persons who are still entirely uncontaminated, blameless initiates,
become infected with syphilis on the very first occasion in which they
have sexual intercourse, whilst greater experience and more exact
knowledge of the threatening dangers induce notorious debauchees to
adopt effective measures of protection (which, however, would be useless
if syphilis were really a divinely decreed punishment for licentiousness
of this kind!).
In the third place, the occurrence of syphilis =in little
children=--partly owing to inheritance, partly, however, acquired in the
way already mentioned by casual contact--affords a striking refutation
of the above idea, which, unfortunately, still dominates and fascinates
a large circle of people.
We could adduce further arguments against this view, but what we have
said should suffice to show clearly the untenability of such a
superstition. The syphilis of one individual is not the consequence of
sexual intercourse, but the consequence of another case of syphilis in
another individual--that is to say, syphilis is a =specific infective
disease=, transmissible only by means of its peculiar specific virus,
and this transmission can be effected =without any sexual intercourse=,
by means of contacts of other kinds. =Syphilis arises only from
syphilis.=
We have, therefore, to attack =this= disease precisely in the same
manner as the other venereal diseases. As a Portuguese physician has
most aptly remarked, to the tyranny of syphilis we must oppose the
tyranny of human reason. The principal aim of a campaign against
venereal diseases will be the =organization= of the means offered to us
by reason and experience to cope with the disease. The knowledge of
these means must be diffused in ever-wider circles of humanity, and care
must be taken that every individual is fully and clearly informed
regarding the importance and the dangers of syphilis and the other
venereal diseases.
Here also history is our teacher, our lamp of truth, and promises us
complete success as the result of our campaign against venereal
diseases.
The results of my investigations regarding the origin of syphilis all
point to a =single= extremely important fact--namely, that in the case
of syphilis, and as regards the “old world,” we have to do with a
=specific disease of modern times=, which made its first appearance =at
the end of the fifteenth century=, and of the previous existence of
which, even in the most distant prehistoric times, not the minutest
trace remains. This view was held by very eminent physicians, even
before the publication of my own critical work, based upon entirely new
sources of study. Among these authorities I may mention Jean Astruc and
Christoph Girtanner, in the eighteenth century; in the nineteenth
century, the Spanish army surgeon Montejo, and of German physicians,
above all, Rudolf Virchow, A. Geigel, von Liebermeister, C. Binz, and P.
G. Unna. The great philosopher Arthur Schopenhauer held the same
view.[312]
Ricord, the celebrated French syphilologist, spoke once of a romance of
syphilis which still remained to be written. I should rather compare it
with a =drama=, the separate acts of which are =centuries=. Of this
drama, =four= acts have already been played. At the present moment we
find ourselves at the =beginning= of the =fifth= act. Thus, we have an
=entire= century before us, in which, with all the powers placed at our
disposal by scientific medical research, by practical therapeutics, and
by hygiene in association with social measures, we must work to this
end, that this fifth act shall also be the =last=, as it is in the case
of a proper drama.
The history of syphilis has remained so long obscure, because, until the
time of Philipp Ricord--=that is to say, until the beginning of the
second half of the nineteenth century=--the three venereal diseases,
=syphilis=, or =lues=, the so-called =soft chancre= (=venereal ulcer or
chancroid=), and =gonorrhœa=, were regarded as essentially one disease;
whereas we know to-day that syphilis is a specific infective disease of
a =constitutional= character, which permeates the whole body, and must
be absolutely distinguished from the other venereal diseases, these
latter being purely =local= in character. This earlier belief in the
identity of all venereal infections, an error held even by so great an
authority as John Hunter, who was misled by falsely interpreted
experiments, renders it necessary that the historical side of the
question should be considered also from this point of view.
If gonorrhœa and chancroid were of a syphilitic nature, then certainly
syphilis must have existed from very early times. It would not be
difficult to refer to syphilis some descriptions and accounts of
diseases of the genital organs given by the ancient and medieval
writers. It was the progressive enlightenment regarding the essential
differences between the three venereal diseases which first proved the
untenability of such opinions; we were further assisted by the knowledge
of =pseudo-venereal= and =pseudo-syphilitic= diseases which we have
obtained from modern dermatology. Moreover, in the old world syphilitic
bones belonging to ancient or medieval times have =never= been
discovered.[313] The first syphilitic bones date from =after the time of
the discovery of America=. They appear, above all, =after the outbreak
of the great epidemic of syphilis which followed the Italian campaign of
King Charles VIII. of France, in the years 1494 and 1495=; it was then
that syphilis first became diffused in the old world.
In my work on “The Origin of Syphilis” (Jena, 1901),[314] I have adduced
proof, basing my views upon the criticism of older opinions, and
assisted by the utilization of very abundant new sources of material,
that syphilis was first introduced into Spain in the years 1493 and 1494
by the crew of Columbus, who brought it from Central America, and more
especially from the island of =Hayti=; from Spain it was carried by the
army of Charles VIII. to Italy, where it assumed an epidemic form; and
after the army was disbanded the disease was transported by the soldiers
to the other countries of Europe, and also was soon taken by the
Portuguese to the Far East, to India, China, and Japan. At the time of
its first appearance in the old world, syphilis was extraordinarily
=virulent=. All the morbid phenomena produced by the disease had a more
rapid and violent course than at the present day; the mortality was much
higher; the consequences, even when a cure was effected, were much more
severe. This virulence of syphilis at the time of its first introduction
can only be explained, in accordance with our modern views of the nature
and mode of appearances of the disease, by the fact that the nations of
the old world (who, _nota bene_, were =all= attacked with equal
intensity) had, until that time, been =completely free= from syphilis.
=All classes= of the people and =all nations= were visited by syphilis
to an equal extent and with the same violence.
Even to-day we observe everywhere, when syphilis is introduced into
regions which have hitherto been =free= from the disease, that it has
the same acute course, the same violence of morbid manifestations, that
characterized its first appearance in Europe. In the four centuries that
have elapsed since its introduction into Europe there has occurred a
gradual =mitigation= of the syphilitic virus, or rather a certain degree
of immunization of European humanity against the disease. Speaking
generally, syphilis has to-day--in comparison with that earlier time--a
relatively mild course. To this point we shall return later.[315]
The two other venereal diseases, =gonorrhœa= and =chancroid=,
unquestionably existed in Europe in the days of antiquity. But they also
are =specific infective diseases=, and are only produced by the virus
peculiar to each, just as syphilis has its own peculiar virus.
Ricord (1800-1889), in the years 1830 to 1850, proved the complete
=diversity= of syphilis and gonorrhœa, established the doctrine of the
three stages of syphilis--primary, secondary, and tertiary--and,
finally, taught us to distinguish the =soft, non-syphilitic chancre=
(=chancroid=) from the =hard, syphilitic chancre=. Virchow, in his
celebrated essay on “The Nature of Constitutional Syphilitic Affections”
(_Virchow’s Archiv_, 1858, vol. xv., p. 217 _et seq._), then threw a
clear light on the peculiar course of constitutional syphilis and on the
causes of the occasional disappearance and sudden reappearance of the
morbid phenomena. Hitherto, however, our knowledge of venereal diseases
had rested on an extremely insecure foundation; and =the truly
scientific study of the subject= may be said to have begun in the year
1879, with Albert Neisser’s epoch-making discovery of the =gonococcus=
as the specific exciting cause of gonorrhœa. In the years 1889 to 1892
there followed the discovery of the =bacillus of chancroid= by Ducrey
and Unna, by means of which discovery the complete distinction between
the soft and the hard chancre was definitely proved; and, finally, the
three years 1903 to 1906 were characterized by =remarkable discoveries=,
the full importance of which is not as yet fully realized, =regarding
the nature of the syphilitic virus=. In the year 1903 Eli Metchnikoff
succeeded in transmitting syphilis from human beings to =apes=, and thus
laid the foundation for progressive research regarding syphilis by means
of experiments on animals; this was carried further by Lassar, by the
inoculation of the syphilitic virus from one ape to another, and also by
A. Neisser in his experimental researches in Java;[316] and in March,
1905, the Berlin protozoologist Fritz Schaudinn, since prematurely lost
to the world of science, published his first studies on the probable
exciting cause of syphilis, the so-called “=spirochæte pallida=.”
Numerous subsequent investigations have established the connexion
between this spirilla-form, belonging to the order of protozoa, and
syphilitic disease. In this way we have been brought notably nearer to
the discovery of the certain cure of syphilis and to the discovery of
means of immunization against the disease. In this direction quite new
views are opening before our eyes.[317] Numerous ideas suggested by
recent discoveries in the province of syphilitic research are described
in the admirable essay by J. Jadassohn, “Contributions to Syphilology,”
published in the German “Archives for Dermatology and Syphilis,” 1907.
_Cf._ also the account of the recent doctrines regarding syphilis by P.
G. Unna and Iwan Bloch, “Die Praxis der Hautkrankheiten,” pp. 548-592
(Vienna and Berlin, 1908).
When some day humanity has been freed from the “=sexual plague=,” from
the hydra of venereal diseases, and when a monument is erected to the
liberators, four names will there be commemorated: Ricord, Neisser,
Metchnikoff, and Schaudinn!
After these preliminary remarks on the nature of venereal diseases, I
proceed to a short description of them, and I begin with the most
dangerous of all the venereal diseases, =syphilis=.[318]
The first manifestations of syphilis make their appearance about three
or four weeks =after= infection, at the place at which infection has
occurred, and this is not in every case the genital organs. It is true
that syphilis is most commonly transmitted by means of sexual
intercourse, but frequently also by contacts of other kinds--for
example, by =kissing=; by gynecological or surgical examinations and
operations; by =drinking from a glass= which has previously been used by
some one suffering from syphilis; by the use of uncleansed
pocket-handkerchiefs, towels, and bedding, which have been used by a
syphilitic patient; by the use of tobacco-pipes, wind-instruments,
tooth-brushes, tooth-picks, a glass-blower’s mouthpiece, etc., belonging
to strangers; =by an uncleansed razor=; by the nasty habit of licking
the point of a pencil; by moistening postage-stamps with the tongue; by
sucking the wound in circumcision; =by the suckling of the infant at the
breast of a syphilitic wet-nurse=, etc.[319] In England the custom, when
taking a judicial oath, of kissing the Bible has repeatedly sufficed to
transmit syphilitic infection.
In certain districts in which the level of civilization is a low
one--as, for example, in some parts of Russia and of Turkey--as many as
50 to 60 % of all infections occur independently of sexual intercourse.
All the =discharges= from syphilitic lesions in all three stages of the
disease are infective. The infective character of the tertiary stage of
syphilis was formerly doubted, but has recently been proved beyond
dispute. =Blood= also, although more rarely, can prove infective. On the
other hand, the =pure= secretions--that is, the physiological
secretions, not contaminated by morbid products--such as the saliva,
tears, and milk, are not infective. Syphilis is, however, very
frequently transmitted by means of the =semen=.
Infection occurs in places in which there is a solution of continuity of
the skin or mucous membrane, such as a scratch or a superficial wound,
through which the virus can enter. In this way an apparently healthy
syphilitic patient--when, for example, he gets a small abrasion on the
penis (or, in the case of a woman, in the vagina)--can transmit syphilis
if the other individual also has a similar abrasion through which
infection can occur.
As we have said, it is not till the lapse of two to four weeks after
infection has occurred that the first manifestations of syphilis appear,
in the form of a small vesicle or nodule in the infected area; less
often merely an abraded area of a peculiar red colour. Gradually this
nodule or area enlarges, and becomes continually =harder= at the base,
whilst the surface often undergoes ulceration, and secretes extremely
infective pus (the so-called “=hard chancre=” or “=primary
lesion=”[320]).
This induration is in most cases a certain sign that the syphilitic
virus has already entered the body; at least, it has only been possible
in a few very rare cases, by excision or cauterization of the hard
chancre, to prevent syphilis from entering the blood. Almost always,
notwithstanding such endeavours, the manifestations of general infection
of the body soon appear.
From the place of infection--that is, from the place at which the hard
chancre forms--the syphilitic virus next passes by way of the
lymph-stream into the inguinal glands, so that these, in the third or
fourth week after the appearance of the hard chancre, begin to swell and
to become hard. This swelling of the inguinal glands is painless (the
so-called “=indolent bubo=”), in contrast to the painful swelling which
accompanies the soft chancre. From this region the poison now proceeds
by way of the bloodvessels and lymph paths on its wanderings all over
the body, the individual stages of which can be detected by swellings of
the lymph-glands of the axilla, the elbow, the neck, etc. Sometimes
other symptoms of general infection are noticeable; above all, the
appearance of =fever= (never earlier than forty days after infection),
=pains= in the muscles, joints, nerves, also severe headaches, a general
feeling of =lassitude=, =pallor=, and a falling-off in the nutritive
condition.
These are the forerunners of the so-called =secondary= stage of
syphilis, which now manifests itself by the appearance of a multiform
=skin eruption=, rendering the diagnosis of syphilis absolutely
certain. For this reason, in doubtful cases of ulceration of the genital
organs the patient should inspect his skin very carefully every day for
several weeks or months, and keep watch for the appearance of red spots
or nodules. This syphilitic eruption on the skin is also in the later
periods one of the most certain and most characteristic insignia of the
disease.
