Public Effort Against Syphilis
+The World-wide Movement Against Venereal Disease.+--This chapter is
intended to give some account of the great movements now begun to
control syphilis and its fellow-diseases throughout the world. A
campaign of publicity was the starting-point of the organized attempt to
control tuberculosis, and in the same way a similar campaign has been at
the bottom of movements which now, under the pressure of the tremendous
necessities of war, are making headway at a pace that generations of
talking and thinking in peaceful times could not have brought about.
Although this country at the present writing is probably farther in the
rear than any other great nation of the world in its efforts to control
the venereal diseases as a national problem, it is fortunate in having
had the way paved for it by epoch-making movements such as those of the
Scandinavian countries, and by the studies of the Sydenham Royal
Commission on whose findings the British Government is now undertaking
the greatest single movement against syphilis and gonorrhea that has
ever been launched. For many years Germany has had a society whose roll
includes some of the greatest names in modern science, directing all its
energy toward the solution of the problem of sexual disease, and German
sentiment on these matters is developing so fast that it is difficult,
even for those in touch with such matters, to keep pace with it. In this
country progress has been much slower, hampered by peculiarities of
mental outlook and tradition very different from those which have
controlled the thought of Europe. The association of syphilis with
prostitution has been largely instrumental in putting much valuable
statistical and general knowledge of the disease into semi-private
reports and sources not available to the large mass of the thinking
public. The effect of finding the problem of syphilis invariably bound
up with discussions of the social evil has been to perpetuate in popular
thought an association which simply blocks the way to any solution of
the public health problem. While the control of prostitution will
influence syphilis, ignoring syphilis, or treating it as incidental,
will never contribute anything to the conquest of either. It is one of
the most significant features of the great movements now on foot all
over the world that they have finally adopted the direct route, and are
attacking syphilis and gonorrhea as diseases and not by way of their
association with prostitution.
The agencies in this country which are making notable efforts to push
the campaign against syphilis and gonorrhea deserve every possible
support from the thinking public. The American Social Hygiene
Association is a clearing-house for trustworthy information in regard to
the problems of sexual disease, and publishes a quarterly journal.[16]
The National Committee for Mental Hygiene and its branch societies are
also engaged in spreading knowledge of the relation of syphilis to
mental disease and degeneration. State and City Boards of Health are
active in their efforts to further the campaign, and notable work is
being done by New York City, Buffalo, Cleveland, and Rochester, New
York, both on publicity and in the provision of facilities for
recognizing and treating the diseases in question. Certain states, such
as Ohio, Michigan, and Vermont, have made steps toward an intelligent
legislative attack on different aspects of the problem. Influential
newspapers and magazines have made the idea of a campaign against these
diseases familiar enough to the public, for example, to bring a young
girl to me to ask outright without affectation that she be told about
syphilis, because she had seen the word in the paper and did not fully
understand it. The aggregate of these forces is large, and an awakening
is inevitable.
[16] Social Hygiene, New York.
To prepare ourselves for an active and intelligent share in the
movement, we should review briefly the essential elements of a public
campaign against syphilis as they have been developed by recent
investigations and legislative experiments.
+Undesirable and Freak Legislation.+--Syphilis has had a limited amount
of recognition in law, unfortunately not always wise or timely. Freak
legislation and half-baked schemes are the familiar preliminaries which
precede the grim onset of a real attack supported by public sentiment.
Typical examples of such premature legislation may be found in the
setting up of the Wassermann test as evidence of fitness for marriage
by certain states, and in the efforts of certain official agencies to
enforce the reporting of syphilis and gonorrhea by name. Proposals to
quarantine and placard all syphilis are in the same category, though
seriously entertained by some. The plan to establish by state enactment
or municipal appropriation special venereal hospitals falls in the same
class, since it is obvious that in the present state of opinion none but
down-and-outs would resort to them. The stigma attached to them would
effectually make them useless to the very group of worth-while people
which it is to the public interest to conserve and reëducate.
+Value of Conservative Action.+--It cannot be said too often that a
reasonable conservatism should temper the ardor of reformers, or more
harm than good will be done by the collapse and failure of
ill-considered special legislation. Unified action against syphilis and
gonorrhea as public health problems is as important as unified action on
the problems of railroad control, child labor, or corporate monopoly.
For that reason it is a matter of some uncertainty how much can be
accomplished by individual states in this country in the way of
restrictive legislation, such as that controlling the marriage of
infected persons, or punishing persons who fail to carry treatment to
the point of cure. Under the direction of a national bureau or
department of health administration there is no doubt that the movement
against syphilis would advance at a much more rapid pace than with the
sporadic and scattered activities of mixed state and private agencies.
+The Essential Features of a Modern Campaign.+--The repeated sifting of
the facts which has been done in recent years by important
investigations, such as that of the Sydenham Commission in Great Britain
and the Society for Combatting Sexual Disease in Germany, and the
legislative programs already mentioned, have gradually crystallized into
fairly definite form, the undoubted essentials of a program for
controlling venereal diseases, syphilis among them. These may be
summarized as follows:
1. The provision of universally available good treatment, at the expense
of the state, if necessary, for the diseases in question.
2. The provision by the state of efficient means of recognizing the
diseases at the earliest possible time and with the greatest possible
certainty in any given case.
3. The suppression of quack practice, drug-store prescribing, and
advertising of cures for these diseases.
4. Moral and educational prophylaxis and the vigorous suppression of
prostitution.
In addition to these measures, which are common to all proposals and
working systems for the control of sexual disease, certain other
recommendations may be classed as debatable, inasmuch as they are still
under discussion and have been incorporated into some and omitted from
others. These are as follows:
1. General instruction in personal prophylaxis for the population at
large.
2. Compulsory measures and penalties obliging patients to receive
treatment and continue it until cured, regardless of their own desires
in the matter.
3. Notification or reporting of cases of sexual disease to the health
authorities.
4. Indirect legislation, as it might be called, which aims to detect
infected persons before they enter on marriage rather than at the outset
of the disease, either by releasing the physician in charge of the case
from the bond of professional confidence, or by requiring health
certificates before marriage, and which annuls marriages after infection
is discovered.
+Easily Available Treatment.+--It will be noticed that toleration of
prostitution with supervision has finally disappeared from the modern
program for the control of sexual diseases. The provision for
universally available treatment, regardless of the patient's means or
circumstances, should be thought of as the one fundamental requirement
without which no program has made even a beginning. For over a century
Denmark has provided for the free treatment of all patients with
venereal disease. The Norwegian law, essentially similar, dates from
1860. Italy a few years ago adopted a similar program, placing squarely
upon the state the responsibility of providing for the care of all
patients with venereal diseases. England has just adopted a mixed
provision which will in practice place most of the responsibility upon
the state and very little on the individual, as far as the expense of
treatment is concerned. Germany has compelled her insurance companies
to shoulder the burden, and under pressure of war is hastening matters
by invoking more and more governmental aid. The recent West Australian
Act provides that every medical officer in the pay of the state shall
treat venereal disease free of charge. In comparison with the tremendous
advances over previous indifference which such programs represent, this
country makes a poor showing. Among us, no public agency is formally
charged with any duty in the matter of preventing, recognizing, or
treating the vast amount of venereal infection that mars our national
health. Certain state boards of health are attempting to perform
Wassermann tests, and certain municipalities have well-organized
laboratories for the detection of syphilis and gonorrhea, but there are
few purely public agencies that even pretend to have a specialist in
their employ to assist in the recognition of cases and conduct the
treatment of patients who cannot afford private care. Hospital and
dispensary treatment of venereal diseases is almost entirely in
semi-private hands, and a recent investigation of clinics and
dispensaries for the treatment of syphilis and gonorrhea in New York
city, for example, showed that many of them were so poorly equipped and
run at such unreasonable hours that they were frequented only by
vagabonds, were of no value in the early recognition of syphilis, could
not administer salvarsan under conditions to which a discriminating
patient would dare to trust himself, and made no pretense at following
their cases beyond the door or discharging them from medical care as
cured. One of the largest cities in this country until a year ago had
not even a night clinic to which day workers could come, and is scarcely
awake now to the necessity for such a thing.
