Moral and Personal Prophylaxis
Prophylaxis, of course, means prevention, and it has been a large part
of the purpose of the present study to deal with syphilis from the
standpoint of prevention and cure. The material of this chapter is,
therefore, only a special aspect of the larger problem.
+Repression of Prostitution.+--By the moral prophylaxis of syphilis is
meant the cultivation of such moral ideals as will contribute to the
control of a disease which is so closely associated with sexual
irregularities. Since public and secret prostitution serve as the
principal agencies for the dissemination of the disease, it follows that
anything tending to decrease the amount of disease in prostitutes, on
the one hand, or to diminish the amount of promiscuous sexual activity,
on the other, will retard the spread of syphilis. Systems based on the
first ideas, aiming rather to control the disease in public women by
inspection of their health and activities than by suppressing
prostitution, have failed because the methods of control ordinarily
practised are worthless for the detection of infectiousness. So-called
regulation has, therefore, given way very largely in progressive
communities to the second ideal of repressing or abolishing the outward
evidences of vice as far as possible. In behalf of sanitary control of
prostitution, leaving out of the question its moral aspect, it must be
admitted that Neisser, probably the greatest authority on the sexual
diseases, believed that, as far as syphilis is concerned, the use of
salvarsan as a means of preventing infection from prostitutes has never
had a satisfactory trial. In behalf of abolition it would seem that
systematic stamping-out of the outward evidences of vice, the making of
immorality less attractive and conspicuous, is, in theory at least, a
valuable means of diminishing the extent and availability of an
important source of infection.
+Educational Influences.+--To do something positive against an evil is
certainly a more promising mode of attack than to use only the negative
force of repression of temptation. Education of public opinion offers us
just such a positive mode of attack. Men and women and boys and girls
should first be taught sexual self-control even before being made aware
of the risk they run in throwing aside the conventional moral code.
Teach honor first and prudence next. The slogan of education in sexual
self-restraint is the easiest to utter and the most difficult to put
into practice of all the schemes for the control of sexual diseases. A
large part of the difficulty of making education effective arises from
one or two situations which are worth thinking over.
+Economic Forces Opposing Sexual Self-control.+--In the first place,
while continence, or abstinence from sexual relations, is a valuable
ideal in its place, it cannot be indefinitely extended with benefit
either to the individual or to the race. The instinct to reproduce is as
fundamental as the instinct of self-preservation and the desire for
food. A social order which disregards it or defies it will meet defeat.
To an alarming extent the tendency of the present economic system is to
create unsocial impulses by making the normal gratification of sexual
instinct in marriage and the assumption of the responsibility of a
family more and more difficult. The cost of living is steadily rising
without a corresponding certainty on the part of a large proportion of
young men that they can meet it for themselves, to say nothing of
meeting it for wife and children. The uncertainties of a 'job' are often
serious enough to discourage the rashest of men from depending on a
variable earning power to help him do his share for the advancement of
the race. It will be an impossible task to convince even naturally
clean-minded, healthy young men and women that they should live a life
of hopeless virtue because it is part of the divine order that they
should be so held down by hard times and small earnings as to make
marrying and having children an unattainable luxury. Continence and
clean living as preparations for decent and reasonably early marriage
and the raising of a healthy family are the highest of ideals, and ought
to be preached from every housetop. Continence as a life-long punishment
for the impossible demands of an oppressive social and economic order
gets as little attention as it deserves. First, let us make a clean
sexual life lead with greater certainty to some of the rewards that make
life worth living and we shall then have a more substantial basis for
making continence before marriage other than empty words. If every
father, for example, could say to his sons and daughters that if they
showed themselves clean men and women he would back them in an early
marriage, there would be an appreciable decrease in the amount of young
manhood which is now squandered on indecency. If every employer, or the
state itself, would give a clean marriage a preferred position in the
social and economic scale, and, by helping to meet the cost of it,
recognize in a substantial way the value to the race of a family of
vigorous children, an important factor in youthful sexual laxity would
be robbed of its power. No one will assert that such remedial proposals
are of themselves cure-alls for present evils, but they must have at
least an emphatic place in the future of moral prophylaxis.
+The Teaching of Sexual Self-control.+--First then, make the social
order such that sexual self-control yields a reward and not a
punishment. Second, teach sexual control itself, since it is one of the
fundamental means of attack on the problem of syphilis. How can such
control be taught? Information about the physical dangers of illicit
sexual indulgence is of course of value, and should be spread broadcast.