The eruption commonly appears first on the trunk, in the form of
rose-coloured spots (the so-called “=roseola syphilitica=”), spreads
thence over the whole body, and in many cases, simultaneously with or
shortly after the spotted eruption, =nodules= appear on the skin, and
marked thickenings form on the mucous membranes, especially at the anus,
in the mouth, and on the tongue (the so-called “=plaques muqueuses=,” or
“=condylomata=”). The patient’s attention is spontaneously directed to
these lesions by painful sensations in the mouth or by itching of the
anus. Often it is these painful sensations, associated with a violent
inflammation of the tonsils and pharynx (the so-called “=angina
syphilitica=”), which first lead the patient to consult a doctor, after
all the earlier symptoms have passed by unnoticed! As characteristic
forms of the secondary syphilitic changes in the skin must, therefore,
be mentioned the so-called “=corona Veneris=,” by which distinguished
name is denoted an eruption on the forehead, especially along the margin
of the hair, which by members of the laity is easily confused with other
affections of the skin common in this locality; the so-called “=collier
de Venus=,” or =leukoderma syphiliticum=, a peculiar pigmentation of the
skin on the throat and the back of the neck in the form of =brown=
patches with =white= intervening areas. This symptom, =which occurs
almost exclusively= in women, is an absolutely certain sign of syphilis.
Equally characteristic is the so-called “=syphilitic psoriasis=,” the
appearance of peculiar patches and thickenings on the palms of the hands
and the soles of the feet; characteristic also is the syphilitic =loss
of hair=, by its sudden onset and by the patchy way in which it occurs.
Not rarely do we see =purulent= eruptions on the skin in this secondary
stage of syphilis.
The syphilitic eruption of the skin is only an external manifestation of
a disease affecting the entire body, for the internal organs also
suffer. The affection of the liver manifests itself by jaundice; that of
the brain and the meninges by headaches and by =weakness of memory=,
which is often well marked at this stage; that of the spleen by
swelling; that of the kidneys by the appearance of albumin in the urine;
that of the bones by very painful inflammatory swellings; that of the
eyes specially by the well-known =syphilitic iritis= (60 % of all
inflammations of the iris are syphilitic in nature!).
If the disease remains untreated, the appearances just described become
more general and continually more severe; and after some time, quite new
morbid symptoms are superadded (often as early as the third year, on the
average five to ten years after infection, but also later), resulting
from the transformation of the syphilitic morbid process into the
=tertiary= stage. To these new manifestations belong the appearance of
large =nodules= in the skin and other organs, which sooner or later
undergo ulceration, the so-called “=syphilitic gummata=”; their
ulcerative destruction may entail the greatest disfigurement or danger
to life--for example, perforation of the hard palate; sinking of the
bridge of the nose (the syphilitic “=saddle-nose=”); ulcerative
destruction of large portions of the bones of the skull, of the
intestine, of the liver, the lungs, the testicles, the bloodvessels
(especially dangerous are gummous diseases of the bloodvessels of the
brain), the brain, and the spinal cord. =Apoplectic strokes= occurring
in comparatively young persons and =nervous paralysis= of the most
various kinds, as well as sudden =deafness= and =blindness=, are in most
cases referable to syphilitic disease. Many chronic diseases of the
liver, kidneys, and nervous system, are consequences of previous
syphilis; also =calcification of the arteries=, the very dangerous
dilatation of the great bloodvessels, especially of the aorta (aneurism
of the aorta), are very often of syphilitic origin.
By the researches of Alfred Fournier and Wilhelm Erb, we know to-day
that two severe diseases of the central nervous system--=tabes dorsalis=
or =locomotor ataxy=, and =general paralysis of the insane= (=paralytic
dementia=)--are almost always (in about 95 % of the cases) referable to
earlier syphilis. Among 5,749 cases of syphilis encountered in his own
private practice, Fournier observed no less than 758 cases of brain
syphilis, 631 cases of tabes, and 83 cases of softening of the brain.
Tabes and general paralysis of the insane are all the more dangerous
because they are no longer, properly speaking, “syphilitic” diseases,
and therefore they cannot be cured by antisyphilitic treatment; they are
severe degenerative changes of the central nervous system, which has
been, as it were, prepared for their occurrence by the previous
syphilis. These belong to the class of the so-called “=parasyphilitic=”
diseases in which antisyphilitic treatment has little or no good effect.
Even more tragic are the consequences of syphilis to the =family=, the
=offspring=, and the =race=. =Syphilis in married life=, =congenital
syphilis=, and the =degeneration of the race by syphilis=--these are the
tragic manifestations which come under consideration in this connexion.
In his admirable work on “Syphilis and Marriage,” Alfred Fournier, the
greatest living authority on syphilis in all its manifestations and
relationships, has described the momentous influence exercised by
syphilis in conjugal life; and in his recently published work, “Syphilis
a Social Danger,” he has dealt also with congenital syphilis and racial
degeneration. He found that, on the average, among 100 women suffering
from syphilis, 20 had been infected by their husbands, either at the
very commencement of married life, or in its later course, or finally
through the offspring after conception. Divorce on the ground of
syphilitic infection by the husband is at the present day of frequent
occurrence.
The transmission of syphilis to the child by =inheritance= may be
effected either by the father or the mother; when both the father and
the mother are syphilitic, it occurs with absolute certainty. The
various possibilities of transmission, and the contingent immunity of
mother or child, as they are expressed in Colles’s law (Baumès’s law),
and in Profeta’s law, cannot here be further dealt with. If the mother
has herself been infected with syphilis, or if she was previously
syphilitic, either the child is not carried until term, abortion or
miscarriage ensuing, or, finally, it is born with symptoms of congenital
syphilis.[321]
The frequent occurrence of premature births and still-births in any
family suggests strong suspicions that they are due to syphilis. The
=general mortality= of the children in a family is regarded by Fournier
as an important sign to the physician of congenital syphilis. Syphilitic
infection of the father gives rise to a mortality in the children of
28 %; syphilis in the mother causes a mortality in the children of 60 %;
when the disease affects both parents, the mortality among the children
amounts to 68 %. Absolutely astounding is the mortality of the children
of syphilitic prostitutes; it amounts to from 84 to 86 %.
Children born =alive=, suffering from congenital syphilis, are generally
weakly,[322] of deficient body-weight; have often a flaccid, wrinkled
skin, covered with typical syphilitic eruptions, and frequently with
great purulent vesicles, especially on the palms of the hands and the
soles of the feet (“pemphigus syphiliticus”); the internal organs also,
the spleen, the liver, and the bones, exhibit morbid changes.
Characteristic is the syphilitic affection of the upper air-passages,
especially the syphilitic “cold in the head” (=syphilitic
rhinitis=--“snuffles”), of new-born congenitally syphilitic children.
Congenital syphilis further gives rise to severe =disturbances of
development= and to phenomena to which Fournier has given the name of
“=late syphilis=” (“syphilis hereditaria tarda”), because they first
make their appearance in the later years of life.[323] Permanent
=debility=, =arrest of development=, =stigmata of degeneration=, in the
form of various =malformations=--as, for example, notching of the edge
of the upper central incisor permanent teeth (a symptom first described
by Jonathan Hutchinson), malformations of the nose, the ears, and the
palate, dwarfing, deaf-mutism, malformations of the external and
internal reproductive organs, rickets,[324] epilepsy, and mental
weakness--are the consequences of congenital syphilis. Tarnowsky,
Fournier, and Barthélémy have traced the consequences of congenital
syphilis into the second and third generation, and so have discovered an
important cause of racial degeneration. Syphilis in the grandfather can
still exercise its disastrous influence in the grandson, and give rise
to the above-mentioned stigmata of degeneration.[325] Indeed, congenital
syphilis of the second generation often appears with the same severity
as that of the first generation; and, like acquired syphilis, congenital
syphilis in women can cause a predisposition to miscarriages and
still-births.
According to statistics obtained by Edmond Fournier, relating to 11,000
cases of syphilis (10,000 men, 1,000 women) from the private practice
of his father, Alfred Fournier, regarding the age at which infection
occurs, it appears that in =men= it most commonly occurs between the
ages of twenty and twenty-six years (the maximum number of infections
during the twenty-third year); in =women=, between the ages of eighteen
and twenty-one; 8 % of syphilitic males and 20 % of syphilitic females
were infected before the age of twenty years. Syphilis is to a
considerable extent at the present day a disease of =inexperienced
youth=. This fact is important in relation to the problem of prevention
and the problem of enlightenment.[326]
Of much less importance than syphilis is the purely local =soft
chancre=, or chancroid, which never results in general infection.
Chancroid is produced by a specific exciting cause, a chain-forming
bacillus (streptobacillus), _Bacillus ulceris cancrosi_, which is found
in the pus secreted by the ulcer. =One or two days= after infection, a
small pustule forms at the site of inoculation, generally on the
external genital organs. This pustule soon bursts, and a deeply hollowed
ulcer makes its appearance, which usually undergoes rapid increase, and
frequently, owing to the infective character of the pus, gives rise to
new chancres in the neighbourhood of the original one, so that the soft
chancre is commonly multiple. When suitably treated with antiseptic
powders and cauterization, chancroid usually heals quickly; there are,
however, very dangerous varieties of chancroid--for instance, the
=serpiginous= chancre, which continues to creep irresistibly forward;
and the =phagedænic= or =gangrenous= chancre, which puts the skill of
the physician to the utmost test. A less dangerous but extremely
disagreeable complication of chancroid is inflammation of the inguinal
glands, most commonly only on one side; this painful “bubo” (painful in
contrast with the painless syphilitic bubo) has a well-marked tendency
to suppuration. If this occurs, and the pus finds its way to the
surface, fistulas and new chancrous ulcers are liable to occur at the
place where it opens. By rest in bed, the inunction of iodide ointment,
the application of cold compresses, the injection into the bubo of a
solution of nitrate of silver, and the internal use of iodide of
potassium, this unfortunate course may be prevented.
A remarkable =change of views= has, in the course of the last thirty
years, taken place in respect of the nature and importance of
=gonorrhœa=.[327] Whereas formerly this was regarded as a comparatively
harmless disease, we know to-day that gonorrhœa in the male, and still
more in the female, gives rise to tedious dangers and painful morbid
phenomena, and is the source of unspeakable sorrows, and of the
miserable ill-health of numerous women, and that it is the chief cause
of =sterility= in both sexes.
Gonorrhœa is principally a =disease of the mucous membrane=, and is, in
this way, distinguished from syphilis, which is a general disorder,
diffusing itself by way of the bloodvessels. In rare cases, indeed,
gonorrhœa can exhibit general morbid manifestations, the so-called
=gonorrhœal rheumatism=, gonorrhœal affections of the spinal cord and of
the heart, and gonorrhœal nervous troubles, all of which are so rare,
that for practical purposes they can be left out of consideration.
The typical seat of gonorrhœa is the =mucous membrane of the urinary and
the genital organs= of the male and the female; in the male affecting
=chiefly= the urinary organs, and in the female affecting chiefly the
genital organs. The cause of =genuine= gonorrhœa is always infection,
the transmission from one human being to another of the purulent
inflammation produced by the =gonococcus= discovered by Neisser in 1879.
=Simple urethral inflammations= with a purulent discharge also occur in
which no gonococci are found. These arise also from infection, but their
actual exciting cause has not yet been discovered. Not less obscure is
the relationship of many of the irritants giving rise to simple urethral
catarrh--for example, that which is active during menstruation--to the
supposed exciting cause. In any case, these simple catarrhs have a very
mild course, and undergo a cure after a few days or weeks, spontaneously
or as a result of treatment with mild injections.
Quite otherwise is it with genuine gonorrhœa. In the male it begins from
two to six days after the infective intercourse, with a burning
sensation on passing water, itching at the urethral orifice, which very
easily becomes reddened, and this is soon followed by the discharge,
either spontaneously or as a result of pressure on the urethra, of a
thick fluid, at first mucous, later purulent, and then of a yellow or a
greenish colour. Inflammation, discharge, and pain, the latter
especially in association with urination, increase during the subsequent
weeks; in addition, in a good many cases there are slight fever,
lassitude, and mental depression, and the patient is tormented,
especially during the night, by violent, painful erections. In
exceptional cases there are hæmorrhages from the urethra (the so-called
“=Russian clap=”). In some cases the disease terminates favourably; this
is especially observed after the first attack of gonorrhœa. As early as
the third week the above symptoms become less severe, and in the fourth
or sixth week after infection the whole morbid process may come to an
end, the discharge ceases, the urine becomes clear once more, and, in
fact, definite cure of the gonorrhœa ensues.
But the number of those who are so fortunate is comparatively small. In
the majority of cases, there are other morbid phenomena and
complications; the gonorrhœa becomes “=subacute=,” and later
“=chronic=.” Ricord wrote many years ago: “When anyone has once acquired
gonorrhœa, God only knows when he will get well again!” Happily, this
pessimism is no longer fully justified at the present day; but it is a
fact that in the majority of cases =even to-day= gonorrhœa is a very
obstinate, wearisome illness, a long-continued burden, not only for the
patient, but also for the doctor. The gonococci proliferate in the
deeper layers of the mucous membrane, and pass upwards into the
=posterior= part of the urethra, this latter migration being manifested
especially by frequent and painful =strangury=; further, the =bladder=,
the =prostate gland=, and the =epididymis= may be attacked. Bilateral
epididymitis has often serious consequences as regards the procreative
capacity. In about 50 % of the cases incapacity for fertilization
(impotentia generandi) has resulted.
If the gonorrhœa becomes chronic, thickenings occur in isolated portions
of the urethral mucous membrane; the urine remains turbid for a long
time; the discharge, it is true, becomes scantier, but shows itself with
the most annoying persistency every morning as soon as the patient
leaves his bed, in the form of the so-called =“bon jour” drops= in the
meatus; there are also troubles connected with the prostate (painful
sensations, especially during defæcation), and symptoms of stricture of
the urethra may occur. Very often, also, relative impotence and severe
sexual neurasthenia are observed, as consequences of chronic gonorrhœa.
Worst of all is the =long duration of the infectivity=. There is always
the danger that somewhere or other some gonococci may remain hidden,
and, given an opportunity, may start the process all over again, or may
transmit the infection to another person. Zweifel reports a case in
which a man actually infected a woman thirteen years after he had first
acquired gonorrhœa!
