[Sidenote: Recent publicity regarding vice and disease.]
During the past decade the general public has received some astounding
revelations concerning the enormous extent of illicit sexual
promiscuity, which is immorality according to our commonly accepted
code of morals. Along with the evidence as to the existence of
widespread promiscuity, has come the still more alarming information
from the medical profession that sexual promiscuity commonly
distributes the germs of the two highly infectious and exceedingly
destructive diseases, syphilis and gonorrhea, known in medical science
as venereal or social. When these are acquired by individuals guilty of
sexual promiscuity, they seriously and often fatally affect the victim;
but of far greater social-hygienic importance is the medical evidence
that they are very often transmitted to persons innocent of any
transgression of the moral law, especially to wives and children.
The medical revelations concerning the relation of sexual immorality to
the plague of social diseases, has come from certain eminent
physicians, notably the late Dr. Prince A. Morrow. His translation of
Fournier's "Syphilis and Marriage" (1881), his own "Social Diseases and
Marriage" (1904), and several of his pamphlets published by the
American Society of Sanitary and Moral Prophylaxis, have been
authoritative statements of conditions as the medical world sees them.
[Sidenote: Social diseases and immorality.]
The extent of social diseases is a fairly accurate measure of the
minimum amount of immorality, for nothing is better established in
medical science than that promiscuity in sexual relations is directly
or indirectly responsible for spread of the microorganisms which cause
the diseases. If for several generations all men and women limited
their sexual relations to monogamic marriage, and the relatively rare
cases of non-sexual and prenatal infection were treated so as to render
them non-contagious, the social diseases would probably disappear from
the human family. Such a statement is significant only in showing the
relation of social diseases to sexual promiscuity, for of course, there
is no reasonable hope that the venereal germs will ever be annihilated
by universal monogamy.
[Sidenote: Attack by education and sanitation.]
Reduction of the amount of venereal disease must depend upon (1)
hygienic and moral education which will lead people to avoid the
sources of infection and (2) sanitary and medical science which works
either by applying antiseptic or other prophylactic methods for
preventing development of the causative microorganisms, or by using
germicides for destroying those germs which have already produced
disease. Thus the educational and the sanitary attack on the social
diseases lie parallel. Both are needed, for, even with all the possible
methods of attack, the progress against these diseases will be
exceedingly slow.
Those who are interested in the facts relating to social diseases which
point to the need of sex-education as one method of prevention, are
referred to the pamphlets published by the American Society of Sanitary
and Moral Prophylaxis; Morrow's "Social Diseases and Marriage";
Creighton's "The Social Disease and How to Fight It"; Dock's "Hygiene
and Morality"; Henderson's "Education with Reference to Sex"; and
certain chapters in Warbasse's "Medical Sociology."
[Sidenote: Estimated amount of disease.]
With regard to the accuracy of the commonly quoted statements
concerning the prevalence of social disease, and therefore of
immorality, it must be said in all fairness that there has been much
guesswork and some deliberate exaggeration. We learn from various books
and lectures that fifty, sixty-five, seventy-five and even ninety per
cent of the men in the United States over eighteen years of age are at
some time infected with at least one of the social diseases. The fact
is that there is no scientific way of getting accurate statistics, for
unlike other contagious diseases, the venereal ones are kept more or
less secret, and numerous cases cannot be discovered by health
officers. All the published figures regarding the prevalence of such
diseases are merely estimates based upon the experience of certain
physicians with special groups of men, especially in hospitals. There
is no reliable scientific evidence as to the prevalence of venereal
disease in the whole mass of our American population.
[Sidenote: Education not concerned with percentages.]
However, so far as education is concerned, there is nothing to be
gained by dispute as to the possible inaccuracy of the higher
percentages,[1] for it is generally admitted that probably over fifty
per cent of the men in America and Europe become infected with
gonorrhea or syphilis, or both, one or more times during their lives,
especially in early manhood. This conservative estimate is sufficient
to show that the sexual morals of probably the majority of men are at
some time in their lives loose. There is reason to believe that with
most such men the period of moral laxity is in early manhood before
marriage, which, though not excusable, is explainable on physiological
grounds. It is important to correct the wrong impression which is now
widespread, especially among women who have read the more or less
sensational statements in certain books and magazines, that the quoted
figures on social disease mean that from fifty to ninety per cent of
all men are immoral from time to time for many years. If that were
true, the situation represented by the highest estimates would be
hopeless, and we might as well start out to adjust society to a system
of recognized sexual promiscuity. Fortunately, it is far from true, for
a great many men included in even the conservative statistics of
social disease were infected because they strayed from the moral path
very few times and in many cases only once. This fact makes the outlook
for improved sexual morals and health more hopeful, for probably the
majority of young men need help in controlling themselves for a few
years only, especially between eighteen and twenty-five.[2]
[Sidenote: Established facts.]