+Dispensary Service.+--The provision of adequate treatment and
diagnostic facilities, on a par with those which will presently cover
Europe, will mean the following things: First of all, dispensaries, and
many of them, for the identification of early cases, fully equipped with
dark-field microscopes, with record systems, and with the means for
following patients from the time they enter until they are cured. This
means nurses, it means social service workers, it means doctors with
special and not general knowledge of syphilis and gonorrhea. The
Brooklyn Hospital Dispensary is an admirable example of what such an
institution should be, but it is one where such institutions should be
numbered by dozens and by hundreds. Copenhagen, with a population less
than that of several cities in this country which have none, has seven
municipal clinics whose hours and names are prominently advertised.
+Hospitals.+--In the second place there must be hospital facilities.
They must not be venereal hospitals, but services or parts of general
hospitals, so that patients who are received into them will be protected
from stigma and comment. Pontopidan, a Danish expert, estimated that for
the care of venereal disease one hospital bed to every 2000 of
population was insufficient, and yet there are cities in this country
which do not have one bed available for the purpose to 100,000 people.
The hospital performs a peculiarly valuable function in the care of
syphilis in particular. It provides for temporary quarantine, and for
the education of the patient in his responsibility to the community when
he is discharged. Three weeks or more under hospital direction is the
best possible start for an active syphilis that is to be cured. The
privacy of a syphilitic can be protected in a hospital as successfully
as in a specialist's office, and the quality of treatment which can be
given him is distinctly better than he can obtain while out and around.
Hospitals in general have kept their doors closed to syphilis until
recently, and it is only under the pressure of a growing understanding
of what this means to the public health that they are awakening to their
duty.
+Cheap Salvarsan.+--Before a general campaign for the successful
treatment of syphilis can be made a fact, salvarsan must become, as has
already been pointed out, a public and not a private asset. It must be
available to all who need it at the lowest possible cost[17]--practically
that of manufacture--and must be supplied by the state when necessary.
The granting of patent rights which make possible the present
exploitation for gain of such vital agents in the protection of the
public health is a mistake which we should lose no time in remedying.
While salvarsan does not mean the cure of syphilis, it does mean a
large part of its control as an infectious disease. When it can be given
only to the person who can muster from five to twenty-five dollars for
each dose which he receives, it is evident that its usefulness is likely
to be seriously restricted.
[17] The price of salvarsan before the war was $3.50 per full dose
for the drug alone. It can be profitably marketed at less than $1.00
per dose. The patent rights have been temporarily suspended during
the war, and their renewal by Congress should not be permitted.
+Reduction of the Expense of Efficient Treatment.+--Free treatment for
those who cannot afford to pay is a necessary part of the successful
operation of any scheme for the control of sexual disease. But for those
who can and are willing to pay a moderate amount for what they receive,
there should be pay clinics which will bridge the gap between the rough
and ready quality and the unpleasant associations of a free dispensary,
and the expensive luxuries of a specialist's office. This is a field
which is almost virgin in this country, and which deserves public
support. There is no reason why, for a reasonable fee, the patient with
syphilis should not secure all the benefits of hospital care, the
personal attention of specially trained men, an intelligent supervision
of his case, and the benefit of coöperation between a hospital service
in charge of experts and the home doctor who must care for him during a
considerable part of the course of his disease. Provision of this sort
makes treatment both more attractive and more available to large numbers
of people whose pride keeps them away from the public provision for
charity cases, and whose limited means leave them at the mercy either of
quackery or of well-meaning but entirely inexperienced physicians.
+Value of Expert Services.+--The factor of expert judgment in the care
and recognition of syphilis is an important one, and a progressive
public policy will not neglect to provide for it. The state, municipal
or hospital laboratory which professes to do Wassermann tests should not
be in charge of some poorly paid amateur or of a technician largely
concerned with other matters, or its findings will be worthless. Every
clinic and hospital should also attach to its staff an expert consultant
on syphilis on whom it can draw for advice in doubtful cases and for the
direction of its methods of work. Every city health board which
undertakes a serious campaign against syphilis should not be satisfied
merely with doing Wassermanns, but should enlist in behalf of the public
consultation of the same grade which it expects to employ in the
solution of its traction and lighting problems, and in the management of
its legal affairs. No one would think nowadays of placing a physician in
charge of a great tuberculosis sanitarium whose knowledge of the chest
was confined to what he had learned in medical school twenty or more
years before--yet in a parallel situation one often finds the subject of
syphilis handled with as little attention to the value of expert
knowledge. Expert service is expensive, and if the state wishes to
command the whole energy of progressive men, it must be prepared to pay
reasonably well for what it gets.
+Suppression of Quacks and Drug-store Prescribing.+--The suppression of
quackery is nowhere more urgent than in the control of syphilis. Every
important legislative scheme that has come into existence in recent
years has recognized this fact. The devil may well be fought by fire,
and reputable agencies should enter the field of publicity with some of
the vigor of their disreputable opponents. The brilliant success of this
scheme was admirably illustrated by the results of the recent efforts of
the Brooklyn Hospital Dispensary, which, by replacing the placards of
advertising quacks in public comfort and toilet rooms, and running a
health exhibit on Coney Island, attracted to a clinic where modern
diagnosis and treatment were to be had an astonishing number of young
people who would have fallen victims to quacks. The evil influence of
the drug store in perpetuating the hold of syphilis and gonorrhea upon
us is just being understood. The patient with a beginning chancre, at
the advice of a drug clerk, tries a little calomel powder on the sore,
and it either "dries up" and secondary symptoms of syphilis appear in
due course, or it gets worse or remains unchanged and the patient
finally goes to a doctor or a dispensary to find that his meddling has
lost him the golden opportunity of aborting the disease. If secondaries
appear, a bottle or two of XYZ Specific, again at the suggestion of the
all-knowing drug clerk, containing a little mercury and potassium iodid,
disposes of a mild eruption, and a year or so later a marriage with
subsequent mucous recurrences and the infection of the wife signalizes
the triumph of ignorance and public shortsightedness. The health
commissioner of one of the largest and most progressive cities in this
country stated before a recent meeting of the American Public Health
Association that he had sent a special investigator to twelve
representative drug stores in his city, and that simply on describing
some symptoms, without even the ceremony of an examination, he had
received from ten of them something to use on a sore or to take for
gonorrhea. It is only justice to say that occasionally one finds drug
stores which will refer a patient to a doctor or a dispensary. Drastic
legislation to suppress this sort of malpractice is part of the program
of Great Britain, Germany, and West Australia, and we in this country
cannot too quickly follow in their steps.
+Publicity Campaign.+--The educational campaign against sexual disease
has already been discussed in theory. In close relation to it is the
question of the use of publicity methods for legitimate ends, mentioned
above. It has had a number of interesting applications in practice. The
West Australian law has taken the stand of prohibiting all advertising,
replacing the method of attracting the patient into coming for treatment
of his own free will by the method of making treatment compulsory under
heavy penalty. In this country, where compulsory legislation will be
slow of adoption, publicity methods will have a certain vogue and a
proper place. It has been of great service in the campaign against
tuberculosis and in the movements for "Better Babies" and the like. It
should never be forgotten that it is a two-edged weapon, however, and
that where a stigma exists, as in the case of sexual disease, too much
advertising of the place of treatment as distinguished from the need for
it will drive away the very people whose sensitiveness or need for
secrecy must be considered. On the other hand, the publication of
material relating to sexual diseases in the public press has not yet
reached the height of its possibilities, and should be pushed.