The infection of a woman with gonorrhœa, as we know to-day, is a
disaster. It is the immortal service of the German-American physician
Noeggerath that, in the year 1872, he proved that the majority of the
stubborn “=diseases of women=” were nothing more than the consequences
of gonorrhœal infection. Gonorrhœa selects by preference the internal
reproductive organs of woman; upon the extensive mucous membranes of
these organs the gonococci find the most favourable conditions for their
persistent life; they find a thousand out-of-the-way comers and
hiding-places, where they can elude the therapeutic activity of the
physician.
“They grow luxuriantly, like a weed which it has not been possible to
uproot, over the entire surface of the genital mucous membrane,
attacking with the same vigour the mucous membrane of the uterus and
that of the Fallopian tubes. In women, as in men, they induce
ulceration, they cause adhesions, and they give rise to sterility. But
in the case of women, something further must be added--that, namely,
this disease has upon them a miserably depressing effect, and that, in
contradistinction from men, they are likely to suffer for many years
from intense pains. Whenever they execute certain bodily movements, it
may be during ten years in succession, they experience pains, often
horribly severe, and in most cases they are condemned to a life of
deprivation and misery--not usually for any fault of their own, since
most women are infected by their husbands” (Zweifel).
Gonorrhœa in women, attacking successively the vagina, the uterus, the
Fallopian tubes, the ovaries, and the peritoneum, is a true martyrdom, a
hell upon earth. Sick in body and in mind, these unhappy women drag out
a miserable existence; and to them so often the last consolation, that
of motherhood, is denied, for gonorrhœa is the most frequent cause of
sterility in woman.
Patients infected with gonorrhœa further run the danger of =blindness=,
by transference of the gonorrhœal virus to the =eye=. This is one of the
most distressing of the possible results of the disease. New-born
children whose mothers are infected with gonorrhœa are during birth
exposed to the same danger of eye infection, as they pass down the
genital passage. In earlier days a very large proportion of the blind
were persons who had lost their sight in this way very shortly after
birth. Since Crédé advocated the admirable method of introducing nitrate
of silver solution into the conjunctival sacs of new-born children,
gonorrhœal inflammation of the eye has become one of the greatest
rarities.
APPENDIX
VENEREAL DISEASES IN THE HOMOSEXUAL
It is an old belief, shared by the homosexual themselves, that venereal
infections are extremely rare among them. If male homosexual persons had
sexual intercourse =only with one another=, this assumption would be in
some degree plausible. For the principal focus of venereal infection is
feminine prostitution, by which venereal diseases are transmitted to
heterosexual men. But since these homosexual men often undertake sexual
acts with heterosexual men--apart from occasional sexual intercourse
with women--a priori there is a possibility of infection in their case,
and such infection is, in fact, observed. Above all, many male
prostitutes also indulge in intercourse with women, and thus diffuse
venereal troubles among homosexual men.
It is obvious that =syphilis= can be diffused among the homosexual as
easily as among the heterosexual, for syphilis is transmitted by many
varieties of contact--by kisses, other caresses, etc. But how is it as
regards =gonorrhœa=?
In the case of heterosexual men and women gonorrhœa is almost
exclusively transmitted by the sexual act, by the introduction of the
male penis into the female vagina. The analogous act between men--that
is to say, pæderasty, _immissio penis in anum_--is unquestionably far
=rarer= than the ordinary sexual act between men and women; it is
commonly replaced by mutual onanism, by kisses and other caresses, and
quite frequently by _coitus in os_. This last is much commoner than
genuine pædication. Of gonorrhœa of the rectum produced by pædication
when the active man is suffering from gonorrhœa, we very rarely hear.
But is there, in the case of homosexual men, any possibility of
gonorrhœal infection due to _coitus in os_?
There can be no doubt that typical =gonorrhœa of the mouth= occurs. The
observations of Kuttler, Atkinson, Rosinski, Dohrn, and Kast, have
proved it.[328] Horand and Cazenave have even observed gonorrhœal
infection of the urethra as a result of oral coitus![329] A homosexual
patient told me that some years before, after _coitus in os_ with a man,
he had for several weeks had a discharge from the urethra, which
spontaneously ceased, and therefore cannot have been genuine gonorrhœa,
but only urethritis resulting from infection by contagious angina. In
the case in question, the urethral catarrh was certainly due to the
_coitus in os_, since any other sources of infection could be excluded.
On the other hand, in a second case an apparently =gonorrhœal infection
of the oral cavity= was transmitted from the urethra.
A homosexual man, forty-five years of age, one day allowed a
=heterosexual= man to perform _coitus in os_ on him. Some days
afterwards he experienced difficulty in swallowing, was feverish, and
saw in the looking-glass that the uvula was swollen. A specialist for
throat troubles diagnosed merely a catarrhal infection. The illness
became worse, and a second throat specialist detected the presence of
a purulent angina of both tonsils, ordered painting with argentamin,
also vapour baths, and an astringent gargle, whereupon the affection
gradually subsided. Six weeks later the patient had swelling and pain
in the joints of the right knee and foot; under cold compresses these
swellings subsided after a fortnight. Of the whole trouble nothing now
remains.
This description, on the part of a patient who is thoroughly
trustworthy, aroused strong suspicion of a =gonorrhœal angina=, with a
consecutive gonorrhœal arthritis. Unfortunately, the purulent discharge
from the tonsils was not examined for gonococci by either of the
physicians in attendance. The case remains, anyhow, very remarkable.
In the case of homosexual women, it is obvious that syphilis, and also
gonorrhœa, can be transmitted, the latter by mutual friction of the
genital organs. I do not know what actually occurs in practice.
[312] _Cf._ Iwan Bloch, “Schopenhauer’s Illness in the Year 1823. A
Contribution to Pathography based upon an Unpublished Document.”
Published in _Medizinische Klinik_, 1906, Nos. 25 and 26. (This gives
an account of all Schopenhauer’s utterances regarding syphilis.)
[313] At a meeting of the Société d’Anthropologie de Paris, held on
April 19, 1906, I read a paper on “La Syphilis Prétendue
Préhistorique,” in which I discussed this question. The important
question of ancient bones is further considered in the second volume
of my work on “The Origin of Syphilis,” pp. 317-364 (now in the
press).
[314] The results of this study I have briefly epitomized in an
address given before the Social Science Congress in Berlin, entitled
“The First Appearance of Syphilis in Europe” (Jena, 1904).
[315] Regarding the gradual acquirement (by means of natural
selection) of immunity to epidemic diseases, the works of Archdall
Reid may be most profitably consulted (“The Present Evolution of Man,”
London, 1896; “The Principles of Heredity,” London, 1905). Dr. Reid’s
views on the part played in human history by the transference of
diseases from immunized to non-immunized races are of especial
interest. Unfortunately, as regards syphilis, he accepts Hirsch’s
erroneous statements relative to the antiquity of that disease, and
its origin in the eastern hemisphere (see also p. 384, note
^{346}).--TRANSLATOR.
[316] _Cf._ A. Neisser, “The Experimental Investigation of Syphilis as
it Stands at the Present Day” (Berlin, 1906).
[317] _Cf._ Erich Hoffmann, “The Etiology of Syphilis” (Berlin, 1906);
Hans Hübner, “Recent Researches into the Nature of Syphilis,”
published in the _Journal for the Suppression of Venereal Diseases_,
1906, vol. v., pp. 468-481.
[318] I must not omit allusion to some recent admirable works on
venereal diseases: A. Blaschko, “Venereal Diseases”--a popular
exposition--(Berlin, 1904); Paul Zweifel, “Venereal Diseases and their
Importance to Health” (Leipzig, 1902); Alfred Fournier, “Syphilis a
Social Danger”; Karl Ries, “Blameless Sexual Infection” (Stuttgart,
1904); O. Burwinkel, “Venereal Diseases” (Leipzig, 1905); Waldvogel,
“The Dangers of Venereal Diseases and their Prevention” (Stuttgart,
1905). In view of the large number of popular works on venereal
diseases, those without professional knowledge should confine
themselves to the best names, because in this province trashy
literature is extraordinarily abundant, and by the false and erroneous
views it diffuses, it does much more harm than good. The writings
mentioned in this note I am able to recommend as thoroughly scientific
and =trustworthy=.
[319] Galewsky, “The Transmission of Venereal Diseases in the Suckling
of Children,” published in the _Journal for the Suppression of
Venereal Diseases_, 1906, vol. v., pp. 365-371.
[320] It is true that such a hardening may also occur in other
non-syphilitic affections of the genital organs--for example, when
they are peculiarly situated or as a result of cauterization. Only the
physician can determine whether in such a case syphilitic infection
has actually occurred.
[321, 322] According to English experience, the congenitally
syphilitic child rarely exhibits any sign of syphilis when born. Thus,
Hutchinson writes (“Syphilis,” p. 73): “At the time of birth, the
congenitally syphilitic infant almost invariably has a clear skin, and
appears to be in perfect health.” According to Osler also (“Medicine,”
sixth edition, p. 269): “The child may be born healthy-looking or with
well-marked evidence of the disease. In the majority of instances the
former is the case, and within the first month or two the signs of the
disease appear.”--TRANSLATOR.
[323] _Cf._ the recently published admirable work of Edmond Fournier,
“Recherches et Diagnostic de l’Hérédo-Syphilis Tardive” (Paris, 1907).
[324] Parrot regarded rickets as a manifestation of congenital
syphilis, but this view has never found acceptance in England.
Hutchinson remarks (“Syphilis,” p. 408): “The typical forms of rickets
are constantly met with in conditions which do not lend the slightest
support to the suggestion of syphilis.” As Cheadle remarks: “Syphilis
modifies rickets; it does not create it.”--TRANSLATOR.
[325] This view must be accepted with reserve. See, for instance,
Osler’s “Medicine,” sixth edition, p. 271: “Is syphilis transmitted to
the third generation? The general opinion is opposed to this view.
Occasionally, however, cases of pronounced congenital syphilis are met
with in the children of parents who are perfectly healthy, and who
have not, so far as is known, had syphilis, and yet, as remarked by
Coutts, who reported such a group of cases, they do not bear careful
scrutiny. The existing difference of opinion is well illustrated in
the account by G. Boeck (_Berl. Klin. Wochenschrift_, September 12,
1904) of four instances of hereditary lues in the second generation,
while in the same journal Jonathan Hutchinson expresses his belief
that syphilis is not transmitted to the third
generation.”--TRANSLATOR.
[326] As more important scientific works on syphilis I must mention
that of Isidor Neumann (Vienna, 1899, second edition), containing the
entire bibliography of the subject; that of Joseph Lang (Wiesbaden,
1896, second edition); but, above all, the epoch-making work of Alfred
Fournier, “Traité de Syphilis” (Paris, 1898)--English translation,
Fournier, “The Treatment and Prophylaxis of Syphilis” (Rebman Ltd.,
London, 1906).
[327] The most important scientific work on gonorrhœa is that of
Ernest Finger, “Blennorrhœa of the Sexual Organs,” fifth edition
(Leipzig and Vienna, 1901).
[328] _Cf._ M. von Zeissl, “Diagnosis and Treatment of Venereal
Diseases,” third edition, pp. 171, 172 (Berlin and Vienna, 1905).
[329] _Op cit._, p. 172.
CHAPTER XV
PROPHYLAXIS, TREATMENT, AND SUPPRESSION (BEKÄMPFUNG) OF VENEREAL
DISEASES
“_The friend of humanity may with some confidence anticipate a gradual
diminution in the prevalence of venereal diseases, and may hope for
their complete extinction in a not too distant future. All that is
requisite for the attainment of this end is that those engaged in the
study and practice of general hygiene, and those concerned in the
safeguarding of public morality, should not weary in their efforts;
and that scientific research should pursue its aims firmly and
clearly, uninfluenced by the tyranny of custom, and independent of
prejudice._”--K. F. MARX.
CONTENTS OF CHAPTER XV
The suppression of venereal diseases -- Organization of the campaign
against them -- International Conference in Brussels -- Foundation of
the German Society for the Suppression of Venereal Diseases -- Three
methods of carrying on the campaign against venereal diseases.
_Personal Prophylaxis against Venereal Diseases_: Rôle of cleanliness
-- The preputial secretion and balanitis -- Importance of circumcision
-- Technique of the cleansing of the genital organs before and after
sexual intercourse -- Examination for disease -- Dangers of repeated
coitus -- Special protective measures -- The condom -- Varieties and
technique of its use -- The instillation of solutions of silver salts
-- Their relative value -- The inunction of fat -- Metchnikoff’s
ointment for the prevention of syphilis -- Antiseptic washings -- The
public advertisement of protective measures -- Legal protection
against venereal infection -- Opinions of legal authorities on this
subject (von Liszt, von Bar, Schmölder).
_The Suppression of Venereal Diseases by Medical Treatment_:
Favourable conditions as regards syphilis -- Mitigation of the
syphilitic virus -- Mercury and its importance -- A “triumph of
medicine” -- Methods of employing mercury in the treatment of syphilis
-- Mode of action of the mercury cure -- Means for the after-treatment
of syphilis -- Curability of syphilis -- Treatment of gonorrhœa --
Necessity for microscopical examination and the scientific methods to
be employed -- The different modes of treatment -- The determination
of the cure of gonorrhœa -- Facilitation of the treatment of venereal
diseases for the great mass of the public -- “Krankenkassen”[330] and
venereal diseases.
_State Action and Public Action in the Campaign against Venereal
Diseases_: Statistics of venereal troubles -- Blaschko’s researches --
Frequency of venereal diseases in Denmark -- Among various classes in
Germany -- Prussian statistics of April 30, 1900 -- Conclusions
deducible from these statistics -- The different sources of infection
-- Prostitution the principal source of infection -- Danger of
youthful prostitutes -- Measures to be taken by the State against the
diffusion of diseases by prostitution -- Regulation -- Criticism of
this measure -- Its illegality -- Its uselessness and its dangers --
Favourable results of the withdrawal of “moral control” --
Prostitution and crime -- Soutenage -- Criticism of Lombroso’s theory
of the relations between prostitution and criminality -- The brothel
question -- Diminution in the number of brothels -- Dangers of
brothels -- Brothel streets and the limitation of prostitution to
definite quarters -- Proposals for the examination of the male
clientèle -- Criticism of these proposals -- The true way towards the
suppression of prostitution.
