease may be set forth as follows:
First. Educational (moral) prophylaxis. By this I mean that efforts are
made to so thoroughly inform the personnel on matters of sexual hygiene that
there can be no excuse for the individual to expose himself to the dread effects
of venereal or sexual derelictions through ignorance; coupled with this is the
strongest possible caution and advice to shun every association that may tempt
or endanger. With this instruction, the fact that continence is not inconsistent
with the best manly development, and that the exercise of the sexual functions
is unnecessary for the preservation of health, is taught. This idea is generally
accepted by medical men today.
It is my aim to endeavor to arouse a deeper interest among officers and men
in this educational campaign against the social evil, feeling that in this manner
we have the only hopeful solution of the problem compatible with morality and
the civil and military laws. In this position I think I am in accord with the
most advanced workers in this sociological problem and have the sympathetic
aid and cooperation of the medical profession and such organizations as the
American Social Hygiene Association of New York.
Second. Medical prophylaxis. When the individual in the service fails
to heed the repeated warnings, instructions, prohibitions, etc., given him, and
despite the provisions of civil and military laws, wilfully and of his own volition
exposes himself to the dangers of sexual contact, we have provided probably
the most careful and thorough system of prophylactic treatment that is carried
out anywhere in the world in our attempts to save the victims of venery from the
dreadful results that may follow their wilful disregard of the laws of decent
society.
Third. Mandatory prophylaxis. In order to bring home to the men the
dea of their personal responsibility for loss of time and efficiency, I am in favor
of a law which would deprive men of their pay during the time they are incapaci-
tated by such diseases, contracted by their own indiscretions.
SOCIAL HYGIENE AND THE WAR 625
8. The use of the so-called "preventive or prophylactic packet" is not au-
thorized, and I have been severely criticised in various quarters for my attitude
with regard to this measure. The use of this packet I believe to be immoral ;
it savors of the panderer; and it is wicked to seem to encourage and approve
placing in the hands of the men an appliance which will lead them to think that
they may indulge in practices which are not sanctioned by moral, military, or
civil law, with impunity, and the use of which would tend to subvert and de-
stroy the very foundations of our moral and Christian beliefs and teachings with
regard to these sexual matters.
9. When you consider the youth and immaturity of our personnel, including
the midshipmen (our future officers) and apprentices of the service, who are
entrusted to my keeping with the strong belief that every good and Christian
influence inculcated by many an anxious mother or father will be fostered and
even strengthened by the protecting care of the Navy, could you expect me to
place, or to allow to be placed, in the hands of these often absolutely innocent
boys a "preventive packet" and to say, or allow to be said to them, or inferred,
that there is a possibility, or even the remotest probability, that they may need
these "preventives" while on liberty.
10. The spectacle of an officer or hospital steward calling up boys in their
teens as they are going on leave and handing over these "preventive packets"
is abhorrent to me. It is equivalent to the Government advising these boys
that it is right and proper for them to indulge in an evil which perverts their
morals. I would not permit a youth in whom I was interested to enlist in a
service that would thus give virtual approval to disobeying the teachings of his
parents and the dictates of the highest moral code. You may say that the ideal
raised is too high and we need not expect young men to live up to the ideal of
continence. If so, I can not agree. It is a duty we can not shirk to point to the
true ideal, to chastity, to a single standard of morals for men and women. If,
unhappily, experience has taught us that too few resist temptation, that in no
wise lessens our responsibility to seek to guide the youth to whom we owe a
solemn duty. We need not hope to induce young men to become strong in will
power, firm in resisting temptation, if we say to them: "Go in the way of sin.
We have no admonition to you to refrain from evil. All that we have to say to
you is to be careful not to contract disease." Such admonitions to boys in their
teens would make me, as Secretary of the Navy, an apologist for looseness of
morals. I could not look a boy in the Navy straight in the face while I appealed
to him to lead a clean life, if I were approving the policy and the use of a measure
of this kind.
11. We come now to the main object of this letter, which is to emphasize the
fact that our attention has become so engrossed with the purely medical pro-
phylaxis that I feel the moral prophylaxis has become neglected, and wish to
arouse and reawaken interest and activity in the proper teaching of the person-
nel with regard to the nature and dangers of venereal diseases, and to ask the
hearty cooperation of every officer and man to see, so far as his influence and ex-
ample go, that every associate and shipmate does not become the victim of any
of these diseases through ignorance or the lack of moral support in all that makes
for continence, and for a clean and moral life.
626 SOCIAL HYGIENE
12. Certainly, with this attitude no harm can be done, and while we may
not be able to entirely wipe out this great evil, yet it is my firm conviction that
much good will surely result and the bad condition be materially ameliorated.
13. To this end then it is directed that commanding officers consult with their
medical officers, and that a regular and systematic course of instruction be given
along the lines indicated in this letter, and it is further directed that such efforts
be continued until every man is fully aware of the nature of these diseases and
the dangers that will certainly overtake him if he fails to be guided by the teach-
ings and admonition given him.
14. Nothing in the above is to be considered as minimizing or interfering in
any way with the present authorized medical prophylactic measures, which fill
an important place in tending to limit these diseases, and which insure the best
possible care of those who are infected.
15. Attention is invited to the Confidential Circulars Nos. 1, 2, 3, and 4,
issued by the Medical Department, supplies of which may be obtained by medi-
cal officers from the Naval Medical Supply Depot.
JosEPHtrs DANIELS.
September 24, 1917.
MY DEAR GOVERNOR PLEASANT:
I am sure you will agree with me that we should see to it that the young men
who have enlisted in the military and naval service of the country should be
shielded from those temptations to immoral conduct which, in some instances,
have done more to undermine the fighting strength of an army than the bullets
of the enemy.
The duty is laid upon us both to safeguard the morals of these young men in
every way possible and to close up the pitfalls and evils to which they are ex-
posed by the corrupt machinations of wicked men and women. You have doubt-
less noticed in the newspapers that the conditions surrounding our naval training
camps in several places have been so bad that we have been obliged to call the
attention of the state authorities to the existing conditions. Through the
agency of the Commission on Training Camp Activities, composed of men of
high standing which I have recently appointed, we have been making investi-
gations of conditions surrounding all places where our young men are being
trained for the service. The investigation recently made at New Orleans, where
we have a naval station, shows conditions to be very bad and I am appealing to
you to. close the restricted district because of its proximity to the Navy Yard.
I am informed by men who have made the investigation that the New Orleans
restricted district is one of the most vicious red light districts they have dis-
covered in any of the cities they have investigated. It comprises block after
block of open "cribs" and our reports of recent date show that sailors in uniform
frequent the houses in large numbers, although it is understood that the police
have instructions that soldiers and sailors should be barred out.
I am enclosing a copy of a report which I have received, giving the house
numbers and the dates when sailors were seen frequenting these houses of ill
fame and drinking in them.
I am sending you this information with the full confidence that you will have
the same feeling that I have that the authorities must see to it that our enlisted
SOCIAL HYGIENE AND THE WAR 627
men are protected from these menacing evils, and that you will bring all the
power of tHe state government to bear to see that the conditions which are now
menacing the moral and physical welfare of the men at the New Orleans Navy
Yard are done away with.
I am sending a copy of this letter to the Mayor of New Orleans, in order that
he may know of my intense desire that immediate action be taken.
Sincerely yours,
JOSEPHXJS DANIELS.
Hon. Ruffin G. Pleasant,
The Governor of Louisiana,
Baton Rouge.
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