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Full text of "Social hygiene"

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This Volume is for 
REFERENCE USE ONLY 



From the collection of the 



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v Uibrary 



San Francisco, California 
2007 




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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L3 1 



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 THIRD 1 

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." 

1 Get Home from Third. Reprinted by the Pennsylvania Lines, Passenger 
Department. 

10 



CLINICS FOR VENEREAL DISEASES 1 

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 
~AMLY,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 SPECIALISTS 1 

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 





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 STANDARDS 1 

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 SYPHILIS 1 

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 ALCOHOL 1 

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 halls 5 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 DISEASE 1 

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 PERIL 1 

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 Commission 2 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 

London 1 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 








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 FACTS 1 

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 MAN 1 

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 DISEASES 1 

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, London 1 

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 1916 1 

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 Murfus 


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 


71 1 


17 


15 


13 


10-20 


90 1 


21 


10 


9 


20+ 


93 1 


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 "notochord 7 * 
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 CAMPAIGN 1 

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 Hall 4 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 states 8 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 DISCIPLINE 1 

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 13 1 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 Dispensary 2 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 Davis 4 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 handbook 1 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 resume 1 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 Supervision 1 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 Diseases 1 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