CHAPTER XV
The motto which I have placed at the head of this chapter on the
campaign against venereal diseases and on the attempt to suppress them
is taken from an interesting academic essay by the former professor of
medicine at Göttingen, K. F. H. Marx, who is well known to have been the
physician of Heinrich Heine during the latter’s student life in
Göttingen. The title of this essay is “The Diminution of Diseases in
Consequence of Advancing Civilization,” p. 35 (Göttingen, 1844).
The hopeful view which is here expressed by the university professor
regarding the ultimate eradication of venereal diseases was shared at
that time by the eminently =practical physician= Parent-Duchatelet. He
appeals, unfortunately, not to medical men and students of social
hygiene, but to the police:
“Pursue without cessation the diseases which are diffused by means of
prostitutes; =take it as your goal to cause them to disappear from the
list of human troubles; do not doubt that your labours will ultimately
be crowned with success, although the task may be one that will occupy
several generations=.”[331]
Two complete generations had, however, to pass away before =the campaign
against venereal diseases and the attempt to suppress them became a
burning question of the time=, became a question of =public health= and
social hygiene, like those which concern the fight with tuberculosis,
with infant mortality, and with alcoholism. Once again I must repeat
that the =organized systematic campaign against venereal diseases is
still in its very earliest stages=. Strictly speaking, it dates only
from seven years ago, when the =first international congress for the
prophylaxis of syphilis and other venereal diseases= was held in
Brussels, from September 4 to 8, 1899. Almost all the civilized
countries, European and other, took part in this congress, and not only
physicians and dermatologists, but also lawyers, clergymen, attachés of
embassies, authors, and philanthropists, explained their views, and
thereby showed that the question of the suppression of venereal diseases
was one of equal interest to all classes of society, and one which must
exercise the activity of the community at large. At the conclusion of
this first international conference in 1899, there was founded the
=International Society for the Sanitary and Moral Prophylaxis of
Syphilis and other Venereal Diseases=, which has its seat in Brussels,
and meets at periodical intervals for international conferences.
Especially in Germany has this organization aroused active interest, and
it was soon decided to found a national =German Society for the
Suppression of Venereal Diseases=, whose first meeting was held on
October 19, 1903, in the hall of the Berlin Rathaus. The meeting was
opened by a speech from Albert Neisser, after which Alfred Blaschko
spoke on “The Diffusion of Venereal Diseases,” Edmund Lesser on “The
Dangers of Venereal Diseases,” Martin Kirchner on “The Social Importance
of Venereal Diseases,” and Albert Neisser on “The Aims of the German
Society for the Suppression of Venereal Diseases.” The =committee= of
the Society consists of Messrs. A. Neisser, president; E. Lesser,
vice-president and treasurer; and A. Blaschko, general secretary. The
organ of the Society is issued six times yearly, under the title,
_Reports of the German Society for the Suppression of Venereal
Diseases_, and has been published for the last four years; it is
supplied gratis to members; to non-members the yearly subscription is
only three marks. In the spring of the year 1903 there was founded a
larger _Journal for the Suppression of Venereal Diseases_, of which five
volumes have hitherto appeared; this serves for the publication of more
comprehensive critical studies.
Still in the same year, 1902, there were formed the first =branches= and
=local groups= of the German Society for the Suppression of Venereal
Diseases in Hanover, Wiesbaden, Breslau, and Berlin. Subsequently other
branches were formed in Mannheim, Munich, Cologne, Beuthen, Danzig,
Stettin, Posen, Dortmund, Elberfeld, Frankfurt-on-the-Main, Görlitz,
Hamburg, Königsberg, Nürnberg, Stuttgart, and Heidelberg.
During the last four years, by means of lectures, the circulation of
pamphlets and leaflets, and by public discussions, information regarding
the dangers of venereal diseases has been diffused among the widest
circles of the population. Of the other activities and measures of the
Society we shall have to speak later.
We pass on to the consideration of the principal elements of the modern
campaign against venereal diseases. In view of the limits of this work
our discussion of this question must necessarily be a brief one. The
eradication of venereal diseases must be effected in a =threefold=
manner:
1. By measures of =personal prophylaxis= against infection.
2. By the proper =medical treatment= of all cases of venereal disease.
3. By measures belonging to the province of =public hygiene=, to that of
=state action=, and to that of =education=.
The =personal prophylaxis= of venereal diseases[332] has made great
progress with the increasing scientific knowledge of the causes and
modes of infection of these diseases. We know now precisely where and
how we can lay down =personal= rules which give us at least a =fairly
secure guarantee= that in an individual case venereal infection will not
occur. Various points of view must then be taken into consideration, the
combined influence of which will alone promise a successful result. No
one single measure will suffice to gain this end.
Above all, in this department of the prophylaxis of venereal diseases,
experienced physicians, alike of earlier and more recent times, will
unanimously agree in this proposition, that the principal preliminary
means for the avoidance of venereal infection, means which it is
absolutely essential to employ in every instance, consist of =perfect
cleanliness= on both sides. He who insists on the most scrupulous
cleanliness of body, clothing, and underclothing, will be sure to get
rid =immediately= of any uncleanliness acquired in sexual intercourse.
Cleanliness and health are often (not always) identical. In any case,
the =greatest mistrust= should be felt as regards a person evidently
unclean, with a neglected exterior, for this is always a sign that such
a person is not particular as regards choice in matters of sexual
intercourse. “=Germany, get into your bath!=” Heinrich Laube once
exclaimed. This would be a good device to adopt in the campaign against
venereal diseases. Every uncleanliness is an irritant; it impairs the
intactness of the skin; and especially is this true of any uncleanliness
of the genital organs, and above all of the male genital organs, where,
under the foreskin, the “smegma” (the sebaceous secretion of the
preputial glands) often undergoes decomposition, and gives rise to an
inflammation, the so-called =balanitis=, which greatly favours the
probability of infection.[333]
If the foreskin has been removed by circumcision, this secretion
entirely ceases, and the mucous membrane covering the glans penis is
transformed into a thick skin, which is much less readily affected by
the causes of infection. There is no doubt that circumcision is to a
certain extent a protective measure against syphilitic infection, whilst
it does not in any way protect against gonorrhœa. Neustätter has
recently collected some very remarkable facts relating to this
question.[334]
Breitenstein has contrasted 15,000 indigenous =circumcised= soldiers
with 18,000 =uncircumcised= European soldiers of the army of the Dutch
Indies, living under similar local and hygienic conditions. Thus, in the
year 1895 there were infected with venereal diseases, of the circumcised
16 %, of the uncircumcised 41 %. As regards infections with syphilis, of
the circumcised 0·8 % were infected; of the uncircumcised, on the other
hand, 4·1 %--that is, five times as many. Similar observations were made
by the celebrated English syphilologist Jonathan Hutchinson, one of the
most ardent advocates of the general introduction of circumcision as a
protective measure against venereal, and above all against syphilitic,
infection. Moreover, with regard to the observations made in Java, the
difference did not depend upon race, because similar differences have
been observed as regards comparative immunity from infection in respect
of circumcised Christians, circumcised on account of phimosis and other
troubles, whose number is by no means insignificant.
Since, however, it is unlikely that circumcision will come into general
use in Europe as a prophylactic measure, it only remains to recommend
that, as a fundamental procedure, the greatest possible care should be
employed in the daily and delicate cleansing of the preputial sac. By
this means inflammation and laceration of these parts will be most
effectually prevented, and even without circumcision a certain resisting
power will be induced. For washing this region, lukewarm water which has
been boiled and cooled may best be employed; then dry the part
carefully, so as not to rub off the skin. In the case of women,
frequent washings of the external genital organs, and vaginal douches,
are also of great importance in regard to the prevention of venereal
infection. =Before= and =after= the sexual act, these measures are of
especial value, because =often by simple mechanical means=, infective
material already deposited may be carried away. The same purpose is
subserved by urination, a procedure certainly adapted for washing out
gonorrhœal pus which has found its way into the urethra, before the
gonococci have had time to establish themselves in the mucous membrane.
I know a number of patients who =use no other means of protection in
sexual intercourse beyond the observation of extreme cleanliness, by
washing and douching, in both sexes=, before and after sexual
intercourse, and by passing water immediately after intercourse, and
thus have remained free from infection; but who promptly became infected
=as soon as they discontinued these simple measures=.
For this reason, these measures, where possible with the assistance of
=soap=, which certainly exercises some antiseptic influence, cannot be
too warmly recommended, although they naturally =do not offer any
absolute security=. They have, however, the advantage that, in the first
place, they can always be employed, even when the true protective
measures of which we speak below are not available, and that, in the
second place, they can always be used in addition to these. It sounds,
perhaps, somewhat absurd, and yet it is true, to say that =washing= and
=urination= are the =first= and =most important= protective measures
against sexual infection.
The second point, which must also be considered important in this
connexion, is the =exercise of self-command= before and during the
sexual act, as far as this is possible in view of the nature of sexual
excitement, which always lessens the personal responsibility, and
overcomes reason and understanding. Yet no one should have sexual
intercourse when =in a state of alcoholic intoxication=, in which
self-control is =completely= lost; as we have shown in an earlier
passage (pp. 292-296), there are several reasons why intercourse is apt
to be disastrous to a drunken man. Moreover, =love= prefers the dark,
but =precaution= prefers =the sunlight=. Before having intercourse with
a woman previously unknown to him, a man should inspect her in clear
daylight, with a view to her state of health. Suspicious spots on the
skin, especially on the forehead and on the trunk; white areas on the
lips, the tongue, the throat, and the back of the neck; visible
glandular swellings; a marked discharge from the genital organs;
ulcerated areas in this region, etc., are of an extremely suspicious
nature, and should cause abstinence from intercourse. French physicians
go so far as to recommend examination of the inguinal and cervical
glands under the harmless form of pretended caresses; but persons
without medical education would seldom be sufficiently skilled to be
able to detect glandular swellings unless these were unusually well
developed. Especially enlargement of the cervical glands--this “pulse of
syphilis,” as Alfred Fournier terms it--is a comparatively certain
indication of syphilis.
It is dangerous also in many cases to repeat the sexual act =several
times= in brief succession, because old experience has taught us that
infective material may first make its appearance at the second or third
act of coitus, and thus infect then only. This affords an explanation
also of a fact often observed--that in intercourse with an infected
woman on the part of two healthy men, with but a brief interval between
the acts, the one who had intercourse first often remains healthy,
whilst the second is infected.
I pass on to consider the =special protective measures= which have long
been recommended for the prophylaxis of venereal infection.
1. =The Condom.=--This is the =oldest= and even to-day beyond question
the best and =most trustworthy= artificial protective measure. Employed
long ago in the days of antiquity, it was in the sixteenth century once
more recommended by the Italian physician Fallopius, and therefore is
not the invention of a physician “Conton,” after whom it is said to have
been named (perhaps the name is connected with that of the French town
“Condom”). Hans Ferdy (A. Meyerhof) suggests that the word is derived
from “condus”--that is, one who =preserves= or protects--and that the
article should properly be called “condus” instead of “condom.”[335]
The condom is a protective membrane, with which the penis is covered
before intercourse. We distinguish as “=rubber condoms=” those made of
rubber, gutta-percha, or caoutchouc; and as “=cæcal condoms=” those made
out of the cæcal mucous membrane of the goat or sheep (incorrectly
termed also “isinglass condoms”). The cæcal condom is thinner and more
delicate, and blunts sensation less, than the rubber condom. The rubber
condom, however, is more =trustworthy=, in respect of durability and its
slighter liability to laceration, if the little precaution is not
neglected to keep it in a cool place, and to protect it from the
long-continued influence of warmth. The habit of carrying about a rubber
condom in the pocket for a long time favours its rapidly becoming
untrustworthy and easily torn. Cæcal condoms, on the other hand, very
readily become fragile and pervious, although the contrary is the common
opinion, and they are preferred to rubber condoms in the belief that the
dearer article must be the better. Advertisement is exceedingly active
in this direction, and every kind of speciality is widely recommended.
In England condoms are sometimes sold bearing the portrait of some
celebrated person!
The condom is a “=general protective measure=”--that is, it protects
against both gonorrhœa and syphilis, in so far as the latter disease, as
is usually the case, is transmitted from the genital organs. All the
leading physicians engaged more especially in the treatment of venereal
diseases are agreed that the condom, when of good quality, when properly
applied, and when removed with care (for in the removal material
adhering to the outer surface may very readily give rise to infection),
constitutes the =very best= and =most certain= of all the protective
measures hitherto advocated. It is true that it can be used by men only,
but when used by the man it simultaneously protects the woman from
gonorrhœal infection, and not rarely also from syphilitic infection.
2. =The Instillation of Solutions of Silver Salts.=[336]--These serve
exclusively for the prophylaxis of gonorrhœa, and are not, therefore,
general protective measures. We owe their introduction to Blokusewski,
who recommended the use of a =two % solution of nitrate of silver=. More
recently, the albuminates of silver have been preferred, such as
=protargol= in a 10 to 20 % solution, =albargin= in a 4 to 10 %
solution, or a solution of 20 % protargol-gelatine. These solutions can
be carried about in small drop-bottles--for example, as the “Sanitas”
(silver nitrate) of Blokusewski, the “Viro” or the “Phallokos” apparatus
(these are trade names for proprietary preparations--solutions of
protargol). All solutions of silver salts must be kept in the dark, and
after the lapse of any considerable time, some freshly prepared solution
must be introduced, for time and the influence of light destroy their
efficacy. Immediately after intercourse and urination, one or two drops
of the solution are instilled into the urethra, and a drop or two also
allowed to run over the frænum præputii.[337]
The views regarding the value of these protective measures are
conflicting. Beyond question, they are less trustworthy than the condom.