The reports of medical men regarding the damage done by the social
diseases are inaccurate chiefly when they attempt to state percentages
of the whole population. They are reliable when they state observed
facts, such as the following: It is now established in medical science
that (1) gonorrheal infection results in tens of thousands of cases in
complications, such as heart disease, gonorrheal rheumatism, sterility
of both men and women, blindness of infants, inflammatory diseases of
female reproductive organs, and other well-marked sequelae of the
disease; and (2) that syphilis is responsible for a large majority of
cases of locomotor ataxia, paresis and certain types of insanity, and
also for numerous aneurisms of arteries, many apoplexies, and much
disease of liver, kidneys, and other organs. Moreover, syphilis is
charged with being the greatest race destroyer. Fournier, the great
French specialist, noted that only two children survived from a series
of ninety pregnancies of syphilitic women of the well-to-do class. It
is probably true that much less than ten per cent of syphilitized
embryos ever grow into mature men and women, and even these few
survivors are likely to carry in their bodies the germs or the "virus"
of syphilis which may affect the next generation.
[Sidenote: Social diseases admittedly dangerous.]
Such direct statements as the above may be accepted as not exaggerated.
However, it little matters in sex-education, except for the purposes of
sensational writers, whether statistics regarding the damage done by
venereal diseases are more than estimates; for it is sufficient to
remember that every physician of large experience agrees that syphilis
and gonorrhea are so common and so destructive of health and life that
they must be classed among the most dangerous diseases that now
threaten the human race. This ought to be sufficient to attract the
serious attention of every thinking man and woman.
[Sidenote: Double standard of morality.]
Thus, in general survey, we see the great problems of social-sexual
hygiene caused by diseases that are widely distributed because sexual
instincts are uncontrolled. In short, the alarming problem of the
social diseases results from masculine promiscuity or the failure of
men to adhere to the monogamic standards of morality. In other and
familiar phrasing, there is widespread acceptance and practice of the
so-called "double standard of sexual morality," a monogamic one for
respectable women and promiscuity for many of their male relatives and
friends. (See writings of Morrow, especially "The Sex Problem"; also
Creighton's "The Social Disease.")
[Sidenote: One problem for sex-education.]
Our brief survey of the hygienic problems caused by sexual promiscuity
and its characteristic diseases is sufficient to indicate one great
problem for sex-education. Such social-hygiene problems have been most
responsible for the recent and rapid rise of the movement for
sex-education, and they must be recognized in any adequate scheme for
instruction of young people.
[Sidenote: Is sex-hygiene adequate?]
Can scientific education hope to solve the sexual problems of society
by inculcating such fear of venereal diseases that men will remain true
to the monogamic code of morality? Many cynical disbelievers in
sex-hygiene answer this question negatively by asking in biblical
phrase, "Can the leopard change his spots?" In other words, these
doubting ones believe that sexual instincts are so firmly fixed in the
nature of _many_ men and _some_ women that there is no hope of radical
change through education.[3] There is something in this point of view.
It is probably true that even the most radical advocates of
sex-education do not hope to secure universal monogamy and consequent
disappearance of social diseases. A conservative and rational answer to
the above question whether sex-education can solve the problem of
social diseases, is that a large percentage of even civilized people
are not yet ready to have their most powerful instincts controlled by
scientific knowledge. Hence, there is no hope that the hygienic task of
sex-education will be finished soon after instruction becomes an
established part of general education in homes and schools. At the very
best there will be incomplete returns for the social-hygienic aspect of
sex-instruction, but already we know for a certainty that enough young
men will be influenced to make the teaching justifiable. I feel sure of
this because I have met personally many such men and my friends know
many more.
According to the investigations made by Dr. Exner, the medical
secretary of the Young Men's Christian Association, a great reduction
of venereal disease has followed sex-hygienic campaigns in college
towns.