+Utilization of Personal Prophylaxis.+--Passing now to the debatable
elements in a public campaign, opinion about the value of personal
prophylaxis (Metchnikoff) against syphilis shows interesting variations
in different countries at the present time. English-speaking countries
hesitate over this. On the other hand, eminent German authorities, such
as Neisser and Blaschko, urged it at the outset of the present war, and
their views have apparently overcome a vigorous opposition. As a result,
the knowledge of methods of preventing venereal infection are being
spread broadcast over Germany in the hope of diminishing the inevitable
risk that will arise with the disbanding of armies after peace is
concluded, no matter how stringent the precautions taken to insure the
health of soldiers before their return to civil life. The results of
this experiment will be watched with the most intense interest by all
those familiar with the situation, and the results will be of value as a
guide for our own policy when we have had time to develop one. It is
interesting that the most radical departure in the way of legislative
provision for sexual disease, that of West Australia, takes up the
patient at the point where his infection begins and promptly places him
under penalty in the hands of a physician, but assumes no responsibility
for other than indirect prevention. The most radical of all present-day
legal measures against the disease has therefore not yet reached the
radicalism of compulsory prophylaxis as it exists in armies, or even the
radicalism of compulsory vaccination for smallpox.
+Reporting of Syphilis to Health Officers.+--The question of reporting
syphilis to health officers as a contagious disease is a good one to
raise in a meeting when a stormy session is desired. Upon this question
wide differences of opinion exist all over the world. The right of a
sick person to privacy, always deserving of consideration, becomes acute
when it touches not only his physical but his social, economic, and
moral welfare. It becomes a matter of importance to the state also when
the prospect that his secret will not be kept leads him to conceal his
disease and to avoid good public aid in favor of bad private care. It is
a question whether the amount gained by collecting a few statistics as
to the actual presence of the disease will be offset by the harm done in
driving to cover persons who will not be reported. Modified forms of
reporting sexual diseases, without name or address, for example, can be
employed without betraying a patient's identity, thus doing away with
some of the objections, and they have been in force in such cities as
New York for some time. Vermont has recently adopted a compulsory
reporting system, with the almost ludicrous result that by the figures
her population shows 0.5 per cent syphilis, when the truth probably
stands nearer 10 per cent. Much of the difficulty with reporting systems
goes back to the lack of an educated public or professional sentiment
behind them. For this reason they may be fairly placed in the category
of premature legislative experiments, and should be postponed until a
more favorable time. That this view has the sanction of students of such
problems is borne out by the recent comment of Hugh Cabot on this issue,
and by the decision of the British Royal Commission which, after careful
deliberation, decided not to recommend to the Government at the present
time any form of reporting for sexual disease. The West Australian law
recognizes the wisdom of providing the patient having sexual disease
with every safeguard for his secret provided he conforms to the
requirement of the law in the continuance of his treatment. German
sentiment is strongly against reporting, and no provision is made for it
in the civil population. On the other hand, the very complete programs
of the Scandinavian countries provide for reporting cases without names.
It is, therefore, apparent, in view of this conflict of opinion, that we
can afford to watch the experience of our neighbors a little longer
before committing ourselves to the risk of arousing antagonism over a
detail whose importance in the scheme of attack on syphilis is at best
secondary to the fundamental principles of efficient treatment and
diagnosis. There is no apparent reason why we should not be satisfied,
for the present, at least, with drawing to our aid everything which can
give us the confidence and the willing coöperation of those we want to
reach. Physicians who work with large numbers of these patients realize
that privacy is one of the details which has an attraction that cannot
be ignored.
+Compulsory Treatment.+--Compulsory provisions in the law form the
third debatable feature of a modern program against syphilis. The
Scandinavian countries have adopted it, and in them a patient who does
not take treatment can be made to do so. If he is in a contagious
condition, he can be committed to a hospital for treatment. If he
infects another, knowing himself to have a venereal disease, he is
subject, not to fine, but to a long term of imprisonment. The West
Australian law is even more efficient than the Scandinavian in the vigor
with which it supplies teeth for the bite. The penalties for violations
of its provisions are so heavy as to most effectually discourage
would-be irresponsibles. At the other end of the scale we find Great
Britain relying thus far solely upon the provision of adequate
treatment, and trusting to the enlightenment of patients and the
education of public sentiment to induce them to continue treatment until
cured. Italy has, in the same way, left the matter to the judgment of
the patient. The Medical Association of Munich, Germany, in a recent
study has subscribed to compulsory treatment along the same lines as the
West Australia act, although thus far enforcement has been confined to
military districts. The program for disbanding of the German army after
the war, however, includes, under Blaschko's proposals, compulsion and
surveillance carried to the finest details. A conservative summary of
the situation seems to justify the belief that measures of compulsion
will ultimately form an essential part of a fully developed legal code
for the control of syphilis. The reasons for this belief have been
extensively reviewed in the discussion of the nature of the disease
itself (pages 104-105). On the whole, however, the method of Great
Britain in looking first to the provision for adequate diagnosis and
treatment, and then to the question as to who will not avail himself of
it, is a logical mode of attacking the question, and as it develops
public sentiment in its favor, will also pave the way for a sentiment
which will stand back of compulsion if need be, and save it from being a
dead letter.
+Backwardness of the United States in the Movement.+--It will be
apparent, from the foregoing review of the world movement against
syphilis, and the essentials of a public policy toward the disease, that
the majority of our efforts in this direction have been decidedly
indirect. We have no national program of which we as a people are
conscious. It is all we can do to arouse a sentiment to the effect that
something ought to be done. In these critical times we must mobilize for
action in this direction with as much speed at least as we show in
developing an army and navy, slow though we are in that. To limit our
efforts to the passing of freak state legislation regulating the price
of a Wassermann to determine the fitness of a person for marriage, when
both Wassermann test itself, and Wassermann test as evidence of fitness
for marriage, are likely, under the conditions, to be absolutely
worthless, is to play penny eugenics. The move to take the gag from the
mouth of the physician when an irresponsible with a venereal disease
aims to spread his infection by marriage is at least intelligent,
preventive, even if indirect, legislation, because it acts before and
not after the event. Although at the present time we cannot boast a
single example of a complete program of direct legislation, the example
of Michigan, which is providing free hospital treatment for adults and
children with syphilis, should be watched as the first radical step in
the right direction. If war and our mobilization for defense leave us
with every hospital and dispensary and public health resource and all
the expert judgment we have available within our borders enlisted
finally in a great campaign against gonorrhea and syphilis, it will have
accomplished a miracle, though it will have done no more than war has
done for Europe. If it leaves us even with our more progressive states
committed to an expanding program of universal efficient and accessible
diagnosis and treatment, it will have conferred a blessing.
