Syphilis as a Social Problem
The simple device of talking plain, matter-of-fact English about a thing
has a value that we are growing to appreciate more and more every day.
It is only too easy for an undercurrent of ill to make headway under
cover of a false name, a false silence, or misleading speech. The fact
that syphilis is a disease spread to a considerable extent by sexual
relations too often forces us into an attitude of veiled insinuation
about it, a mistaken delicacy which easily becomes prudish and
insincere. It is a direct move in favor of vulgar thinking to misname
anything which involves the intimacies of life, or to do other than look
it squarely in the eye, when necessity demands, without shuffling or
equivocation. On this principle it is worth while to meet the problem of
a disease like syphilis with an open countenance and straightforward
honesty of expression. It puts firm ground under our feet to talk about
it in the impersonal way in which we talk about colds and pneumonia and
bunions and rheumatism, as unfortunate, but not necessarily indecent,
facts in human experience. Nothing in the past has done so much for the
campaign against consumption as the unloosing of tongues. There is only
one way to understand syphilis, and that is to give it impartial,
discriminating discussion as an issue which concerns the general
health. To color it up and hang it in a gallery of horrors, or to befog
it with verbal turnings and twistings, are equally serious mistakes. The
simple facts of syphilis can appeal to intelligent men and women as
worthy of their most serious attention, without either stunning or
disgusting them. It is in the unpretentious spirit of talking about a
spade as a spade, and not as "an agricultural implement for the
trituration of the soil," that we should take stock of the situation and
of the resources we can muster to meet it.
+The Confusion of the Problem of Syphilis with Other Issues.+--Two
points in our approach to the problem of syphilis are important at the
outset. The first of these is to separate our thought about syphilis
from that of the other two diseases, gonorrhea, or "clap," and
chancroids, or "soft sores," which are conventionally linked with it
under the label of "venereal diseases."[2] The second is to separate
the question of syphilis at least temporarily from our thought about
morals, from the problem of prostitution, from the question as to
whether continence is possible or desirable, whether a man should be
true to one woman, whether women should be the victims of a double
standard, and all the other complicated issues which we must in time
confront. Such a picking to pieces of the tangle is simply the method of
scientific thought, and in this case, at least, has the advantage of
making it possible to begin to do something, rather than saw the air
with vain discussion.
[2] The three so-called venereal diseases are syphilis, gonorrhea,
and chancroid or soft ulcer. Gonorrhea is the commonest of the
three, and is an exceedingly prevalent disease. In man its first
symptom is a discharge of pus from the canal through which the urine
passes. Its later stages may involve the bladder, the testicles, and
other important glands. It may also produce crippling forms of
rheumatism, and affect the heart. Gonorrhea may recur, become
latent, and persist for years, doing slow, insidious damage. It is
transmitted largely by sexual intercourse. Gonorrhea in women is
frequently a serious and even fatal disease. It usually renders
women incapable of having children, and its treatment necessitates
often the most serious operations. Gonorrhea of the eyes, affecting
especially newborn children, is one of the principal causes of
blindness. Gonorrhea may be transmitted to little girls innocently
from infected toilet seats, and is all but incurable. Gonorrhea,
wherever it occurs, is an obstinate, treacherous, and resistant
disease, one of the most serious of modern medical problems, and
fully deserves a place as the fourth great plague.
Chancroid is an infectious ulcer of the genitals, local in
character, not affecting the body as a whole, but sometimes
destroying considerable portions of the parts involved.
Let us think of syphilis, then, as a serious but by no means hopeless
constitutional disease. Dismiss chancroid as a relatively insignificant
local affair, seldom a serious problem under a physician's care.
Separate syphilis from gonorrhea for the reason that gonorrhea is a
problem in itself. Against its train of misfortune to innocence and
guilt alike, we are as yet not nearly so well equipped to secure
results. Against syphilis, the astonishing progress of our knowledge in
the past ten years has armed us for triumph. When the fight against
tuberculosis was brought to public attention, we were not half so well
equipped to down the disease as we are today to down syphilis. For
syphilis we now have reliable and practical methods of prevention, which
have already proved their worth. The most powerful and efficient of
drugs is available for the cure of the disease in its earlier stages,
and early recognition is made possible by methods whose reliability is
among the remarkable achievements of medicine. It is the sound opinion
of conservative men that if the knowledge now in the hands of the
medical profession could be put to wide-spread use, syphilis would
dwindle in two generations from the unenviable position of the third
great plague to the insignificance of malaria and yellow fever on the
Isthmus of Panama. The influences that stand between humanity and this
achievement are the lack of general public enlightenment on the disease
itself, and public confusion of the problem with other sex issues for
which no such clean-cut, satisfactory solution has been found. Think of
syphilis as the wages of sin, as well-earned disgrace, as filth, as the
badge of immorality, as a necessary defense against the loathesomeness
of promiscuity, as a fearful warning against prostitution, and our
advantage slips from us. The disease continues to spread wholesale
disaster and degeneration while we wrangle over issues that were old
when history began and are progressing with desperate slowness to a
solution probably many centuries distant. Think of syphilis as a medical
and a sanitary problem, and its last line of defense crumbles before our
attack. It can and should be blotted out.
+Syphilis, a Problem of Public Health Rather than of Morals.+--Nothing
that can be said about syphilis need make us forget the importance of
moral issues. The fact which so persistently distorts our point of view,
that it is so largely associated with our sexual life, is probably a
mere incident, biologically speaking, due in no small part to the almost
absurdly simple circumstance that the germ of the disease cannot grow in
the presence of air, and must therefore find refuge, in most cases, in
the cavities and inlets from the surface of the body. History affords
little support to the lingering belief that if syphilis is done away
with, licentiousness will overrun the world. Long before syphilis
appeared in Europe there was sexual immorality. In the five centuries in
which it has had free play over the civilized world, the most optimistic
cannot successfully maintain that it has materially bettered conditions
or acted as a check on loose morals, though its relation to sexual
intercourse has been known. As a morals policeman, syphilis can be
obliterated without material loss to the cause of sexual self-restraint,
and with nothing but gain to the human race.
It is easier to accept this point of view, that the stamping out of
syphilis will not affect our ability to grapple with moral problems, and
that there is nothing to be gained by refusing to do what can so easily
be done, when we appreciate the immense amount of innocent suffering for
which the disease is responsible. It must appeal to many as a bigoted
and narrow virtue, little better than vice itself, which can derive any
consolation in the thought that the sins of the fathers are being
visited upon the children, as it watches a half-blind, groping child
feel its way along a wall with one hand while it shields its face from
the sunlight with the other. There are better ways of paying the wages
of sin than this. Best of all, we can attack a sin at its source instead
of at its fulfilment. How much better to have kept the mother free from
syphilis by giving the father the benefit of our knowledge. The child
who reaped his sowing gained nothing morally, and lost its physical
heritage. Its mother lost her health and perhaps her self-respect.
Neither one contributes anything through syphilis to the uplifting of
the race. They are so much dead loss. To teach us to avoid such losses
is the legitimate field of preventive medicine.
On this simplified and practical basis, then, the remainder of this
discussion will proceed. Syphilis is a preventable disease, usually
curable when handled in time, and its successful management will depend
in large part upon the coöperation, not only of those who are victims of
it, but of those who are not. It is much more controllable than
tuberculosis, against which we are waging a war of increasing
effectiveness, and its stamping out will rid humanity of an even greater
curse. To know about syphilis is in no sense incompatible with clean
living or thinking, and insofar as its removal from the world will rid
us of a revolting scourge, it may even actually favor the solution of
the moral problems which it now obscures.