[Sidenote: Medical treatment.]
In another way hygienic teaching may reduce the amount of venereal
diseases, and that is by leading infected individuals to seek thorough
medical treatment without delay. This, of course, will render the
diseased person non-infectious to others. Physicians report that there
is now a marked movement in this direction and, moreover, that many
infected young men voluntarily seek medical examinations before
marriage.
[Sidenote: Woman's need of information.]
Even if we refuse to believe that social-hygienic teaching will protect
many young men from sexual diseases, there is the woman's need of
information to be considered. As said before, women more than men
suffer the consequences of venereal infections. Therefore, every young
woman who considers marriage should know the possibility of danger to
herself and her children, and be able to decide accordingly. Of course,
even with much knowledge she may marry the wrong man, for correct
diagnosis of social disease is not always easy; but if her confidence
is betrayed and she becomes infected, she ought to know the importance
of immediate and radical medical treatment. Let me illustrate these
statements that women should know the danger of venereal disease. One
of my college friends neglected an important legal case to travel seven
hundred miles in order to tell face to face another college friend that
she was about to marry a dangerous man. Being utterly ignorant of the
existence of sexual diseases, the girl and her mother characterized my
friend's statement by a short and ugly word, and ordered him to leave
their home instantly. The marriage occurred and some months later the
young woman went to her grave, a victim of gonorrheal salpingitis and
peritonitis.
Another case which illustrates the danger of a woman's ignorance: One
of my students of many years ago married a minister who infected her
with syphilis and kept her from medical attention until the disease
was in a highly developed stage, and even then conspired with an
inefficient doctor to keep her ignorant of the nature of the disease.
[Sidenote: The right to knowledge.]
These are not extreme cases, for any physician with large experience
knows that such things are common. Medical literature is full of such
painful recitals of venereal tragedies. It is not desirable that all
young women should know the details of such tragedies, but they should
know that dangers exist. Parents and educators will not have done their
duty until they cooperate to give all young women the protective
knowledge they have a right to demand.[4]
[Sidenote: Best people must lead.]
There is another way of looking at the possible effect of the social
side of sex-hygienic instruction. It is sure to make a decided
impression upon many young people of the type that we regard as the
best in every way. These will be the leaders of the future and they in
turn will help improve conditions. Perhaps it may all work out as the
drug problem is being solved. Widespread social and hygienic
information regarding the harmful effect of alcohol, cocaine, opium,
and other drugs has first of all impressed leading citizens; and these
are beginning to control by laws those who cannot be reached directly
by education. In some such ways those who are impressed by formal
sex-education may lend a hand in influencing many who could not be
touched directly by hygienic education.
[Sidenote: Legislation needed.]
There is no doubt that public enlightenment regarding the dangers of
social diseases will soon lead to legislation and public medical work
which will contribute greatly towards reduction of the diseases. For
example, legislation with reference to venereal disease should require
doctors to report cases to health officers, should forbid "quack"
advertising of fake "cures," should forbid sale by drug stores of
nostrums for personal treatment, should provide dispensaries and
hospitals for reliable treatment at reasonable cost, should require
medical examinations for marriage licenses and provide for such
examinations at moderate charges or at public expense, should require
certain sanitary precautions in care of eyes of new-born infants, and
should provide for discovery and treatment of congenital syphilis in
school children. These are lines in which good laws might help vastly
in the war against the social diseases. Moreover, it is obvious that
all laws which help control the social evil will work indirectly
against the social diseases.
[Sidenote: Probable results of instruction.]
In conclusion, it seems probable that popular knowledge of the social
side of sex-hygiene will reduce the amount of venereal disease (1) by
teaching some people the dangers of promiscuity, (2) by adoption of
certain sanitary precautions that lessen danger of infection, (3) by
leading people to seek competent medical aid which, while often
failing to restore the victim's health, will probably eliminate the
danger of contagion for others, and (4) by intelligent support of laws
that directly or indirectly affect the social diseases.
[Sidenote: Social diseases not most important.]
I have given great prominence to the social-sexual diseases in their
relation to sex-education because along this line there has been
developed the widespread interest in sex-instruction as _one_ method of
protecting young people against promiscuity. So far as the questions of
teaching are concerned, my personal view is that some of the other
reasons or problems for sex-instruction are more important, because I
believe that educational emphasis on them will give the greatest
results in improved sexual conditions of society.