Infection has been observed in spite of the use of instillations. Above
all, however, the continued use of these methods gives rise to
disagreeable =irritative manifestations= in the urethra and may even
cause =catarrhal inflammation=, and thus artificially increase the
liability to infection. Hence, these instillations should be reserved
for =occasional= use; =habitually=, only the condom should be employed.
3. =Inunction.=--Whereas the instillation of chemical solutions serves
to protect against gonorrhœa only, the practice recommended for a much
longer time of =anointing= the penis with a simple fatty material, or
with an antiseptic ointment, =before= or =after= sexual intercourse,
protects against syphilis only. It is obvious that a layer of fatty
material covering the penis exercises the purely mechanical function of
preventing the passage of infective matters to the skin. It is, however,
equally obvious that by the to-and-fro friction during sexual
intercourse, especially when this occupies a considerable time, this
fatty covering will be rubbed away, so that the virus can find a means
of entrance. The protection is thus extremely relative. Still, such
authors as Neisser, Max Joseph, Loeb, and Campagnolle, report favourable
experiences regarding the prevention of syphilis by the inunction of the
penis, for which purpose simple vaseline, or Schleich’s wax-soap cream,
which is sold with the “Viro” apparatus, may be employed. In any case,
this method is better than nothing at all. He who has no other
protective measure available should remember that in every house there
is always some fat or ointment obtainable which can be used for this
purpose.
In order, whilst using this method, to protect simultaneously against
gonorrhœa, it has been recommended that antiseptic ointment should be
inserted into the urethra before intercourse, but this is a very
unsatisfactory and untrustworthy method.
Well worth attention is the inunction recently recommended by
Metchnikoff[338] of =a specific mercurial ointment=, after intercourse,
for the destruction of any syphilitic virus which may have been
deposited.[339] He used for this purpose, not the strongly irritant blue
ointment, but the =white precipitate ointment=, an ointment of the
=salicyl-arseniate of mercury= (=enesol=), and, above all, a =30 %
calomel ointment=. After any suspicious coitus, this ointment should be
rubbed for four or five minutes into the area of possible infection;
this should be done without delay; but even after the lapse of eighteen
to twenty-four hours an effect has been traced. The experiments on apes
inoculated with syphilis gave positive results; also in the case of a
student of medicine who voluntarily offered himself for inoculation with
the syphilitic virus, the inunction of calomel ointment appears to have
prevented the outbreak of the disease.
=In any case, these new methods for the prophylaxis of syphilis demand
the most careful attention.= Further experience is needed to determine
whether they deserve general application.
4. =Antiseptic Washes.=--Washing of the penis and douching of the vagina
with antiseptic lotions (sublimate, lysol, permanganate of potassium)
after intercourse are among the most uncertain of protective measures,
because the sublimate solution, or whatever may be used, does not find
its way into any possible lacerations; and because, in consequence of
the profuse secretion of the sebaceous glands of the male and female
genital organs, these organs are covered with a layer of fatty material,
which prevents the contact of watery fluids, but does not in the same
degree prevent the entrance of the syphilitic poison. Antiseptic washes
=after= the sexual act have as little value as the same used before the
sexual act.
The knowledge of these protective measures--above all, of those named
under the first, second, and third headings--ought to be very much more
general than it is. Unfortunately, however, in public life such measures
are still viewed largely from the standpoint of the moralist as
“=indecent=” or “=improper=”; and the criminal law classifies them thus,
so that their =public recommendation= and diffusion is still exposed to
great hindrances.
At the second congress of the Society for the Suppression of Venereal
Diseases, held in Munich in March, 1905, the question of the public
recommendation of protective measures was opened to discussion, and was
dealt with in two admirable addresses by O. Neustätter[340] and Georg
Bernhard.[341] Bernhard proposed that to Section 184, paragraph 3, of
the Criminal Code, which declares it to be a punishable offence to
“expose for sale articles intended for an indecent use, or to recommend
or sell such articles to the public,” should be added a =legal
definition= in the following sense: =articles which are used either to
prevent venereal diseases or to prevent conception are not regarded as
“intended for an indecent use”=; and Neustätter pleaded for an
=alteration of the existing state of the law=, in the sense that =the
public recommendation of means for the prevention and cure of venereal
diseases= should be legally permissible, being restricted merely by
certain =regulations against quackery, extortion, and other misuse=. The
regulation of the recommendation could best =be associated with the
necessary control of the recommendation of therapeutic and preventive
measures in general. A supreme sanitary authority= should be
constituted, =part of whose duties= should be to =examine the form and
contents= of recommendations of this character.
Another juristic relationship of the prophylaxis of venereal diseases
concerns =legal protection against venereal infection=. Franz von
Liszt,[342] von Bar,[343] and Schmölder,[344] opened the discussion on
the biological and criminal aspects of the prophylaxis of venereal
diseases at the first congress of the Society for the Suppression of
Venereal Diseases, held at Frankfurt-on-the-Main in the year 1903.
Hitherto the heedless or deliberate transmission of venereal disease was
punishable only as personal injury, since in the Criminal Code there was
no paragraph directly relating to this matter. Only in the Criminal Code
of Oldenburg of 1884 was such punishment expressly provided for (Article
387), and by this provision =the intercourse of an infected person with
a healthy one was punishable, without regard to the subsequent
infection=. In the legal regulations of other countries than Germany, we
find several instances in which the witting transmission of venereal
infection by means of sexual intercourse is punishable. In Germany a
measure proposing this was rejected by the Reichstag in 1900. Von Liszt
advocated the introduction of the following paragraph into the Criminal
Code:
“One who, being aware that he is suffering from a contagious venereal
disorder, performs coitus, or in any other way exposes another human
being to the danger of infection, shall be punished with imprisonment
for a term of two to three years, and in addition shall be deprived of
civil rights.”
Schmölder enlarged this clause by an amendment relating to the
punishment of prostitutes disseminating venereal diseases.
On the other hand, von Bar drew attention to the inconveniences and
dangers which a punishment of this nature would involve, especially to
the dangers of =blackmail=, and to the =duty it would impose on
physicians= of breaking their obligations of professional secrecy.
Moreover, a proof of the =knowledge= of venereal infection is difficult
to obtain; the proof that infection is derived from a definite person is
also far from easy. Von Bar opposed the addition of such a clause on
this and other grounds. In the discussion upon the motion, this view was
shared by C. Fränkel, Ries, Oppenheimer, and others; Neisser was in
favour of a punishment of this kind, because then, at any rate, there
would be a public recognition of the fact that such an action was open
to severe =punishment=, and was a =disgraceful= one; thus, by the mere
existence of the paragraph an =educative influence= would be exerted.
In any case, such a punishment would be a two-edged weapon, and as far
as present necessity goes, we have sufficient powers in the application
to such offences of the paragraphs of the Criminal Code relating to
bodily injury.
* * * * *
The second great means for the limitation and entire suppression of
venereal diseases is =to deal with them by medical treatment, to cure as
speedily as possible persons suffering from syphilis of gonorrhœa, and
thus to prevent these persons from becoming sources of fresh infection.
Systematic, methodical treatment on a large scale=--that is the =goal=
at which we have to aim. To the poor man or woman suffering from
venereal infection the same advantages should be opened as to the
wealthy voluptuary. The provision of means of treatment of venereal
diseases =cannot be too free=. In public hospitals, private clinics,
ambulatoria, and sanatoria, in convalescent homes, and polyclinics for
prostitutes, everywhere must be provided means for an intelligent
treatment of venereal diseases. Just as tuberculosis is now attacked
systematically and vigorously, so must it be with venereal diseases.
Since =syphilis= constitutes only about 25 %--only one-fourth part, that
is to say--of venereal diseases in general, since also during the last
four centuries the disease has shown a natural tendency to decline in
virulence, since a mitigation in the intensity of the virus is clearly
recognizable, it is in the case of this disease that the =hope of
radical success= is especially great.
Our forefathers carried out for us a great part of the campaign against
syphilis. The =comparatively mild= course of syphilis in the majority of
uncomplicated cases leads us to infer that there has been a relative
immunization against syphilitic poison.
Albert Reibmayr remarks that “=during the last 400 years, every human
being now living in Europe has had about 4,000 ancestors; of these,
however disagreeable the fact may seem, a considerable number must have
had to contend with syphilis=.”[345]
But this undoubted fact, that =all of us= have been to a certain extent
“=syphilized=,”[346] plays its part to our advantage in the campaign
against syphilis--that campaign which our own time has taken up with
joyful hope of success.
Above all, let honour be paid to the ever youthful and fresh master and
Nestor of European research into the subject of syphilis, Alfred
Fournier, the evening of whose life is devoted to the campaign against
syphilis as a “social danger.” To the great scientific works of his life
he has now added the small, but not less valuable, =explanatory
writings=, which are being sold at a low price all over France, and in
part also have already been translated into German and English.[347]
Their aim is to get the =people= on our side in the campaign against
syphilis.
When, in April, 1906, I paid the master a visit, he gave me the last of
these popular campaign writings. Its title was in the form of a
question:
“En Guérit-on?” (“Is it Curable?”).
And the answer given on p. 4 runs: “=Yes, it is curable, for of all
diseases syphilis is the one which can best, most easily, and most
certainly be cured.=” And why? Because we have a wonderful specific
against this disease, which, when given =at the proper time= and =in the
proper manner=, works a miracle. This remedy is
=Mercury=.
I put this name clearly and visibly before the eyes of the reader, a
name which for every physician to whose lot it falls to treat cases of
syphilis has a truly miraculous sound, a name against which =the
unconscientious ignoramuses, the evil-disposed enemies= of the human
race have spoken their anathema, one which a great thinker and
honourable man like Schopenhauer regarded as a “triumph of medicine,” a
fact which he experienced personally in his own body. All honourable,
critical, and scientific physicians agree in this opinion. In my work on
“The Origin of Syphilis,” vol. i., p. 127, I have expressed the matter
in the following words:
“Mercury is and remains--notwithstanding the ignorant and
ill-considered hostility of quacks and their kindred--the =divine
means= for the treatment of syphilis; mercury is to syphilis what
=water is to fire=, in the hands =of that physician who knows how to
use the drug rightly=, how to apply it =at the right time= and =in the
right form=, who watches closely the =course= of the disease in his
patient, and who supports the mercury cure (always of =primary
importance=) by other therapeutic measures as indicated.”
Only the =physician=, the scientifically trained medical man, can cure
syphilis; the quack certainly cannot; in his hands mercury is truly
enough a dangerous “poison.” But he has no right to say, and he speaks
deliberate untruths when he says, that we physicians “poison” the
“unfortunate” syphilitics with mercury. To such preposterous accusations
we can give a brief and incisive answer.
Therefore, during my lecturing journey, undertaken recently[348] under
the auspices of the German Society for the Suppression of Venereal
Diseases, I prepared the following brief account of the therapeutic
employment of mercury in syphilis, which in my opinion suffices to throw
the proper light upon the value and importance of the mercurial
treatment of the disease; it is a sufficient answer to the
“Nature-Healers,” who are opposed to the use of this “poison”:
1. =In innumerable instances it has been observed by the most
experienced and scientific physicians, that cases of syphilis treated
without mercury run a very severe course, accompanied by the most
dangerous symptoms, such as extensive destructive lesions of the skin,
lesions of the internal organs, brain syphilis, eating away of the
bones, loss of the nose, etc.=
2. =In cases which previously have been treated without mercury, the
administration of the latter drug immediately arrests the destructive
processes, and saves the patient from death, or from very severe
illness, and from physical disfigurement.=
3. =No less an authority than Virchow, in his celebrated treatise “On
the Nature of Constitutional Syphilitic Affections,” pp. 7-14 (Berlin,
1859), has shown that the hypothesis of Hermann[349] is entirely devoid
of foundation in fact.=
4. =I should feel conscientiously compelled to denounce myself for the
commission of grievous bodily harm if I ventured to-day, after the
accumulated experience of four centuries, to treat a case of syphilis
without mercury.=
What use is it to continue to fight against the disbelief and
superstition which clings to mercury? Why should we for ever be occupied
in contradicting the false accusations brought against this drug? For
four centuries the divine mercury has withstood all attacks, and will
continue to withstand them, until a greatly desired and even better
measure is discovered--=prophylactic immunization against syphilitic
infection=.[350]
How mercury is to be given, whether in the form of the long-prized
“=schmierkur=” (=cure by inunction=), or by =hypodermic injection=, or
by =ordinary internal use=, must be left in individual cases to the
decision of the medical man, for numerous considerations, which can only
be properly weighed by the physician, have to be taken into account. A
mercury cure is a =serious= matter, but always also one which repays all
the trouble that we take. In “En Guérit-on?” Fournier has most admirably
described the wonderful results of a =critically considered and
carefully conducted= mercury cure. I do not, indeed, belong to the
“doctors who build for themselves a house of pure quicksilver,” when
they enter the field against the “French” (= syphilis), as the phrase
runs in Schiller’s work “The Robbers.” I hold by a =reasonable,
measured= use of mercury in the course of the treatment of syphilis, and
I advise a good “=after-treatment=” in addition to the treatment with
mercury.[351] Mercury, when given in moderate but sufficient doses, not
only destroys the syphilitic virus, but also has a very favourable
influence on the general condition, and sometimes even gives rise to an
increase in the number of the red blood-corpuscles. Thus, mercury is not
only not a poison: it is a most valuable =restorative and vitalizing
means=. This is well illustrated by the following case, which came under
my own observation, and which I recommend to the Nature-Healers, in the
hope that it may lead them to revise their views regarding the action of
mercury:
The case was that of an official, thirty years of age, who had been
under my care several times before since the year 1898 for other
troubles (gonorrhœa, etc.), and who was always pale and with hollow
cheeks, in no way giving the impression of possessing a constitution
with strong powers of resistance. Late in the summer he was infected
with syphilis; the attack proved a severe one, running a serious
course, complicated by an extremely painful suppurative inflammation
of the lymphatic vessels of the penis, and accompanied by fever,
lassitude, and a sense of exhaustion. An energetic inunction cure was
immediately begun. Under this not only did the morbid symptoms rapidly
disappear, but there occurred a remarkable change in the general
condition, in the sense of an increase of strength, such as had not
existed before the illness. Notwithstanding slight stomatitis, the
patient during and after the cure =felt stronger and more fit for work
than he ever had before=, and even now this favourable state continues
unaltered, as is manifested above all by the increase in the
body-weight, by the good appearance, etc. =The patient=, who now, one
and a half years after the cure, has had no relapse, =informed me
repeatedly and spontaneously that this delightful improvement in his
health could only be attributed to his syphilis (!) or to the
mercury!=
A =single= mercury cure will suffice, in some cases, to cure syphilis
for ever! Regarding this, we have numerous trustworthy observations. In
most cases, indeed, during the early years relapses occur, and then we
need to use the indispensable mercury cure once more =with care=, and to
employ all the other measures which make up the above-mentioned
“after-treatment,” the supplementary means being, above all, =iodide of
potassium, sulphur= (in the long-celebrated sulphur-baths of Aix,
Nenndorf, etc.) and =arsenic= (first recommended by me); also the water
cure, brine-baths, and iodide-baths, and a visit to the seaside or to
the mountains, and massage, are good accessory means to the cure. Above
all, however, =the State of nutrition= of the patient[352] must always
be kept under consideration, and assisted where necessary, for which
purpose preparations of iron, nutritive preparations like sanatogen, and
milk cures, are of value. =Strict abstinence= from alcohol is always
necessary in the treatment of syphilis. Alcohol has a =very
unfavourable= influence on the syphilitic process, and is often the only
cause of continually recurring relapses of this disease.