But taken by itself, the fear of disease, especially if it enters the
individual's life after the age when he has already experienced the
force of his sexual instincts, is a feeble influence. The person who has
nothing but the knowledge that he is taking great risks between him and
the gratification of his sexual desires will take the risks and take
them once too often. One cannot begin to teach the boy or girl of high
school age that sexual offenses mean physical disaster, and expect to
control syphilis. The time to control the future of the sexual diseases
is in the toddler at the knee, the child whose daily lesson in
self-control will culminate when he says the final 'No' to his passions
as a man. The child who does not learn to respect his body in the act of
brushing his teeth and taking his bath and exercise, and whose thought
and speech and temper are unbridled by any self-restraint, will give
little heed when told not to abuse his manhood by exposing himself to
filth. The prevention of syphilis by sexual self-control goes down to
the foundations of character, and has practical value only in those
whose self-control is the expression of a lifelong habit of
self-discipline bred in the bone from childhood, not merely painted on
the surface at puberty. Those who want their sons and daughters never to
know by personal experience the meaning of syphilis must first build a
foundation in character for them which will make self-control in them
instinctive, almost automatic. Knowledge of sexual matters has power
only in proportion to the strength of the character that wields it, and
on well-rounded character education, rather than mere knowledge of the
facts, the soundest results will be based.
[Illustration: E. ROUX
ÉLIE METCHNIKOFF [1845-1916]
(From McIntosh and Fildes, "Syphilis from the Modern Standpoint,"
New York, Longmans Green & Co., 1911.)]
The moral prophylaxis of syphilis is then briefly summed up in the
repression of as many of the recognized agencies for the spread of the
disease as possible; the making of continence a preparation for a normal
sex life rather than an end in itself; the control and remedying of
those influences which are making normal marriage harder of attainment;
and the development of an instinctive self-control and self-discipline
in every field of life from childhood up as the character basis
necessary to make knowledge about sexual life and sexual disease
effective.
+Personal Preventive Methods.--Continence.+[15]--There remains to be
considered what is often called the personal prophylaxis of syphilis,
meaning thereby the methods by which the individual himself can diminish
or escape the risk of infection. The first and most effective method of
avoiding syphilis is abstinence from sexual relations and intimacies
except in normal marriage with a healthy person. Although it has been
alluded to under the moral prophylaxis of syphilis, it deserves to be
reëmphasized. No consideration as to the justice or desirability of
continence and self-restraint can add anything to the simple fact that
it is _the_ way to avoid disease, and can be unhesitatingly recommended
as the standard for personal prophylaxis. In the experience of
physicians it is an axiom that disillusionment sooner or later overtakes
those who think they are exempt from this rule. Persons who discard
continence in favor of what they believe to be some absolutely safe
indulgence are so almost invariably deceived that the exceptions are not
worth considering. Although infection with syphilis is no necessary
evidence of unclean living, clean living will always remain the best
method of avoiding syphilis.
[15] The American Social Hygiene Association, 105 W. 40th Street,
New York City, can supply pamphlets and lists of authoritative
publications bearing on this and related subjects.
+The Metchnikoff Prophylaxis.+--The second method of personal
prophylaxis of syphilis was developed as a result of the discovery of
Metchnikoff and Roux in 1906, that a specially prepared ointment
containing a mercurial salt, if rubbed into the place on which the germs
were deposited within a few hours (not exceeding eighteen hours, and the
sooner the better) after exposure to the risk of syphilis, would prevent
the disease by killing the germs before they could gain a foothold. This
method of protection against syphilis has been subjected to rigid tests,
with fairly satisfactory results. It has been adopted by the army and
navy of practically every country in the world, and, as carried out
under the direction of physicians and with military control of the
patient, has apparently reduced the amount of syphilitic infection
acquired in the armies and navies using it to a remarkable degree. The
method, of course, cannot assume to be infallible, but if intelligently
applied, it is one of the important weapons for the extinction of
syphilis in our hands at the present day. It fails to meet expectations
precisely in those circumstances and among those persons in whom
intelligent employment of it cannot be expected. This of course covers a
considerable number of those who acquire syphilis. What disposal an
awakened opinion will make of this knowledge remains to be seen. At the
present time it may well be doubted whether the indiscriminate placing
of it in the hands of anybody and everybody would not work as much harm
as good through ignorant and unintelligent use. This opinion is shared
by European as well as American authorities. Administered under the
direction of a physician, the Metchnikoff prophylaxis of syphilis would
undoubtedly be at its best in the prevention of the disease. For these
reasons, as well as to prevent the spread of the knowledge to those who
would be damaged by it, those interested are referred to their
physicians for a description of the method. Any one having the benefit
of it should be able to convince his medical advisor that there is good
reason why this kind of professional knowledge should be brought to bear
on his case. The ordinary methods of preventing infection by washes and
similar applications used by the "knowing ones" are most of them
worthless or greatly inferior to the Metchnikoff prophylaxis. They are,
moreover, a positive source of danger because of the false sense of
security which they create. If every person who has run the risk of
contracting syphilis should visit his physician _at once_ to receive
prophylactic treatment, the effect on syphilis at large would probably
be as good as in the army and navy. There would still be opportunity on
such occasions to bring moral forces and influence to bear on those who
would respond to them. There can be no object in withholding such
knowledge from those who are confirmed in their irregular sexual habits.
At the same time there could be few better influences thrown across the
path of one just starting on a wrong track than that exerted by a
physician of skill and character, to whom the individual had appealed to
avert the possible disastrous result of an indiscretion.