+Relation of War to the Spread of Venereal Disease.+--The frequent
reference to the relation of war to the problems of sexual disease seems
to justify a concluding paragraph on this aspect of the matter. Much of
the impetus which has carried European nations so far along the road
toward an organized attack on syphilis and gonorrhea, as has been said,
is undoubtedly due to the realization that war in the past has been the
ally of these diseases, and that a campaign against them is as essential
to national self-defense as the organization of a vast army. Conflicting
reports are coming from various sources as to the prevalence of syphilis
and gonorrhea among European troops, although hopeful indications seem
to be that troops in the field may have even a lower rate of disability
than in peace times (British figures). The most serious risks are
encountered in troops withdrawn from the front or sent home on leave,
often demoralized by the strain of the trenches. The steady rise in the
amount of syphilis in a civil population during war is evidenced, for
example, by the figures of Gaucher's clinic in Paris, in which, just
before the war, 10 per cent of patients were syphilitic; after the first
sixteen months of the war 16.6 per cent were syphilitic, and in the last
eight months, up to December, 1916, 25 per cent had the disease. There
can be no doubt that a campaign of publicity can do much to control the
wholesale spread of infection under war conditions, and we should bend
our efforts to it, and to the more substantial work of providing for
treatment and the prevention of infectiousness, with as much energy as
we devote to the other tasks which preparedness has forced upon us. The
rigorous provisions proposed for continental armies should be carefully
studied, and in no cases in which either syphilis or gonorrhea is active
should leave or discharge be granted until the infectious period is
over. Compelling infected men to remain in the army under military
discipline until cured might have a deterrent effect upon promiscuous
exposure. In addition we should create as rapidly as possible a
mechanism for keeping inactive cases under surveillance after discharge
until there can no longer be the slightest doubt as to their fitness to
reënter civil life. Observers of European conditions in the population
at large are emphatic in saying that home conditions must have as much
attention as the army, and that suppression of open prostitution, a
watchful eye on the conditions under which women are employed or left
unemployed, and the control of contributory factors, such as the liquor
traffic, must be rigorously carried out. Nation-wide prohibition will do
much to control venereal disease.[18] It is interesting and significant
that little reliance is being placed on the obsolete idea that
prostitution can be made a legitimate and safe part of army life solely
by personal prophylactic methods, or by any system of inspection of the
women concerned. It is a hopeful sign that this conception is at last
meeting with the discredit which has long been due it.
[18] Through the effect on prostitution. A well-known and very
intelligent prostitute, with whom this question was recently
discussed, rated the liquor traffic first among the influences
tending to promote prostitution.
The question has occurred to those interested in compulsory military
service as a measure of national defense as to whether the mobilization
of troops for training will favor the spread of sexual disease.
Unfortunately, there are no satisfactory figures for the civil
population showing how many persons per thousand per year acquire
syphilis or gonorrhea, to be compared with the known figures for the
onset of such infections in the army. Arguing from general
considerations, however, there seems to be no reason to suppose that the
army will show a higher proportion of infections than civilians. In
fact, there is every ground for believing that the percentage will be
lower, since the army is protected by a fairly efficient and enforceable
system of prophylaxis which is taught to the men, and they live,
moreover, under a general medical discipline which reduces the risk of
infection from other than genital sources to the lowest possible terms.
In opposition to the conception that the sexual ideals of the army are
low, it may be urged that they are no lower than those of corresponding
grades in civil life, and that hard work and rigid discipline have a
much better effect in stiffening moral backbone than the laxities of
present-day social life. In the last analysis, the making of the moral
tone of the army is in our own hands, and by putting into it good blood
and high ideals, we can do as much to raise from it a clean manhood as
by submitting that same manhood to the temptations and inducements to
sexual laxity that it meets on every street corner.
This chapter closes the discussion of syphilis as a problem for the
every-day man and woman. It represents essentially the cross-section of
a moving stream. Today's truth may be tomorrow's error in any field of
human activity, and medicine is no exception to this law of change. It
is impossible to speak gospel about many things connected with syphilis,
or to offer more than current opinion, based on the keenest
investigation of the facts which modern methods make possible. None the
less, the great landmarks in our progress stand out with fair prospect
of permanent place. The germ, the recognition of the disease by blood
test and dark field microscope, the treatment and prevention seem built
on a firm foundation. As they stand, without regard to further advances,
they offer a brilliant future to a campaign for control To that
campaign, each and every one of us can address himself with the
prospect of adding his mite of energy to a tremendous movement for human
betterment. For every man or woman to whom the word syphilis can be made
to mean, not a secret, private, shameful disease, but a great open
problem in public health, a recruit has been called to the colors. There
are no signs more hopeful of the highest destiny for humanity than those
of today which mark the transition of disease from a personal to a
social problem. Such a transition foreshadows the passing of syphilis.
In that transition, each one of us has his part. Toward that
consummation, a goal only to be won by united and stubborn assault, each
one of us can contribute the comprehension, the sympathetic support, the
indomitable determination, which make victory.
INDEX
ABORTION, syphilis as cause of, 95
Abortive cure and marriage, 127
of syphilis, 27, 86
salvarsan in, 73, 79, 89
time required for, 87
Accidents, late, 45. _See also late syphilis_
Advertising in regard to treatment for syphilis, 175, 176
Alcohol, effects of, in syphilis, 137
America, backwardness of, in movement against venereal diseases, 181
state control of venereal diseases in, 170
American Social Hygiene Association, 165
pamphlets, 161
Antibodies in disease, 54
Antiseptics, effect of, on germ of syphilis, 27
Appearance of chancre, time elapsing before, 29
Armpits, contagious patches in, 38
Army and navy, Metchnikoff prophylaxis in, 162
probable outlook for venereal diseases in, 184
proposed measures relative to venereal disease in, 183
syphilis in, 25
Arsenic in salvarsan, 71
Arteries, effect of syphilis on, 47
Australia. _See West Australia_
BABIES, hereditary syphilis in, 99
Baltimore Vice Commission, report of, 134
Baths in treatment of syphilis, 140
Bath-tubs not means of transmitting syphilis, 114
Berlin, syphilis in clerks and merchants of, 25
Birth, premature, 95
Blaschko and German sexual disease program, 177, 180
estimate of syphilis in Berlin, 25
Blindness in hereditary syphilis, 104
Blood, Spirochæta pallida in, during secondary stage of syphilis, 35
test for syphilis, 54. _See also Wassermann test_
vessels, late syphilis in, 46
Board of Health, activities of, against syphilis, 165
national, need for, 167
Body, invasion of, by germs in secondary stage of syphilis, 35
Bones in hereditary syphilis, 102
late syphilis (gumma) in, 46
Spirochæta pallida in, 39
supposed effect of mercury on, 63
Bordet and Wassermann, blood test for syphilis, 14
Brain, late syphilis of, 48
softening of, 48
Brawl chancre, 116
Breasts, contagious patches on, 38
Brooklyn Hospital Dispensary, 171
health exhibit by, 175
CABOT, Hugh, comment on reporting syphilis, 179
Cancer following smoker's patch, 138
Chafe, chancre resembling, 30
relation of, to infection with syphilis, 28
Chancre, 29
and cold sores, 30
appearance of, 30
brawl, 116
combined with chancroid, 30
concealment of, by gonorrhea, 30
contagiousness of, 109
contracted during engagement, 117
cure of syphilis in stage of, 85
developed from kissing game, 117
diagnosis of, prevented by improper treatment, 32
ease with which overlooked, 30
enlargement of glands near, 33
extra-genital, from lax relations, 134
importance of early recognition of, 31, 34
in women, 30
location of, 28
of the lip, 117, 119
on knuckle (brawl chancre), 116
painlessness of, 30
soft, 30. _See also chancroid_
tertiary symptoms following, 45
urethral, in men, 30
variations in, 30
Chancroid, 16
and syphilitic infection, 30
confusion of, with syphilitic chancre, 31
Child, death of, in syphilitic miscarriages or abortion, 95
early signs of hereditary syphilis in, 99
effect of syphilitic eye trouble on development of, 103
healthy, born of syphilitic mother, 94
infection of wet nurse by syphilitic, 100
necessity of teaching sexual self-control to, 160
older, effect of hereditary syphilis on, 102
transmission of syphilis from mother to, 92
treatment of syphilis in, before birth, 97
unborn, effect of syphilis on, 98
Child-bearing, effect of syphilis on, 95
Children, adopted, syphilis in, 106
syphilitic, mental condition of, 101
Clap, 16.
