By Edith R. Spaulding, M. D.
[Resident Physician, Reformatory for Women, South Farmington, Mass.]
That a better knowledge of the mental and physical characteristics of
the prostitute herself could be obtained, and the causes as well as the
results of her life be understood, the following study was undertaken.
240 women who have recently been inmates at the Massachusetts
Reformatory for Women have been studied. All cases were included
in which at any time there had been a history of commercialized
promiscuous sex immorality. Only those cases were discarded in which
the physical examination was incomplete, if the history obtained gave
no evidence of disease.
A study such as this does not aim to discover the fundamental physical
or mental causes of prostitution as a social problem in the community.
Such a problem is too involved to be considered from this limited
standpoint. Recognizing, however, the fact that there is the demand in
society, this aims to show the types of women from whom the supply is
obtained and the benefits which may be derived for the community by
further study and treatment of such types.
Two hundred and five of the cases studied have received a psychological
examination. This has included the history of their educational
advantages and a study of the results obtained, as well as
psychological tests which estimate native ability aside from formal
educational training. In all doubtful cases, or in cases in which there
appeared to be mental defect, the Binet-Simon tests have also been
used. As a result of these examinations the cases have been roughly
classified as follows:
Per Ct.
Mentality Good 43 cases 20.9 32.6
” Fair 24 ” 11.7
” Dull 30 ” 14.6
” Subnormal 62 ” 30.3
Moron 45 ” 22.5 52.8
Imbecile 1 case
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Total 205 cases
About a third of the cases showed fair or good mentality. These cases
have been studied in detail for evidence of other mental and nervous
defects aside from mental deficiency. The results will be given later.
Over half of the cases studied were found to be defective mentally.
This corresponds to the results of the investigation of the White Slave
Commission[2] made recently in Massachusetts, in which 51 per cent. of
300 cases studied mentally were found to be defective and represented
segregable types. We should consider at least one quarter of our own
cases segregable from a standpoint of mental defect alone, and besides
these perhaps, another 20 per cent., candidates for a defective
delinquent institution, if such a classification should include
those cases which show marked psychopathic tendencies associated
with subnormal mentality. The cases which are considered segregable
types appear to be unable to care for themselves in the community.
Besides the harm that may be done to them on account of their weakened
resistance they become an active menace to others; first, through the
spread of venereal disease; second, through their immoral influence
in the community; and third, through bringing into the world children
who will grow up to be as much a menace to society as they themselves
have been. It should be the responsibility of representative members of
society to see that provision is made for the care of such individuals,
and that they are not punished for offences for which they can in no
way be considered responsible.
Besides the cases showing mental defect alone, there are many cases
both among the mentally defective and those showing normal mentality,
which show other mental or nervous defects, such as epilepsy, hysteria
and psychopathic tendencies. In the study of criminality of all kinds,
such abnormal mental and nervous conditions play an important part.
This is especially true of the class of women which is arrested on
account of sex offences. In the environment of mill towns and certain
sections of large cities, from which a large part of this population
comes, the temptations which appeal to sex are tremendous, even to the
individual who has a normal mentality and is well balanced. If through
such conditions as slight mental dullness or extreme nervousness, the
equilibrium is disturbed, the power of resistance is lost and the
individual is unable to cope with the temptations which are usually
about her.
Eighteen cases or 7.5 per cent. of the 240 cases studied have been
epileptics; 16 cases or 6.6 per cent. have hysteria. Both conditions
are very important as factors of social instability. The variability of
epileptics and the extremes of which they are capable are well known to
students of criminology. Many times we find cases suggesting a latent
epilepsy among individuals in whose families there are other cases of
the same disease. In these cases we see only what appear to be psychic
manifestations or great irregularity in tests and behavior.
The cases of hysteria are also interesting on account of their extreme
suggestibility. It is only necessary to watch the manifestations of
this characteristic in an institution, to realize what an important
factor suggestibility has been in the outside world in leading to their
delinquencies. Mental imagery in such cases is of immense importance.
One case of hysteria which we had under observation would while in
her attacks of unconsciousness, often repeat (naming a woman who was
living a life of prostitution outside), “Mary, I will come to you; I
will give up my child; there is nothing else for me in the world and I
will come to you and do as you say.” In studying her mental processes,
the pictures which had been drawn for her of luxury and gaiety in such
a life were continually before her, too strongly contrasted with any
reasonable pictures which it was possible for us to conjure up for her.
Another important class is that which includes the borderline cases,
which have perhaps never been satisfactorily classified. Many of these
would be in the group termed by one authority “control defectives.”
The term expresses well their explosive natures which may be seen
when, without provocation they attack any person who happens to
incite their enmity, whether she be officer or other inmate, or when
by unreasonableness and loss of temper they bring unruliness and the
necessity for discipline into an otherwise peaceful and well-behaved
group. Many of these cases come from families in which there are many
cases of insanity, and although they themselves show no signs of a
definite psychosis, there appears to be much inherited instability.