The =thorough= treatment of syphilis is a matter of several years,
during which the patient must repeatedly present himself to the
physician for examination, and should any relapse occur, he must be
subjected to renewed treatment. Such thoroughness will invariably be
rewarded. =Attention to detail= will always bear fruit. Syphilis is
=curable=. It is purely fanciful to say that syphilis is never cured,
that it pursues its victims up to the end of life, that it knows no
pardon. That is not true. =Treat= your syphilitic patients, treat them
properly and thoroughly, if necessary for years in succession, and they
will be freed from the disease. “Syphilis,” says Fournier, “is a
misfortune, but it is a misfortune from which complete recovery is
possible.” From the day when the patient becomes aware that he is
suffering from syphilis, he must face the situation “in a calm and manly
fashion,” and must say to himself:
“Now there is to be a fight between syphilis and me. To work,
therefore, and courage! Courage, because science assures me that with
the aid of =mercury=, of =hygiene=, and of =time=, an end will come to
the syphilis, and because science gives me an absolute assurance that
some day I shall be as healthy as I was before, and that I shall again
have the right to a family, that I shall attain the freedom and the
happiness of being a father!”[353]
With these admirable words of the greatest living authority on syphilis,
I close my account of the suppression of syphilis by medical treatment,
and turn to the not less important question of the =management of
gonorrhœa=.
Recent scientific researches, especially those of A. Neisser and E.
Finger, have shown that the infective urethritis of the male produced
by gonococci is by no means the “trifling and childish complaint” which
it was formerly supposed to be, but, on the contrary, is a very serious
and obstinate trouble, often resisting the very best means of treatment,
so that it may =persist for years=, and =remain for years infective=.
Still worse is it as regards gonorrhœa of the female genital organs, the
cure of which is even more difficult, and the consequences of which are
even more disastrous than in the case of the male. If the =physician= is
needed for the cure of syphilis, still more is this the case as regards
gonorrhœa. He only can command the scientific methods, and the very
complicated technique of the treatment of gonorrhœa. He only can
undertake the =indispensable= control of the treatment by means of
=microscopic= and other methods of investigation. Every cobbler thinks
he can cure gonorrhœa, and yet it is this disease which, even more than
syphilis, demands the most precise knowledge of the local anatomical and
pathological conditions. Blaschko rightly says:
“While no one gives a damaged watch to a baker to mend, or a torn coat
to a tinsmith, every one seems to believe that in order to restore the
most valuable gift of humanity, health, it is unnecessary to possess
the profoundest knowledge of the human body, and to understand the
nature and the causes of the disease. Anyone who has come to grief in
his ordinary profession, but who understands how with a brazen voice
to denounce the so-called ‘medicine of the schools,’ and to praise
with sufficient confidence his own successes, is supposed to possess
the wonderful power, without any exact knowledge at all, of charming
all the illnesses of mankind out of the world.”
Gonorrhœa is also a =curable= disease, though curable often with great
difficulty. We see this from the fact that, notwithstanding the
extraordinarily wide diffusion of gonorrhœa (for a far greater number of
infections with gonorrhœa occur than of infections with syphilis), still
ultimately the =majority= of the men, and a large proportion of the
women, infected with gonorrhœa are =completely cured= of their trouble.
The treatment of gonorrhœa is a complicated affair. =Within the first
two days=, by the injection of =powerful caustic agents=, we are
sometimes able to cut the matter short and to put an end completely to
the gonococci. In every case the patient, as soon as he perceives a
discharge, though not yet purulent, from the urethra, should
=immediately= consult a physician, in order to determine the nature of
his disease, which, in the majority of cases, will be found to be true
gonorrhœa. If it is not possible to abort the gonorrhœa, then the
disease will have to run its course. The best measure, whenever
possible, is =rest in bed= for a week or two, in association with a
=mild, unstimulating diet=, and the =absolute prohibition of all
alcoholic beverages=--the last is indispensable throughout the duration
of the gonorrhœa--the drinking of uva ursi tea, and, if the inflammatory
symptoms are severe, the application of cold compresses to the penis.
Only when the first more severe symptoms have passed away, by which
time, owing to the reaction of the urethral mucous membrane, a large
proportion of the exciters of the disease will already have been
expelled, is it time to begin =injections= or =irrigations= of the
=urethra=, containing medicaments the nature of which must be left to
the decision of the experienced =physician=, who will regard each
individual case on its own merits. If rest in bed is not possible, the
patient must wear a so-called “=suspensory=” bandage, in order to give
as much rest as possible to the testicles and the epididymis, which are
gravely endangered in every attack of gonorrhœa. If, as often happens,
gonorrhœa ascends to the posterior part of the urethra, or to the
bladder, or to the prostate, or if, finally, it becomes chronic, then
special methods of treatment, with =internal medicines, with local
cauterization, massage, distension, medicated bougies, baths=, etc., are
needful. The cure will ensue very gradually; relapses are frequent; even
cessation of the discharge is no certain sign of cure, as the presence
in the still turbid urine of “threads” containing gonococci sufficiently
proves. Only when the urine has become perfectly clear, and any threads
which it may contain are shown by repeated search to contain no more
gonococci; when also the prostate, a favourite seat of the last remnants
of gonorrhœa, is free from inflammation, can the cure be regarded as
complete. Even more difficult is the determination of a cure in women.
But persistency in the treatment, and frequently repeated examinations,
will lead also in women to the desired goal, or, at any rate, will
overcome the capacity for spreading the infection.
In the campaign against venereal diseases by the methods of medical
treatment, the =facilitation= of treatment for the =great masses of
impecunious= persons, for the proletariat, is of great value. For them,
above all, the provision of _Krankenkassen_[354] is needed, and it is
very satisfactory to note that during recent years the Krankenkassen
have especially directed their attention to venereal diseases, since A.
Blaschko,[355] A. Neisser,[356] R. Ledermann,[357] and Albert Kohn[358]
drew attention to the duties of Krankenkassen in this relationship in a
number of admirable works. Krankenkassen are in a position to obtain
exact statistics regarding venereal diseases; to diffuse information,
verbally and in writing, to the widest extent among their members; to
facilitate hospital treatment, and treatment by specialists; to give
medical aid as required to infected relatives of the insured; to carry
out regularly every year, once or twice, a medical examination of all
members, and to distribute among all these writings on the prophylaxis
of venereal diseases. The question also of payment on the part of the
patient requires new regulations as regards venereal diseases.[359]
Finally, it has been recommended that, in association with the
Krankenkassen there should be founded “=daily sanatoria=” (Neisser),
“=work sanatoria=” (Saalfeld), “=ambulatory places for treatment=”
(Ledermann), and “=convalescent homes=” (Stern), for members of
Krankenkassen suffering from venereal disease, and for insured persons
similarly affected. All these institutions would, moreover, be valuable
to the community at large.
What admirable results are obtainable by such a =systematic= treatment
of as far as possible =all= the venereal patients throughout an entire
country has been shown by the astonishing decline in the number of cases
of venereal diseases in Sweden and Norway, and in Bosnia, where a
gratuitous treatment of all such patients at the cost of the state has
been introduced. Thus the =organized campaign= against venereal
diseases, which during recent years has been initiated in all the
civilized countries of Europe, has led more particularly to efforts in
the direction of the sufficient treatment and speedy cure of =recent=
syphilis and =recent= gonorrhœa.
* * * * *
We pass now to the consideration of the =third= factor in the campaign
against venereal disease, which comprises the duty of the =state=, the
task of =social hygiene=, and the task of =public pedagogy=.
The =foundation= for the suppression of venereal diseases by state
effort consists in a knowledge of the =extent of the diffusion= of these
diseases; we need, that is to say, =accurate statistics regarding
venereal diseases=.
It is once more the great service of Blaschko to have been the first in
Germany to work on these lines.[360]
Dismissing from consideration the distribution of venereal diseases in
countries outside of Europe, regarding which he gives interesting
reports, we find that the European conditions are of such a nature that
the large towns, the centres of industry and manufacture, garrison
towns, and university towns, are most severely affected; that the
smaller provincial towns suffer less; that the agricultural population
is comparatively free from this disease, with the exception of the
uncultivated country districts of Russia and of the Balkan States, where
the country people suffer from syphilis to a terrible extent. No exact
statistical data are at present available regarding the diffusion of
venereal diseases in the individual countries of Europe. The best
measure of the prevalence of these diseases is afforded by the figures
for the different armies. From these we learn that Denmark, Germany,
German Austria, and Switzerland, show the most favourable conditions;
next come Belgium, France, Spain, Portugal, North and Middle Italy.
Worst of all are the conditions in Southern Italy, Greece, Turkey,
Russia, and--England. These army statistics are, however, insufficient,
for, as a matter of fact, =England= is most favourably placed in respect
of the diffusion of venereal diseases. The most exact reports come from
the Scandinavian countries, from Norway and Denmark, in which for
several years =all physicians= have kept a list of all the infective
diseases treated by them, as they are compelled =every week= to make a
return to the Board of Public Health. According to these reports, it
appears that venereal diseases in Copenhagen constitute the greater part
of such diseases in the entire country; but in the period between 1876
and 1895 these diseases have notably =declined= in frequency in
Copenhagen, and all venereal diseases have shared in this decline;
gonorrhœa constitutes 70 % =of all= cases of venereal disease. With
regard to the diffusion of infection, it appears from the Copenhagen
statistics that =one= woman with venereal disease serves to transmit it
to =four= men; on the other hand, of =four= men with venereal disease,
=one= only will transmit that disease to a woman. On the average, there
are infected with venereal disease every year 16 to 20 % of all young
men between the ages of twenty and thirty years; with gonorrhœa 1 in 8
are infected; with syphilis 1 in 55 are infected. In these last ten
years, for every 100 young men living, there have been 119 infections
during ten years; that is to say, =on the average every one has been
infected once, and a great many have been infected more than once=; in
the same period of ten years, for every 100 young men, there have been
18 infected with syphilis--that is to say, 1 for every 5·5.
Especially valuable also are the figures which Blaschko obtained in 1898
from the carefully kept books of a large mercantile Krankenkasse whose
operations were diffused throughout Germany; these figures also give the
result of an inquiry regarding venereal diseases amongst workmen,
waiting-maids, secret prostitutes, and students. The result of these
statistics, as regards Berlin, are given briefly in the following table:
+---------------------------------------------------------+
| |
|============================== Secret Prostitutes, 30 %. |
| |
|========================= Students, 25 %. |
| |
|================ Shop Employees, 16 %. |
| |
|========= Workmen, 9 %. |
| |
|==== Soldiers, 4 %. |
| |
+---------------------------------------------------------+
VENEREAL DISEASES AFFECTING VARIOUS CLASSES OF THE POPULATION OF BERLIN
(AFTER BLASCHKO).
According to these statistics, the diffusion of venereal diseases among
=shop employees=, =students=, and =secret prostitutes= (chiefly
=barmaids= and =waitresses=), is the greatest; it is much =less= among
=workmen= and =soldiers=. It further appears, from Blaschko’s inquiry,
that =of the men who entered on marriage for the first time when above
the age of thirty years, each one had, on the average, had gonorrhœa
twice=, and =about one in four or five had been infected with syphilis=.
Wilhelm Erb, in Heidelberg, obtained similar results.
Still more remarkable were the results of the statistical investigation
which was carried out for the =entire Kingdom of Prussia= by the
Prussian Ministry of Ecclesiastical Affairs and Public Instruction on
April 30, 1900.[361]
According to this investigation, it appeared that on this day, in
Prussia, there were 41,000 persons suffering from venereal disease,
among whom 11,000 were infected with recent syphilis; in Berlin, on the
same day, there were 11,600 cases of venereal disease, among whom 3,000
were infected with recent syphilis. The general relations are shown in
the following table:
+------------------------------------------------+
| |
|=== The whole of Prussia, 0·28 %. |
| |
|============== Berlin, 1·42 %. |
| |
|========== Towns over 100,000 inhabitants, 1 %. |
| |
|====== Towns over 30,000 inhabitants, 0·58 %. |
| |
|===== Towns below 30,000 inhabitants, 0·45 %. |
| |
|== The Army, 0·15 %. |
| |
+------------------------------------------------+
VENEREAL DISEASES AFFECTING THE MALE POPULATION OF PRUSSIA, APRIL 30,
1900 (AFTER BLASCHKO).