_See also gonorrhea_
Clinics for pay patients to secure better treatment, 173
inadequate, for venereal disease, 170
night, necessity for, 171
Cold sores and chancres, 30
College students, syphilis in, 25
Commission, Baltimore Vice, 134
Sydenham Royal, 164
Complications, serious, of syphilis, 45
Compulsory treatment, state provision for, 169
Conception, influence of syphilis on, 95
treatment of syphilis occurring in mother after, 97
Coney Island Health Exhibit, 175
Contagiousness of moist sores in syphilis, 27, 38, 110
of secondary relapses in syphilis, 42
syphilitic sores, 38
of syphilis, 109. _See also infectiousness, infection, and transmission_
and medical examination of prostitutes, 135
control of, by salvarsan, 73, 74, 122
detection of, by examination of patient, 123
disappearance of, in late syphilis, 110
duration of, in late syphilis, 112
under treatment, 123
effect of incomplete cure on, 83
of local irritation on, 43
of mercury on, 64
of moisture on, 27, 38, 110
of time on, 111
of tobacco on, 138
estimate of risk for wife, 125
factors tending to increase, 112
five-year rule in relation to, 124
hereditary, 100, 105
ignorance of, in women, 135
impracticability of quarantine in control of, 121
in wet nurses, 101
inability of mercury to control, 123
obstacles to control by treatment, 123
Continence as personal prophylaxis, 161
economic forces opposing, 157
Copenhagen, dispensaries for treatment in, 171
Cost, economic, of mental disease due to syphilis, 51
of living, effect of, on marriage and sexual life, 158
of treatment, effect of, 84, 149
Cups, drinking, transmission of syphilis by, 113
Curability of syphilis, critical estimate of, 90
Cure, importance of, for the wife, 128
incomplete or symptomatic, danger of, 82
of early syphilis, abortive, 27, 34, 86, 127
of hereditary syphilis, 107
of syphilis, 124, 126, 129. _See also five-year rule_
abortive, salvarsan in, 73, 79, 89
complete, responsibility of the physician in regard to, 84
effect of cost on, 84, 149
stage of disease on, 85
importance of, 90
in early stage, 27, 86
in primary stage, 85. _See also cure of syphilis, abortive_
in secondary stage, 86, 88
methods of determining, 90
obstacles to, 80
radical or complete, 80
Wassermann test in, 58
symptomatic, in late syphilis, 87
time required for, 87
DARK-field examination, use of, in recognizing contagious recurrences, 111
germ of syphilis in, 22
importance of using, 22
use of, in recognizing early syphilis, 33
Deafness and loss of speech due to hereditary syphilis, 104
Deaths due to hereditary syphilis, 98, 99
due to late syphilis, 48
Denmark, free treatment of syphilis in, 169
Disgrace, syphilis and, 142, 144
Disinfection of hands, dishes, etc., by washing and disinfectants, 114
Dispensaries for syphilis in large cities, 170
Drinking of alcoholic liquors, effect of, in syphilis, 137
"Drops," 69
Drug stores and drug clerks, evil influence of, 175
prescribing, suppression of, 168, 174
Drying, effect on germ of syphilis, 27
Dumbness (loss of speech) in hereditary syphilis, 104
Dyes, relation of, to salvarsan, 70
EARS, secondary recurrences affecting, 43
Ears, trouble in, in hereditary syphilis, 104
Eating utensils, transmission of syphilis by, 113, 115
Education and character in the control of syphilis, 160
as means of controlling contagiousness of syphilis, 122
Ehrlich, Paul, 70
Engagements, syphilis contracted during, 117
to marry in syphilitics, precautions in connection with, 129
England, action of, against drug stores prescribing for syphilis, 176
provision for treatment of venereal disease in, 169
treatment not compulsory in, 180
English-speaking countries, attitude on Metchnikoff prophylaxis in, 177
Eruptions, absence of, in serious syphilis, 46
effect of mercury on syphilitic, 64
in hereditary syphilis, 100
non-syphilitic, 37
recurrent, 42, 43
secondary syphilitic, 36
syphilitic, effect of salvarsan on, 74
Estimate of damage caused by syphilitic eye trouble, 103
of frequency of relapse and recurrence in secondary syphilis, 125
of increase of syphilis during war, in Paris, 183
of percentage of marital syphilis, 119
of percentage of non-genital syphilis, 119
of prevalence of gonorrhea, 26
of syphilis, 24, 25
of risk of infecting wife, 125
of syphilis in prostitutes, 134
Examination, medical, before marriage, 130
limitations of, in detecting contagiousness, 123
Excesses, effect of, on the syphilitic, 137
Expense of treatment, effect of, 77, 84, 149
Expert advice, importance of, 32
in secondary stage of syphilis, 86
in pay patient clinics, 174
services, value of, in control and
treatment of syphilis, 173
Eye trouble in hereditary syphilis, 103
in later life, 105
in secondary syphilis, 36
Eyes, secondary syphilitic recurrences affecting, 43
FAMILY, economic forces working against, 158
transmission of syphilis in, 116
Fathers of families, encouragement of early marriages by, 159
syphilis in, 93, 126
Fiancée, non-genital chancre in, 129
First sore, 29. _See also chancre_
Fist chancre, 116
Five-year rule, 124, 126, 129
in relation to marriage, 126
Founder's estimate of prevalence of syphilis, 24
France, increase of syphilis in, during war, 183
GAUCHER'S estimates of increase in syphilis during war in France, 183
Genital syphilis in lax individuals, 133
Genitals, contagious sores on, 38, 112
fitness of, for harboring germs of syphilis, 118
Germ of syphilis, 40. _See also Spirochæta pallida_
Germany, action of, against drug store prescribing for syphilis, 176
attitude on Metchnikoff prophylaxis in, 177
compulsory treatment of venereal disease in, 180
sentiment against reporting of venereal disease in, 179
society for preventing sexual disease in, 164
syphilis in, 25
Germs, behavior of, in various diseases, 40
Glands, enlargement of, in neighborhood of chancre, 33
in chancre of the lip, 33
Gonorrhea and syphilis, measures to prevent spread from army to general
population, 183
concealment of chancre by, 31
confusion of, with syphilis, 13, 16, 31
drug store treatment of, 175
estimated prevalence of, 26
in prostitutes in Baltimore, 134
Gonorrhea, transmission of, by toilet seats, 114
Great Britain. _See England_
Gumma, 46. _See also syphilis, late_
effect of treatment on, 47
nature of, 46
Gummatous infiltration in hereditary
syphilis, 102
in late syphilis, 46
HAITI, origin of syphilis in, 11
Hata, 70
Headaches in syphilis, 36
Health, effect of secondary syphilis on, 36
Exhibit, Brooklyn Hospital Dispensary, 175
Hearing, disturbances of, in hereditary syphilis, 104
in secondary syphilis, 36
Heart in hereditary syphilis, 102
Hereditary syphilis, apparently healthy children with, 101
as cause of abortions and miscarriages, 95
of death, 98
blindness in, 104
bones and teeth in, 102
contagiousness of, 100, 105
deafness in, 104
early signs of, 99, 100
effect of accident and injury in, 105
eye trouble in, 103
heart, blood-vessels and nervous system in, 102
Hutchinson's teeth in, 102
immunity in, 106
in adopted children, state provision for care of, 106
in infant, 99
in unborn child, 98
late, in older children and adults, 101
moral costs of, 99
non-transmission of, by marriage, 105
treatment of, 107
in school hospitals, 108
Hoffmann's rule for marriage of syphilitics, 124
Hospital beds, number of, needed for venereal disease, 171
treatment for hereditary syphilis, 108
Hospitals in treating venereal disease, 171
special venereal, 167, 171
Hot Springs in treatment of syphilis, 140
Hunter, John, 13
Husband, probability of infection of wife by, 125
Hutchinson's teeth in hereditary syphilitics, 102