Other cases show the results of a meningitis or an encephalitis which
they have had in childhood. Occasionally we see cases in which the
instability apparently followed a head injury.
Besides these cases there are many who have previously been confined in
hospitals for the insane, and who represent very unstable types. They
may or may not have defective mentality, associated with the defect
in self-control. They are one of the hardest classes of cases to deal
with in institutions of any kind. The officers of penal institutions
recognize their abnormality, and feel that they should be confined in
insane hospitals because of their dangerous character. On account of
the lack of a definite psychosis the insane hospitals naturally take
them very unwillingly. Even though they show marked mental defect,
institutions for the feebleminded are unwilling to admit them because
of the demoralizing effect they produce on the more amenable types and
the upsetting influence they have upon the institution routine. Many of
these cases will doubtless be sent to defective delinquent institutions
when those institutions shall at last be established. Whether the
defect is a mental one or a nervous one matters little in their menace
to society. The following case may be cited as an illustration of such
a type:
A woman was arrested for assault after trying to throw vitriol in her
lover’s eyes. At that time she was taken from the jail to a hospital
for the insane because she had marked hallucinations of sight and
hearing. These at the time were thought to be of alcoholic origin,
and disappeared quickly. She was transferred to the reformatory where
she had previously served a sentence. At various times since her
confinement there she has assaulted other inmates and matrons, often
violently. Recently, after such an attack on a matron, she apparently
seemed ignorant of what she had done. While she acknowledged having
attacked people in the past, she felt that this time they had attacked
her. A few days later she was found in a vague although rather savage
mental condition, with marked delusions. She had had hallucinations of
sight and was not oriented as to time or place. The woman is subnormal
mentally and it would have been hardly possible for her to have
feigned the condition. That evening, becoming annoyed at something,
she flew into a tremendous rage, which was much more characteristic of
her usual self than the previous dazed condition had been. Her violent
temper seemed to bring her to herself, and the next morning she could
recall but faintly what she had said the day before, although she
remembered vaguely being much more frightened at what she thought she
had seen in her room. Two days later she laughed at what she was told
she had said, realizing the ridiculousness of it and could hardly
believe that it was true.
Although the condition and its quick recovery suggested an hysterical
basis (no evidence of epilepsy has been found, and alcohol was ruled
out by her long stay in the institution) nevertheless, the condition
while it lasted made her wholly irresponsible, and it can easily
be seen what a menace such an individual would be in a community.
Thirty-seven per cent. of the 240 cases studied represent aberrational
types of greater or less intensity. It can readily be understood what
a factor such types would be in furnishing individuals of weakened
resistance to help fill the demand of prostitution.
The 67 cases showing apparently normal mentality when studied further
have revealed the following characteristics:
Twenty-eight cases have shown hysteria, epilepsy or marked aberrational
tendencies. Of the 39 cases remaining, 8 show innate characteristics,
which, combined with the unfortunate conditions of home and environment
in which they were placed, were apparently responsible for their
delinquency. The innate characteristics of these cases include the
following:
The aggressive untamed personality with primitive passions; the woman
who has gone through life with a chip on her shoulder, believing that
the world owed her a living; the sensual type which has over-developed
physical characteristics; the immature personality, non-resisting in
temperament (often called weak-willed), which is unable to appreciate
and shoulder responsibility; excessive vanity and love of pleasure in
an indolent nature, or the craving for excitement and applause and the
love of leadership, with only undesirable avenues open in which to
exercise it.
Three cases were due largely to home environment alone. In these cases
there has been immorality between different members of the family.
Five cases were due to the environment in the community alone,--with
an apparently good home environment a single bad companion or group
of companions had definitely influenced them to lead immoral lives.
The factors in two cases were unresolved. Twenty-one cases appear
to be due to the environment in the home and in the community, and
were apparently normal types. The last group of 31 cases, however,
represents but 15 per cent. of the 205 cases studied. Considering
that those cases which show poor mental ability are perhaps not able
to cope fairly with their environment on account of their slight
mental defect, we find 85 per cent. of the cases studied showing some
underlying defective mental or physical factor. We do not believe
that this represents to any extent the cause of prostitution, for
there are doubtless large numbers of individuals in the community
with the same mental and physical defects who are not leading such
a life. Still we feel that this class of women, if not sufficiently
protected, represents the ones who are first (on account of their
weakened resistance) to offer themselves to fill the demand. It may be
interesting to note, in this connection, that although all of these
cases have been studied from a social standpoint, and their own reasons
for going into such a life have always been inquired into, in only
two cases have we been able to find any definite relation between the
economic conditions and the choice of this means of livelihood.