Thus, for every 10,000 adult men there were on this day persons
suffering from venereal diseases to the following numbers: in Berlin,
142; in the remaining large towns, 100; in the smaller towns, 50; and in
the whole of Prussia, on the average, 28. Naturally the figures should
in reality be larger, for of the physicians to whom inquiries were sent,
only 63 % returned an answer. Moreover, the =annual= figure of cases is
a very much larger one. Kirchner[362] assumes that =every day= in
Prussia more than =100,000 individuals=--that is to say, about 3 per
mille--are suffering from a transmissible venereal disease, and he
estimates the damage to the national property by typhoid fever as about
8 million marks annually, but that from venereal diseases as not less
than =ninety million marks annually=. In these reports of April 30,
1900, the ratio of men to women suffering from recent syphilis was as
3 : 1.
In order to obtain more exact information regarding the diffusion of
venereal diseases, and the actual number of those affected by them, it
is of very great importance that there should be a =revision= of the
duty of medical men in respect of the =notification of diseases=, and
also in respect of the duty of =professional secrecy=.[363]
This latter question is also of importance in respect of the prevention
of venereal infection in married life. (The question of syphilitic
infection of married women by their husbands has recently been
considered by Alfred Fournier: “Syphilis in Honourable Women.”)
In addition to the question of the diffusion and frequency of venereal
diseases, the greatest interest attaches to the =sources of dangerous
infections=--that is to say, the question where men and women most
frequently contract venereal disease.
Here also Blaschko has obtained interesting information; he states:
Of 487 syphilitic men, the disease was acquired by 395 (81·1 %) from
professional prostitutes (officially inscribed or secret); 23 (4·7 %)
from waitresses and barmaids; 23 (4·9 %) from their “intimate”; 45
(9·2 %) from casual acquaintances, shop-girls, or workwomen.
According to this report, it appears that =prostitution=, public and
secret (under which heading the waitresses and “casual acquaintances”
must be numbered), forms the =principal focus= of venereal infection.
And that wild sexual intercourse is here almost exclusively to blame is
shown by the following statistics, given by Blaschko:
Of 67 syphilitic wives, almost all the wives of workmen, 64 were
infected by their =husbands=; whereas, =on the contrary=, of 106
husbands, 7 only acquired the disease from their wives; the remaining 99
acquired it by =extra-conjugal sexual intercourse=, either before or
after marriage.
Another very valuable set of statistics dealing with the sources of
infection has been published by Heinrich Loeb.[364]
These relate to the conditions in Mannheim. It appears that the sources
of infection were as follows:
Waitresses and barmaids 155 instances.
Maidservants, cooks 67 „
Shop-girls 65 „
Middle-class girls 29 „
Seamstresses and embroidery workers 27 „
Chambermaids 20 „
Factory workwomen 17 „
Artistes, singers, and ballet-girls 16 „
Wife or betrothed 12 „
Tailoresses and modistes 11 „
Ironers 9 „
Book-keepers 4 „
Widows 4 „
Country girls 3 „
Mistresses 3 „
---
Total 442
Here, as we see, the chief types of =secret= prostitution, the
=waitresses= and =barmaids=, play the principal part; next, but a long
way after, come maidservants and shop-girls. This, however, does not
amount to saying that public prostitution is less dangerous. We know
that a prostitute who has never been infected with venereal disease is
something very rarely seen; that prostitutes under regulation are almost
all, especially when still quite young, in an infective state, and that
they serve just as much as secret prostitutes for the diffusion of
venereal disease. It is a well-known fact that youthful prostitutes are
=more dangerous= than women who have long practised prostitution,
because the former are all suffering from more or less recent infection,
and both gonorrhœa and syphilis are present in them in the stages in
which they are still strongly infective. H. Berger bases upon
statistical investigations[365] his belief that red-haired girls have
the most delicate epithelium, fall sick most rapidly and in the greatest
numbers; dark haired women at first suffer less. After they have been
prostitutes for some time, there is no important difference between
blonde, brown, and black-haired women; but black-haired prostitutes are,
in fact, more inclined to infection =later= in their career, because
they are more in request.
Now that we have learned that at the present day =prostitution= remains
the principal source of venereal infection, the following question
immediately demands an answer: =What can the state do in order to remove
these sources of infection? and have the measures which the state has
hitherto put into operation been of any use in this direction?= To put
it shortly, what part has been played by the state =regulation= of
prostitution, as hitherto practised, in the campaign against venereal
diseases?
With Schmölder,[366] we understand by “regulation” the following
practice, which is what obtains in the majority of civilized countries:
The police keep a list in which the girls and women regarded by them as
prostitutes have their names entered. The “inscribed” (_inscrites_)
receive a “_licentia stupri_”--that is to say, =the permission to
practise professional fornication under continual observation on
the part of the police= (the renowned “moral control”[367]), which
is associated with a number of commands, prohibitions, and
regulations--above all, with the =necessity of submitting to medical
examination at definitely stated intervals=, and, where necessary, to
=compulsory medical treatment=. At the same time, public prostitution on
the part of those who are not inscribed is suppressed as much as
possible. Berger has admirably described (“Prostitution in Hanover,” pp.
1-19) the methods of regulation and their consequences. Above all,
however, have Blaschko, Schmölder, and Neisser considered the modes of
regulation customary at the present day from the moral, legal, and
medical points of view, and have in part entirely condemned them
(Blaschko and Schmölder), in part declared them to be gravely in need of
reform (Neisser).[368]
Among those who have recently discussed the question of the regulation
of prostitution, we may mention Anna Pappritz,[369] who condemns the
practice; Clausmann, who is in favour of it;[370] Friedrich Hammer, also
in favour of it;[371] and, finally, S. Bettmann, who leaves the question
open.[372]
In our consideration of the coercive system of regulation, we take a
=single standpoint=--namely, that of its possible value for the
suppression of venereal diseases. Some demand the =abolition= of
regulation on ethical and humanitarian grounds, and we do not wish in
any way to make light of these grounds. But they could not be decisive,
if, as an actual fact, regulation had an effect either in diminishing
the prevalence of venereal diseases or in checking prostitution; but, in
truth, the =reverse= is the case!
Schmölder[373] has shown beyond dispute that the compulsory inscription
of prostitutes, introduced from France, is in our country an utterly
=illegal= measure, arbitrarily enforced by the police. It has been amply
proved that this illegal compulsory inscription has actually made
prostitutes of many girls who had no inclination to permanent
professional prostitution; that this method =produces artificial
prostitutes=. What errors of judgment, what abuses of power, occur on
the part of the police, in connexion with this compulsory inscription!
How often does the inscription result from a denunciation made on
grounds of private spite! The “Committee of Fifteen,” constituted for
the study of prostitution in New York, declares in its report:
“Men with political insight are of opinion that every limitation of
the freedom of the individual is in itself an evil, and that such a
limitation can only be justified in cases in which the good derived
from the infringement can really be estimated at a very high
valuation. A system which permits the police, simply on grounds of
suspicion, to arrest a citizen, to submit him to an injurious
examination, only with the aim of discovering a disease he is
suspected to have, and then to put him into prison, on the suspicion
that he might have indulged in immoral intercourse if he had been left
at liberty, cannot possibly be regarded as harmonizing with the
principles of personal freedom.”[374]
Blaschko and Fiaux have proved that regulation concerns only a =small
fraction= of prostitutes, usually the older ones; whereas the
=beginners=, who are precisely those most dangerous in respect of
venereal infection, and, further, the army of =secret prostitutes=,
=half prostitutes=, =occasional prostitutes=, and the =half-world=,
remain free from regulation--are probably left free deliberately--and
anyhow could not possibly be supervised, on account of the enormous cost
of supervision. In Berlin, speaking generally, only =one-fifth= part of
the girls arrested are subjected to regulation, four-fifths are simply
“warned and discharged”; and even of this fifth part, in reality a large
percentage does not come under control because “escape from the lists”
renders permanent observation impossible. Fiaux proves that =more than
50 %= of the medical examinations which ought to have been made on the
4,000 women under regulation in Berlin during the years 1888 to 1901,
=were in fact neglected=.[375]
It is =certain= that regulated prostitution is =more dangerous= from the
point of view of public health than free prostitution. The prostitute
remaining under surveillance is in constant fear of compulsory treatment
in the lock hospital, and therefore endeavours to conceal her illness
=as long as possible, or temporarily to avoid medical examination
altogether=. The free prostitute has a personal interest in becoming
well again as soon as possible, and generally goes voluntarily and at
once to seek treatment from a physician. Thus it happens that, among the
regulated prostitutes, the number of those infected =appears=
surprisingly small. In addition, we have to consider the =inadequacy of
the medical examination=, because the number of the physicians and the
time assigned to them are too small. And whilst it appears to be a fact
that every third prostitute is infected with gonorrhœa, in Berlin,
during the year 1889, as the result of official examination under
regulation, only one prostitute in 200 was declared infected, and in
1884 only 1 in 1,873. Moreover, =very many= infected prostitutes under
compulsory medical treatment are, as Blaschko proves, allowed to resume
their professional occupation in an uncured state, and to diffuse their
illness freely once more. The figures given by Blaschko speak very
clearly on this point:
+---------------+-------------+-------------------------+
| | | _Annual Percentage of |
| | | Prostitutes attacked |
| _Place._ | _Date._ | by Syphilis._ |
| | +------------+------------+
| | | Regulated. | Free. |
+---------------+-------------+------------+------------+
|Paris | 1878-1887 | 12·2 | 7·0 |
|Brussels | 1887-1889 | 25·0 | 9·0 |
|St. Petersburg | 1890 | 33·5 | 12·0 |
|Antwerp | 1882-1884 | 51·3 | 7·7 |
+---------------+-------------+------------+------------+
From this it is clear that the =abolition= of the regulation of
prostitutes will not have an unfavourable, but, on the contrary, will
have a thoroughly =favourable=, influence in respect of the frequency of
venereal diseases. The conditions in England and Norway show this very
clearly. In Christiania, after the abolition of regulation in the year
1888, syphilis declined in frequency--in the first place, because the
number of girls who applied for treatment increased, whilst prior to the
abolition of regulation they had concealed their illness in order to
avoid falling into the hands of the police; and in the second place,
because now the fear of venereal infection kept many young men from
having intercourse with prostitutes, whereas previously they had
erroneously believed that the “control” would free them from the danger
of venereal infection. The same was the case in London, where there is
no regulation; the frequency of venereal disease has decreased because
young men now avoid intercourse with prostitutes as much as possible. In
France, the country in which regulation was first introduced, the
commission formed for the study of prostitution came to the conclusion
that “=regulation of prostitutes should be abolished=.” The principal
reason for which the police continue to advocate the preservation of the
system of regulation--namely, that they have an interest in the matter
on account of the =intimate connexion between many prostitutes and
criminality=--will not bear examination. It is true enough that
=soutenage=[376] is inseparable from prostitution. Moreover, =the world
of criminals= is very near to prostitution, in the first place, because
the prostitute also has need of a man on whom she can lean, who can be
something to her from the =personal= point of view, to whom she is not
simply a chattel;[377] and, in the second place, because the prostitute
is, like the criminal, =despised and defamed=--she shares with the
criminal the pariah nature. Lombroso’s doctrine that prostitution is
throughout equivalent to criminality is certainly not justified. =It is
only by the outward circumstances of their life that the bulk of
prostitutes are driven into intimate relations with criminality.= And
among these outward circumstances, =regulation=, and the =expulsion= of
prostitutes from honourable society (which is a necessary part of
regulation) play the principal rôle! For this reason, if for this reason
alone, regulation must be abolished, because then a strong supplement to
criminality from the circles of prostitution would be cut off.
Even before investigators had become convinced of the uselessness and
danger of regulation the cry arose: “=Away with the brothels!=” We have
already alluded to the continuous =decline= in the number of brothels in
all large towns. In 1841 there were in Paris still 235 brothels (to
1,200,000 inhabitants); in 1900 there were only 48 brothels (to
3,600,000 inhabitants); and for St. Petersburg and other large towns a
similar decline in the number of brothels can be established,
notwithstanding the fact that everywhere the population has markedly
increased. This proves that the brothels no longer correspond to any
real need.[378] At the present day, owing to the great development of
intercourse in modern times, brothels are a public calamity; they bring
the quarter of the town in which they exist into disrepute, and deprive
the neighbourhood of its proper monetary value. Moreover, the time is
past for slave-holding on the part of the brothel-owner. The existence
of brothels favours the traffic in girls (the “White Slave Trade”),
encourages sexual perversities, and increases the diffusion of venereal
diseases. The prostitute living in a brothel is sometimes compelled to
have intercourse with ten or twelve men in a single day, and is thus
pre-eminently exposed to venereal infection, all the more because she
must admit the embraces of =every= man who pays the brothel-keeper
money; whilst the prostitute living freely can at least refuse to have
anything to do with a man who appears to her to be ill. According to
Lecour, Mireur, Diday, and Sperk, prostitutes in brothels suffer from
syphilis about =three times as often= as free prostitutes.[379]
Other modifications of brothel life, such as the so-called “=controlled
streets=,”[380] the best known of which are in Bremen[381]--that is to
say, streets closed to ordinary traffic, the houses of which are
inhabited only by prostitutes under control, but the girls being in
other respects free and not living under the domination of a
brothel-keeper; also the “=Kasernierung=”[382] of prostitutes, their
confinement to particular streets, or special “quarters” of the town
(“Dirnenquartiere”)[383]--are all to be rejected on the same grounds.