Hygiene, personal, of the syphilitic, 136
IDIOCY in hereditary syphilis, 101
Immunity in syphilis, absence of, 139
hereditary, 106
Incubation period of syphilis, 28, 29
Infection, break in skin necessary to, 28
double, with gonorrhea and syphilis, 30
with syphilis and chancroid, 30
point of entry of, site of chancre, 29
risks of, 32
time elapsing after, before chancre appears, 29
unsuspected risk of, 161
with syphilis favored by moisture, 27
Infectiousness of syphilis. _See contagiousness_
of syphilitic discharges, 28
Infiltration, gummatous, in late syphilis, 46
in hereditary syphilis, 102
Injections, mercurial, 66
Innocence, question of, in transmission of syphilis, 118
Inoculation, favorable ground for, 114
Insane asylums, amount of syphilitic mental disease in, 50
Inunctions, advantages of, 66
disadvantages of, 65
mercurial, 65
number required for cure, 66
Iodid of potash, 69
Irresponsible mental attitude in syphilis, 150, 151
Irritation, effect of, on contagious recurrences, 43
Italy, non-compulsory treatment in, 180
provision for treatment of venereal disease in, 169
KERATITIS, interstitial, in hereditary syphilis, 103
Kernels. _See glands_
Keyes' estimate of risk of infection of wife by husband, 125
Kissing, rules governing, in syphilitics, 138
transmission of syphilis by, 116
Knuckle chancre, 116
LATE syphilis, non-contagious character of, 110
premature development of, 45
prospects for cure in, 86
Latent or concealed syphilis, 22
Law, Ohio, relative to physicians and marriage of syphilitics, 131
controlling professional confidence, 131
crippling physician in relation to marriage of syphilitics, 131
providing for compulsory treatment in various countries, 180
Legal control, necessity for, in irresponsible syphilitics, 153
Legislation, conservative, 167
indirect, against venereal disease, 169
undesirable and freak, 166
Legs in locomotor ataxia, 49
Lemberg, study of prostitutes in city of, 134
Lesion, primary. _See chancre; also sore_
Life, well-balanced, for syphilitic, 137
Lip, chancre of, glands in, 33
Liquid medicine, giving of mercury in form of, 65
Liquor, alcoholic, effect of, in syphilis, 137
traffic, importance of abolition of, in prevention of venereal
disease, 184
Liver, Spirochæta pallida in, 39
Locomotor ataxia, 48
frequency of, 51
stomach symptoms in (gastric crises), 49
symptoms in legs, bladder and rectum, 49
syphilitic germs in spinal cord in, 49
treatment and prevention of, 52
London, syphilis in, 24
Luetin test, Noguchi, 79
MALARIA, comparison of, with syphilis, 62
Marriage and abortive cure of syphilis, 127
and five-year rule, 126
and syphilis, 125
and Wassermann test, 130
annulment of, for concealment of syphilitic infection, 132
early encouragement of, by state, parents, employers, 159
effect of economic forces on, 158
medical examination for syphilis before, 130
of hereditary syphilitics, 105
of persons with syphilis, inability of physician to prevent, 131
of syphilitics, Hoffmann's rule for, 124
syphilis acquired in, 120
Massachusetts, syphilitic mental disease in, 51
Medical examination before marriage, 130
in relation to syphilis, 130
of prostitutes, 135, 136
Mental attitude in relation to syphilis, 141
morbid, in syphilis, 153
disease and hereditary syphilis, 101
Mental disease and syphilis, 50
Hygiene, National Committee for, 166
Mercury, 62
and salvarsan, combination of, in controlling contagiousness, 124
comparative value of, 68
deceptive value of, 64
effect of, on syphilis, 63
inability of, to control contagiousness, 123
ineffectiveness of, by mouth, 65
injections of, 66
injurious effects of, 67
inunctions (rubs), 65
methods of administering, 64
of using in treatment, 62
misconception in regard to, 63
Metchnikoff and Roux, 14
prophylaxis in syphilis, 162
Michigan, legislative measures against syphilis in, 182
Military service, universal, and spread of venereal disease, 184
Miscarriage and abortion, syphilis as cause of, 95
repeated, 95
Misconceptions regarding cure of syphilis with salvarsan, 72
syphilis in children, 100
Moisture, effect of, on contagiousness of syphilis, 27, 38, 110
relation of, to infection with syphilis, 27, 38, 110
Moore, Noguchi and, 48
Moral problems in relation to syphilis, 18
Morality, sexual, in relation to syphilis, 18
Morals, syphilis and, 144
Morbidness in syphilitics, 153
Mother, knowledge of, in adopting a child, 106
syphilitic, apparent good health of, 93
period of greatest danger to child, 94
treatment of syphilis in, 97
Mouth, administration of mercury by, 64
contagious sores in, 38, 42. _See also mucous patches_
effect of mercury on, 67
late syphilis in, 47
Mucous patches, 38, 42
cancer following, 138
effect of salvarsan on, 74
of tobacco in predisposing to, 43, 112
susceptibility of prostitutes to, 136
NATIONAL Board of Health, need for, 167
Neck, enlargement of glands in, 33, 34
Neosalvarsan, 75
Nervous strain, effect of, on syphilis, 137
system, complications, relation of, to mild secondary syphilis, 45, 46
examination of, in determining cure of syphilis, 90
relapses, 43
Spirochæta pallida in, 39
New York City, clinics and dispensaries in, 170
reporting of syphilis in, 178
Noguchi, 48
test, luetin, 79
Non-genital syphilis, estimate of percentage of, 119
in lax individuals, 133, 134
Notification of venereal disease. _See reporting_
Nurse, accidental infection of, with syphilis, 116
wet, syphilis in, 100
Nursing mothers, syphilitic germs in milk of, 39
of syphilitic child by mother, 101
OHIO, law permitting physician to prevent marriage of contagious
syphilitic person, 131
Overwork, effect of, on syphilitics, 137
PAPEE'S study of prostitution in Lemberg, 134
Paralysis, general, danger to others in, 49, 50
estimated frequency of, 51
mental symptoms in, 49
of insane, 48
syphilitic germs in brain in, 49
treatment and prevention of, 52
Paresis, 48. _See also paralysis, general_
Paris, increase of syphilis in, during war, 183
Physician, accidental infection of, with syphilis, 116
coöperation of, in educating syphilitic, 148
importance of informing, in regard to syphilis, 105, 140
inability of, to prevent marriage of persons with syphilis, 131
Physician proper person to administer Metchnikoff prophylaxis, 163
Piles, contagious sores mistaken for, 43
Pills, ineffectiveness of, in treating syphilis, 65
mercury, 65
Pinkus' estimate of syphilis in Germany, 25
Pontopidan's estimate of number of hospitals needed for venereal
diseases, 171
Population, civil, syphilis in, 183
general, prevention of venereal disease in, during war time, 184
Potash, iodid of, 69
Pregnancy, syphilis acquired during, 94
treatment of mother during, 97
Prevalence of gonorrhea, estimates of, 26
of syphilis, estimates of, 24, 25
Prevention of locomotor ataxia and general paralysis, 52
of syphilis. _See prophylaxis_
Primary lesion. _See chancre_
stage. _See also chancre_
contagiousness of syphilis in, 109
cure of syphilis in, 85
Prohibition, national, importance of, in controlling venereal disease, 184
Prophylaxis, educational, 157
state provision for, 168
Metchnikoff, 162
utilization of, in public campaign, 177
moral, of syphilis, 156
Prophylaxis, personal, of syphilis, continence in, 161
general instruction in, 169
in army and navy, 162
physician proper person to administer, 163
unsatisfactory features of, 162
Prostitutes in Baltimore, gonorrhea in, 134
medical examination of, 135
syphilis in, 134
Prostitution, abolition or repression of, 156, 157
and syphilis, 18, 133
clandestine, risks of, 136