_The Physical Aspect._
As complete a clinical history as possible has been obtained from
each woman, and has been supplemented in as many cases as possible
by laboratory tests to determine the extent of venereal disease. If
the clinical history or the laboratory findings have given evidence
of venereal disease, the individual has been considered to have the
disease without the verification by both methods. As has been stated
before, those cases in which there was no evidence of disease, but in
which it was impossible to make a complete physical examination, have
been discarded. As a result of these examinations we have found only
one case, which after complete examination, did not show the presence
of either disease. Thus over 99-1/2 per cent. of the cases show the
presence of one of the two venereal diseases--134 cases or 55.8 per
cent. gave no evidence of having had both.
Of 238 cases which were examined for syphilis, 156 or 65.5 per
cent. gave evidence of having had the disease. The results of the
examinations for syphilis are as follows:
Per cent.
Number of cases giving evidence of the disease clinically
or having a positive Wassermann reaction 156 or 65.5
Number of cases giving positive Wassermann reaction 137 or 57.5
Number of cases giving a positive history or presenting
symptoms of the disease 85 or 35.7
Number of cases which were verified by both history and
Wassermann reaction 64 or 26.9
Number of cases giving a negative Wassermann reaction and
presenting no clinical evidence of the disease 82 or 34.9
Number of cases giving evidence clinically or
bacteriologically of the disease 216 or 96.8
Number of cases which gave a clinical history of the
disease 209 or 93.7
Number of cases verified by bacteriological examination 159 or 71.3
Number of cases verified by both methods 152 or 68.17
Number of cases examined clinically and bacteriologically
which gave no evidence of the disease 7 or 3.1
If only the cases were selected in which it was possible to obtain
complete examinations both clinically and by laboratory methods also,
these percentages would undoubtedly be much higher. However, as
they stand at present, they represent a great factor in the problem
of prostitution. Statistics have shown that 22 per cent. of first
admissions in hospitals for the insane are cases with general paresis,
which is considered psychosis resulting from syphilis. This factor
alone should make us realize the importance of the treatment of such a
disease in the community and the necessity for hospitals (as pointed
out by the report of the White Slave Commission of Massachusetts) where
people could be invited to come for the treatment of this disease as
well as for gonorrhoea. At present, as is only too well known, there
are very few hospitals where either of these diseases are treated, and
it will be remembered that these are the only contagious diseases which
have not been made reportable by the Board of Health.
In studying the lives of these individuals for the factors which
have determined their mode of life, there are several physical
characteristics which should be mentioned. First, the perfectly normal
condition of adolescence is always to be taken into consideration.
In many cases of individuals with less than normal stability and
insufficiently protected environment, it has been the adolescent
tendencies which have been the dominant factor in determining their
life. Again, the factor of too early development has often been seen.
Puberty appears before the inhibitions which come with adolescence have
had time to be correspondingly developed. This is a very noticeable
factor in the study of such cases found in the juvenile court, and has
been recognized in our own cases and verified by the histories obtained
from the parents of the individual. Besides these factors, there is
the type in which the physical characteristics predominate from birth.
While it may be possible for these individuals to have their energy
directed along constructive lines, it is often impossible to reach them
and recognize their struggles until habits of an unfortunate nature
have been irrevocably formed in their lives.
_Summary._
In reviewing the 240 cases, which we appreciate represent the types
which come to reformatories and are not necessarily characteristic of
all types of prostitution in society, we find the following facts: 52
per cent. defective; 16 per cent. dull; 28 of the remaining 67 cases
with normal mentality showed other mental and nervous defects. Only
15 per cent. of the whole number appeared to be normal mentally and
physically. Probably 40 per cent. could be considered segregable types
and should be placed permanently, or at least during the child-bearing
age, in custodial institutions. If these cases who are apparently
unable to care for themselves could be removed from the community, we
believe the supply for prostitution would be materially lessened and
that such a movement would be a help in attacking the problem.
As has already been said, practically 100 per cent. of the cases
studied show the presence of at least one of the two venereal diseases,
while over 55 show the presence of both.
Of the cases studied for evidence of syphilis, over 65 per cent. had
had the disease; of those studied for gonorrhoea over 96 per cent. gave
evidence of having had it. Should we not recognize the far-reaching
results of such diseases in a community and use every means possible to
help eliminate them?
No one disputes the fact that the problem of prostitution is largely
a moral one, and must be solved through educational methods. However,
while we believe that certain conditions can be much alleviated, we
believe also that the problem will never be fully solved from the moral
standpoint alone. The most crying need of the present time is in the
mental and physical aspect of the situation, and we believe that the
greatest possible emphasis at this time should be laid on these factors
and their great menace to society.
[1] Read at the National Conference of Charities and Corrections,
Memphis, May, 1914.
[2] Report of the Commission for the Investigation of the White Slave
Traffic so called.