The whole nature of brothel life, and the very serious dangers it
involves, have been discussed in excellent works by E. von Düring,[384]
Henriette Fürth,[385] Karl Nötzel,[386] and Martin Bruck.[387] They
illumine the whole question, and provide sufficient grounds for the
condemnation of brothels.
A few authors, however, continue to advocate the preservation of
brothels, and some of these wish to enforce medical examination, not
only of prostitutes, but also of their masculine clients. This
proposition is made, for example, by Ernst Kromayer in his work, which,
notwithstanding many Utopian ideas, is nevertheless very stimulating,
“The Eradication of Syphilis,” pp. 67, 68 (Berlin, 1898). Von Düring, in
his criticism of these ideas, rightly points out that this
recommendation would be quite useless in practice, because, in the first
place, only a small proportion of men visit brothels at all. In the
second place, in the hurry in these resorts no proper examination could
be undertaken. In the third place, the doctors who were to be appointed
as a kind of medical porters to brothels, would not easily be found to
accept such situations. Lassar, who answers this last criticism, is of
opinion that the brothel-master, or anybody with a little experience,
could easily undertake this examination in the case of men.[388]
But these men would probably also decline the office; and even if they
were willing, it is very doubtful if they would be in a position to make
the suggested examinations, which, after all, require =real medical
skill=; and, finally, the only result would be--to increase the number
of quacks. Therefore, this idea of the examination of the male visitors
to brothels is Utopian.
No, the true hope lies in =absolute freedom=; in =relieving prostitution
from the oppression of the police=; in its gradual =separation from
criminality=; in--I am not afraid of the word--in an “=ennoblement=” of
prostitution.[389] The “prostitute” (German _Dirne_ = drab) must
disappear, and the “human being” must reawaken. The prostituted woman
must be readmitted into the social community. No more coercion! =Free
and voluntary treatment=, in polyclinics[390] and hospitals; the
“=rescue=” of youthful prostitutes,[391] not in the prison-like
“=Magdalen Homes=,” but by means of ethically instructive influence
=from human being to human being=, of the value of which the “Letters to
Prostitutes” of the noble philanthropist Frau Eggers-Smidt,[392] and
also the experiences of the Salvation Army,[393] give such admirable
evidence.
Very aptly, also, Kromayer has shown to what an extent a change in our
present attitude towards sexual intercourse outside the conditions of
coercive marriage, the removal of the stamp of infamy from such
intercourse, would limit prostitution, and therewith also limit venereal
diseases.[394] This is as clear as daylight. But, unfortunately, those
very persons who declare the existing conditions in respect of
prostitution to be absolutely intolerable will not admit its truth.
The misery of the life of these unhappy creatures must be relieved, but
=we= must do it =ourselves=, and soon; for they are not in a position to
do so. The last, the highest goal of the campaign against venereal
disease is the humanization of the prostitute.[395]
SUPPLEMENTARY NOTE.--In the essay on “The Woman’s Question” in the
sociological section of his work, “The Ethic of Free-Thought,” Karl
Pearson discusses the question of Prostitution in relation to the
Woman’s Question at large. His remarks have especial interest in view
of what is said above about “the ennoblement of prostitution” and “the
humanization of the prostitute,” and it seems expedient to quote the
passage at length (_op. cit._, 1888, pp. 379-382).--TRANSLATOR.
“The emancipation of woman, while placing her in a position of social
responsibility, will make it her duty to investigate many matters of
which she is at present frequently assumed to be ignorant. It may be
doubted whether the identification of purity and ignorance has had
wholly good effects in the past; indeed, it has frequently been the
false cry with which men have sought to hide their own anti-social
conduct. It is certain, however, that it cannot last in the future,
and man will have to face the fact that woman’s views and social
action with regard to many sex-problems may widely differ from his
own. It is of the utmost importance that woman, not only on account of
the part she already plays in the education of the young, but also
because of the social responsibilities her emancipation must bring,
should have a full knowledge of the laws of sex. Every attempt
hitherto to grapple with prostitution has been a failure. What will
women do when they thoroughly grasp the problem, and have a voice in
the attitude the state should assume in regard to it? At present
hundreds do not know of its existence; thousands only know of it to
despise those who earn their living by it; one in ten thousand has
examined the causes which lead to it, has felt that degradation, if
there be any, lies not in the prostitute, but in the society where it
exists; not in the women of the streets, but in the thousands of women
in society, who are ignorant of the problem, ignore it, or fear to
face it. What will be the result of woman’s action in the matter? Can
it possibly be effectual, or will it merely tend to embitter the
relations of men and women? Possibly an expression of woman’s opinion
on this point in society and the press would do much, but then it must
be an educated opinion, one which recognizes facts and knows the
difficulties of the problem. An appeal to chivalry, to a Christian
dogma, to a Biblical text, will hardly avail. The description we have
of Calvin’s Geneva shows that puritanic suppression is wholly idle.
What form will be taken by the reasoned action of women, cognizant of
historical and sexualogical fact?
“Perhaps it may be that women, when they fully grasp the problem, will
despair, as many men do, of its solution. They may remark that
prostitution has existed in nearly all historic times, and among
nearly all races of men. It has existed as an institution as long as
monogamic marriage has existed; it may be itself the outcome of that
marriage. I do not know whether any trace of a like promiscuity has
been found in the animals nearest allied to man--I believe not. The
periodic instinct has probably preserved them from it. How mankind
came to lose the periodic instinct, and how that loss may possibly be
related to the solely human institution of marriage, are problems not
without interest. On the one hand, it has been asserted that
prostitution is a logical outcome of our _present_ social relations,
while, on the other hand, it is held to be a survival of matriarchal
licence, and not a _sine qua non_ of all forms of human society. There
is very considerable evidence to show that a large percentage of women
are driven to prostitution by absolute want, or by the extremities to
which a seduced woman is forced by the society which casts her out.
This point is important. It may, perhaps, be that our social system,
quite as much as man’s supposed needs, keeps prostitution alive. The
frequency with which prostitutes, for the sake of their own living,
seduce comparative boys, may be as much a cause of the evil as male
passion itself. The socialists hold the sale of a woman’s person to be
directly associated with the monopoly of surplus labour. Is the
emancipated woman likely to adopt this view? and if so shall we not
have a wide-reaching social reconstruction forced upon us? That
emancipated woman would strive for a vast economic reorganization, as
the only means of preserving the self-respect and independence of her
sex, is a possibility with the gravest and most wide-reaching
consequences. We cannot emancipate woman without placing her in a
position of political and social influence equal to man’s. It may well
be that she will regard economic and sexual problems from a very
different standpoint, and the result will infallibly lead to the
formation of a woman’s party, and to a more or less conscious struggle
between the sexes. Would this end in an increased social stability or
another subjection of sex?
“Woman may, however, conclude that the alternative is true--that
prostitution is not the outcome of our present social organisation,
but a feature of all forms of human society. She must, then, treat it
as a necessary evil or as a necessary good. In the former case she
will at least insist on an equal social stigma attaching to both sexes
if she does not demand, as in the instance of any other form of
anti-social conduct, so far as practicable its legal repression. In
the latter case--that is, if its existence really tends in some way to
the welfare or stability of society--women will have to admit that
prostitution is an honourable profession; they cannot shirk that
conclusion, bitter as it may appear to some. The ‘social outcast’
would then have to be recognized as filling a social function, and the
problem would reduce to the amelioration of her life, and to her
elevation in the social scale. Either there is a means of abolishing
prostitution, or all participators must be treated alike as
anti-social, or the prostitute is an honourable woman--no other
possibility suggests itself. Society has hitherto failed to find a
remedy, perhaps because only man has sought for one; woman, when she
for the time fully grasps the problem, must be prepared for one, or
must recognize the alternatives. There cannot be a doubt, however,
that in a matter so closely concerning her personal dignity she will
take action, and that, if only in this one matter, her freedom will
raise questions, which many would prefer to ignore, and which, when
raised, will undoubtedly touch principles apparently fundamental to
our existing social organization.”
[330] See note to p. 390.
[331] Parent-Duchatelet, “The Moral Corruption of the Female Sex in
Paris,” vol. ii., p. 234 (Leipzig, 1837). Similarly, Julius Donarth
remarks (“The Beginnings of the Human Spirit,” p. 19; Stuttgart,
1898): “=Syphilis and alcoholism= can by social arrangement and
carefully adapted measures =be suppressed just as much as plague and
cholera=.”
[332] The literature of this subject is very extensive. In addition to
a comprehensive work dealing with the older literature, by J. K.
Proksch, “The Prevention of Venereal Diseases” (Vienna, 1872), I must
mention the following: E. Lang, “The Prevention of Venereal Diseases”
(Vienna, 1894); M. Joseph, “Prophylaxis of Cutaneous and Venereal
Diseases” (Munich, 1900); Neuberger, “The Prophylaxis of Venereal
Diseases,” pp. 35-37 (Munich and Berlin, 1904); Felix Block, “How
shall We protect Ourselves against Venereal Diseases and their Evil
Consequences?” second edition (Leipzig, 1905); E. Boureau, “Conseils
Pratiques à la Jeunesse pour Éviter les Avaries” (Paris, 1905); Suarez
de Mendoza, “Conseils de Prophylaxie Sanitaire et Morale” (Paris,
1906); same author, “ABC à l’Usage des Mères de Famille pour la
Défense de Leurs Foyers contre les Grands Fléaux du XXe Siècle:
Tuberculose, Avariose [= Syphilis], Neissérose [= Gonorrhœa],
Alcoolisme, Mortalité Infantile” (Paris, 1905); same author, “Avariose
des Innocents” (Paris, 1905).
[333] _Cf_. also the valuable remarks of Robert Hessen, “Cleanliness
or Morality?” published in _Die Zukunft_, June 9, 1906, pp. 367-377
(also separately printed in Munich, 1906).
[334] Otto Neustätter, “The Public Recommendation of Protective
Measures,” published in _The Journal for the Suppression of Venereal
Diseases_, vol. v., No. 3, pp. 225-227 (Leipzig, 1905).
[335] H. Ferdy, “The History of the Cæcal Condom,” published in _The
Journal for the Suppression of Venereal Diseases_, 1905, vol. iii.,
No. 4, pp. 144-147.
[336] _Cf._ in this connexion the admirable essay, distinguished by a
critical spirit, of R. de Campagnolle, “The Value of the Modern
Prophylaxis of Gonorrhœa by Means of Instillations,” published in _The
Journal for the Suppression of Venereal Diseases_, 1904, vol. iii.,
Nos. 1-4, pp. 1-31, 51-115, 148 (with a complete bibliography).
[337] In place of these solutions, Cronquist (“Contributions to the
Personal Prophylaxis against Gonorrhœa,” published in _Medizinische
Klinik_, No. 10, 1906) recommends the use of little rods or bougies
containing 2 per cent. of =albargin=, which melt from the body-heat
when introduced into the urethra (these are sold under the trade name
of “antigon-rods”); they are used, like the solutions, immediately
after coitus. The advantage they possess is their greater durability.
[338] The same idea had already been advanced in Germany by Eduard
Richter and S. Behrmann.
[339] E. Metchnikoff, “The Prophylaxis of Syphilis,” published in
_Medizinische Klinik_, 1906, No. 15, pp. 372, 373. _Cf._ also Paul
Maisonneuve, “Experimentation sur la Prophylaxie de la Syphilis”
(Paris, 1906); and A. Neisser. “Experimental Research regarding
Syphilis,” pp. 81-83 (Berlin, 1906).
[340] O. Neustätter, “The Public Recommendation of Protective
Measures,” published in _The Journal for the Suppression of Venereal
Diseases_, 1905, vol. iv., pp. 203-252.
[341] G. Bernhard, “The Criminal Law and Protective Measures against
Venereal Diseases,” _ibid._, pp. 253-273.
[342] F. von Liszt, “Legal Protection against Dangers to Health from
Venereal Diseases,” published in _The Journal for the Suppression of
Venereal Diseases_, 1903, vol. i., pp. 1-25.
[343] Von Bar, “The Need for a Special Law against Blameworthy
Venereal Infection,” _ibid._, pp. 64-72.
[344] R. Schmölder, “Criminal and Civil Juridicial Significance of
Venereal Diseases,” _ibid._, pp. 73-106.
[345] Albert Reibmayr, “The Immunization of Families by Inheritable
Diseases (Tuberculosis, Lues, Mental Disorders),” p. 17 (Leipzig and
Vienna, 1899).
[346] This conception of “partial syphilization” of our race appears
somewhat vague. If we take care to think clearly, and in terms of
exact biological knowledge, we shall see that--apart from a
spontaneous loss of intensity on the part of the syphilitic virus (of
which we have no precise knowledge whatever)--the only known way of
accounting for syphilis having become milder is by natural selection,
by the death of those who suffered most severely from the disease.
Now, in 400 years, ten or twelve human generations, there has hardly
been time for the development of immunity to a disease to which at
most a small fraction only of the population has ever been exposed. It
appears to me, however, that we may reasonably doubt the alleged
decline in the severity of syphilis. It must be remembered that the
entire absence of mercurial treatment at first, and the misuse of that
specific for many years after its value had been proved, will account
for much in respect of the apparent greater virulence of medieval as
compared with modern syphilis. (See also p. 356, and footnote to that
page referring to the writings of Archdall Reid).--TRANSLATOR.
[347] Alfred Fournier, “The Treatment and Prophylaxis of Syphilis.”
One vol. Rebman, London.
[348] _Cf._ Iwan Bloch, “Personal Reminiscences of my Lecturing
Journey this Year,” published in _Medizinische Klinik_, 1906, No. 10.
[349] Hermann is a fanatical _medical_ opponent of mercury. There are,
in fact, such oddities. They are very rare birds in the medical world.