effects of liquor traffic on, 184
regulation of, 156
Psoriasis, confusion of, with syphilitic eruptions, 37
Public Health, syphilis as problem of, 18
Service, United States, estimates of prevalence of syphilis, 24
opinion about syphilis, 141
sentiment and reporting of syphilis to health officers, 178
Publicity, campaign for, 176
QUACKS, suppression of, 168, 174
treatment of syphilitics by, 140
Quarantine and freak legislation, 167
compulsory, for irresponsible syphilitics, 153
limitations of, in controlling spread of syphilis, 121
temporary, for syphilis, in hospitals, 172
Quiescent period following entry of germ, 28
RAILROAD MEN, locomotor ataxia and general paralysis in, 50
Rash. _See eruption_
Recurrences, contagiousness of, 111
estimated frequency of, in secondary syphilis, 125
in secondary stage, 42, 43
Re-infection with syphilis, 139
Relapses, contagious, in syphilis, 42
frequency of, in secondary stage, 125
in nervous system, 43
Reporting of syphilis, attitude of various countries on, 179
to health officers, 178
Resistance of body to syphilis, 29, 107, 112
Rest, need of, in syphilis, 137
Restaurants, risk of transmitting syphilis under conditions found in, 115
Rheumatism, symptoms resembling, in secondary syphilis, 36
Ricord, founder of modern syphilology, 13
Rub, mercurial. _See inunction_
Rule, five-year, 124, 126, 129
for marriage of syphilitics. _See marriage_
for personal hygiene of syphilitics, 136
governing miscarriage and abortion due to syphilis, 96
sexual relations in syphilitics, 138
variations on, in hereditary syphilis, 96
SALIVA, syphilitic germs in, 38
Salvarsan, accidents due to, 78
action of, in syphilis, 73
and abortive cure, 73, 79, 89
and mercury, comparative value of, 68, 89
in pregnancy, 97
animal tests on, 71
arsenic in, 71
as a social asset, 78
cheap, vital importance of, 172
combination of arsenic and dye, 70, 71
correct administration of, 77
discovery of, 70
effect of first dose, 78
of insufficient treatment with, 76
on mucous patches, 74
expense of treatment with, 76
importance of, in controlling contagiousness of syphilis, 73, 74, 122
in treatment, 89
in control of syphilis in prostitutes, 157
methods of giving, 75
misconceptions regarding cure by single dose, 72
need for governmental control, 77
patent rights on, 172
preliminary tests of, on man, 71, 72
price of, 172
repeated doses, 76
use of, does not justify relaxation of rules for marriage, 127
value of, in syphilis, 73
Scandinavian countries, compulsory treatment of venereal disease in, 180
free treatment of venereal diseases in, 169
provision for reporting venereal disease in, 179
Scars following gummatous changes, 46
Schaudinn and Hoffmann, 14, 22
School-hospitals for hereditary syphilis, 108
Secondary stage of syphilis, 35
contagious relapses in, 42
contagiousness in, 110
cure in, 86
eye trouble in, 36
headaches in, 36
loss of weight in, 36
problems of, 42
rash (eruption) in, 36
rheumatic pains in, 36
severe, 36
spontaneous disappearance of symptoms, 39
time required for cure, 88
Secrecy, professional, right of syphilitics, 139
right of syphilitic, in connection with reporting of disease, 178
Self-control. _See sexual self-control_
Self-deception in regard to risk of infection, 161
Self-treatment in syphilis, 140
Semen, Spirochæta pallida in, 39
Sexual characteristics of syphilitic children, 102
morality, development of, 145
relations, abstinence from, economic influences opposing, 158
of syphilitics, rules governing, 129, 138
Sexual relations, transmission of syphilis by, 117
self-control, economic forces opposing, 157
teaching of, 159
transmission of syphilis, question of guilt or innocence, 118
Silverware, transmission of syphilis by, 115
Single dose cure of syphilis with salvarsan, 72
"606." _See salvarsan_
Skin, recurrences of secondary eruption in, 43
unbroken, importance of, in preventing contagiousness of eruptions, 38
Sleeping sickness, 70
Smoker's patches, 138
Smoking (tobacco) in syphilis, 138
Snuffles in hereditary syphilis, 100
Social evil and syphilis, 165. _See also prostitution_
problem of syphilis, 15
Soft ulcer or sore, 16. _See also chancroid_
Soldiers, syphilis and gonorrhea among, in present war, 183
Sore throat in secondary syphilis, 38
Sores, contagious, effect of salvarsan on, 74
in prostitutes, 136
in syphilis, 38
transitory character of, 123
contagiousness of moist, 27, 38, 110
of open, 109
on nipples in wet nurses, 101
primary. _See chancre_
soft, 16. _See also chancroid_
tertiary. _See syphilis, late, gumma_
Sperk's estimate of frequency of relapse in secondary stage, 125
Spirochæta pallida, 27
average life of, on objects outside body, 113
destruction of, in body, 39
discovery of, 14, 22
distribution of, in internal organs, 39
effect of antiseptics on, 27
of drying on, 27
of salvarsan on, 74
growth of, 27
in brain, in general paralysis of insane, 48
in hereditary syphilitic children, 99
in late syphilis, 45
in lymph-glands, 34
in secondary syphilitic eruptions, 38
in spinal cord, in locomotor ataxia, 49
invasion of body by, in secondary stage, 35
low vitality of, 27
mode of entry into body, 28
sensitizing of body to, 39
strains or type of, 40
variations in behavior of, in different persons, 40
Spleen, Spirochæta pallida in, 39
Stage of syphilis, relation of, to curability, 82
secondary, of syphilis, 35. _See also secondary stage; secondary
syphilis; contagiousness; transmission; and Spirochæta pallida_
Stage, tertiary, of syphilis, 45. _See also syphilis, late_
State, encouragement of early marriage by, 159
provision of, for recognition and treatment of syphilis, 168
Stigma attaching to syphilis, harm done by, 143
of syphilis, effect of, on venereal hospitals, 167
Still birth, relation of syphilis to, 96
Still's statistics on death from hereditary syphilis, 98
Stomach in locomotor ataxia, 49
Sweat-glands, absence of Spirochæta pallida in, 39
Sydenham Royal Commission, 164
views on reporting of venereal disease, 179
Symptomatic cure in late syphilis, 87
Symptoms, absence of, in syphilis, 23
constitutional, of secondary syphilis, 36
Syphilis, absence of immunity in, 139
accidental, in physicians and nurses, 116
acquired, in children, 95
in marriage, 119
action of mercury in, 63
of salvarsan in, 74
active, relation of, to miscarriages and abortion, 96
adequate dispensary service for treating, 171
ageing effect of, in child, 99
and civil population, 183
and engagements to marry, 129
Syphilis and marriage, 125
and mental disease, 50
and prostitution, 18, 133
and public prejudice, 141
and sexual problems, 18
and war, 183
as cause of death in children, 98
of miscarriages and abortion in women, 95
as public health problem, 18
as social problem, 15
blood test for, 54
broader outlook concerning, 146
comparison of, with malaria, 62
compulsory treatment of, 180
concealed forms of, 23
concealment of, by gonorrhea, 30
confusion of, with gonorrhea, 13, 16, 31
problem of, with various issues, 16, 17, 165
congenital, 94. _See also syphilis, non-hereditary_
constitutional symptoms of, 36
contagiousness of, in secondary stage, 110
course of, summary, 52
cure of, 90
danger from irresponsible persons infected with, 150
deaths from, 48
definition of, 21
diminishing virulence of, 12
early, methods of recognizing, 32
educational prophylaxis of, 157
epidemic of, in sixteenth century, 11
eruption in secondary stage, 36
essentials of campaign against, 168
false silence in regard to, 15
five-year rule regarding contagiousness, 124, 126, 129
freak legislation in regard to, 166
guilt or innocence in transmission, 118
harm done by stigma attaching to, 143
hereditary, 92
accident and injury in, 105
contagiousness of, 100, 105
destructive changes in, 101, 102
early signs of, in children, 99, 100
late signs of, 101
mental symptoms in, 101
of eye, 103
treatment of, 107
history of, 11
importance of prohibition in controlling, 184
important advances in knowledge of, 17
in adopted children, 106
in British working men, 24
in families, detection of, by Wassermann test, 128
in father or mother of family, 92, 93, 126
in men who have only had gonorrhea, 31
in prostitutes, 134
in United States, estimates of, 26
in wet nurses, 100, 101
inability of physician to prevent marriage of persons with, 131
incomplete cure of, 82
influence of, on progress of mediæval medicine, 13
innocent, in fiancée, 129
suffering of, caused by, 19
late, attributable to insufficient salvarsan treatment, 73
curability of, 86
destructive effect of, 47
in nervous system, 48
most serious forms of, 47
seriousness of, 45
tissue changes in (gumma), 46
measure to prevent spread of, from army to general population, 183
medical examination for, as means of detecting contagiousness, 123
of prostitutes for, 135
mental attitudes in relation to, 141
Metchnikoff prophylaxis of, 162
mild, dangers of, 41
relation to complications in nervous system, 45
mistaken conceptions of, 13
moral prophylaxis of, 156
morbid fear of, 154
non-genital, 28
or extra-genital, 119
obstacles to control of contagiousness of, 123
to social control of, 141
passive, transmission of, by prostitutes, 135
personal hygiene of, 136
prevalence of, 23
in lax individuals, 133
prevention of, by sexual self-control, 159
public attitude toward, 141
quacks and self-treatment in, 140
radical or complete cure, 80
reinfection with, 139
relation of mouth and tongue cancers to, 138
reporting of, to health officer, 178
risk of acquiring, from prostitutes, 136
of infecting wife with, 125
secondary, cure of, 86
time required for cure of, 86
sexual transmission of, 117
stages of, 26
state provision for treatment of, in Denmark, Norway, Italy,
England, Germany, West Australia, 168, 169
tertiary, 45
transmission and hygiene of, 109
by kissing, 116
to and by wet nurse, 100, 101
treatment of, 60
at Hot Springs, 140
with salvarsan, 75
unnoticed manifestations of, 41
variations in course of, in different persons, 41
Wassermann test for, 54
world movement against, 164
Syphilitic, average type of, 148
child, nursing of, by mother, 101
ideal conscientious type of, 147
irresponsible types of, 151
morbid mental states, 153
personal hygiene of, 136
should tell physician he has disease, 140
rule governing care of personal articles used by, 139
rules governing kissing in, 138
sexual relations in, 138
well-regulated life for, 137
Syphilophobia, 153
TABES dorsalis, 48. _See also locomotor ataxia_
Taboparesis, 50
Teeth, effect of mercury on, 63, 67
(Hutchinson's), in hereditary syphilis, 102
Tertiary stage, 45
Test for syphilis in blood, 54. _See also Wassermann test_
Noguchi, luetin, 79
Throat, contagious sores in, 38
Time treatment principle in relation to marriage, 124, 126, 129
Tobacco, effect of, in syphilis, 43, 112, 138
Toilet seats not means of transmitting syphilis, 114
transmission of gonorrhea by, 114
Tongue and tonsils, contagious sores on, 42
cancer of, following contagious mucous patches, 138
Towels, transmission of syphilis by, 113, 115
Transmission of syphilis by dishes, etc., effect of washing and
disinfection on, 114
by infected articles, 113
by kissing, 116
by sexual contact, 117
effect of treatment on risk of, 124
from father to mother, 93
from mother to child, 92
increased risk of, in tobacco users, 138
medical examination in prevention of, 123
not by door-knobs, bath-tubs, or toilet seats, 114
passive, by prostitutes, 135
personal responsibility in, 124 to wife, 125
under conditions of crowding and bad sanitation, 115
of everyday life, 114
unlikely in marriage of hereditary syphilitics, 105
Treatment, intraspinal, in syphilis of nervous system, 79
lack of effect of, on deafness in hereditary syphilis, 104
obstacles to control of contagiousness of syphilis, 123
of chancre may prevent recognition, 32
of syphilis, 60
advertising in regard to, 176
backwardness of this country in public provision for, 170
by drug clerks, 175
by quacks, 140
compulsory, 180
control of contagiousness, 122, 124, 126
dispensary service necessary for, 171
efficient, 88
expense of, 76, 173
expert advice in, 174
hospitals in, 171
importance of salvarsan in, 89
in pay-patient clinics and hospitals, 173
necessity for cheap salvarsan in, 172
various state provisions for, 168, 169
Wassermann test in, 57
with salvarsan and mercury combined, 89
specific methods of, 60
Troops, syphilis and gonorrhea in, 182
UNITED STATES. _See America_
VEDDER'S estimate of prevalence of syphilis, 25
Venereal disease, 16
and marriage, annulment of, 132
effect of universal military service on, 184
European and American provision in regard to care of, 169, 170
importance of national prohibition in controlling, 184
proposed military measures in connection with, 183
relation of war to spread of, 182
world-wide movement against, 164
hospitals and freak legislation, 167
Vermont, reporting of syphilis in, 178
Vice Commission, Baltimore, syphilis in prostitutes, 134
Virulence of syphilis in 15th and 16th centuries, 12
Vomiting in locomotor ataxia, 49
WAR, control of venereal diseases during, 183, 184
War, relation of, to spread of venereal disease, 182
Warts, contagious syphilitic, 42
Washing, effect of, on transmission of syphilis by dishes, 114
Wassermann test, 54
as evidence of fitness to marry, 130
difficulties of, 55
effect of mercury on, 67
of treatment on, 58
factor of error in, 56
importance of expert performance of, 174
to pregnant mother, 97
in connection with adoption of children, 106
in determining cure of syphilis, 58, 90
in family where one member is syphilitic, 128
in freak legislation, 167
in late hereditary syphilis, 106
in syphilitic mothers, 93
negative, development of infectious sores in spite of, 123
meaning of, 56
on spinal fluid, 59
persistently positive, 58
positive, meaning of, 56
practical details concerning, 59
provocative, 130
use of, in recognizing early syphilis, 33
Weight, loss of, in secondary recurrences, 43
in secondary syphilis, 36
Welander homes for hereditary syphilis, 108
West Australia, action of, against drug stores prescribing for
syphilis, 176
attitude of, on personal Metchnikoff prophylaxis, 177
compulsory treatment of syphilis in, 180
state provision of, for treatment of venereal diseases, 170
Wet nurses, syphilis in, 100
Wife, importance of cure for, 128
infection of, by husband during pregnancy, 94
risk of infecting, 125
Williams, syphilis and mental diseases, statistics on, 50
Womb, chancre on neck of, 30
Women, child-bearing, effect of syphilis on, 95
employment of, in connection with problem of controlling venereal
diseases in war times, 184
miscarriages and abortions in, due to syphilis, 95
syphilis in lax, 133
Worry and anxiety, effect of, on syphilitic, 137
Transcriber's Note
The following variably hyphenated words have been left as in the text.
Everyday Every-day
everyday every-day
extragenital extra-genital
lifelong life-long
lifetime life-time
makeup make-up
newborn new-born
All bold text has been surrounded by + symbols.
A List of Illustrations has been added to the text of the file.
End of Project Gutenberg's The Third Great Plague, by John H. Stokes