MEDICAL PHASES
_By Andrew C. Smith_
Some idea of the prevalence of venereal diseases in the United States may
be obtained from the following statistics of the census for 1910. The
registration area covered a population of 48,877,893 persons. The figures
are here extended to cover a population of 90,000,000 people: Deaths
ascribed to venereal disease, 5275; spinal cord diseases, 2598; paresis,
4845. Other diseases partly due to syphilis: softening of the brain, a
term indiscriminately used to cover a number of diseases including brain
syphilis and paresis, 2111; paralysis, usually meaning apoplexy, but
always including many cases of brain syphilis, 14,479; premature birth, by
some believed to be the result of syphilis in one half of all cases,
34,174; congenital debility, deaths due in many cases to feebleness of the
child resulting from syphilis, 25,285; blindness, one fourth the total
number of blind in this country estimated at 15,000 to 20,000. Many
estimate that over half of the entire male population have had gonorrhea.
The principal reason for this alarming distribution among all classes of
these infections and their steady increase is ignorance and
misunderstanding of physiological facts, particularly the viciously false
teaching of the street corner that sexual activity is a physiological
necessity.
These diseases would be arrested were there a widespread knowledge of
their disastrous effects. Although young men hear the mischievous lie that
"gonorrhea is no worse than a bad cold," thousands of them are punished
with sterility as a result of the disease. Nearly all the neglected cases
result in so-called ascending infections, reaching the bladder and kidneys
and causing many deaths, and many men carry the infection in dormant form,
to infect innocent wives in later years.
Appalling as are the consequences of gonorrheal infection in men, they are
not so fatal or so far-reaching as syphilis. The causative parasite of
this disease spares not a single tissue in the body and may disturb any or
all of its functions, not even mentality escaping. As a cause of death it
is extremely frequent. Our statistics ordinarily ascribe to syphilis but
a small percentage of the deaths actually due to it; for instance, many of
our cases of spinal disease, paralysis, arterial and other organic
diseases are tabled under other names, although directly due to syphilis.
In women gonococcic infections are even more destructive than in men, as
it is extremely common for the infection to extend to the tubes and to the
peritoneal cavity, thus necessitating dangerous and mutilating operations,
generally followed by sterility and often by death. Syphilis, though less
frequent in women than in men, is nearly if not quite as fatal as in men,
and otherwise similar in its baneful effects. I The child suffers the most
tragic results of venereal infection, for it is always wholly innocent,
yet infected to a greater or less extent, if the parents be syphilitic,
and frequently if the birth-canal be gonorrheally infected. Although
silver nitrate is a remedy for gonorrheal infection, if applied to the
eyes immediately after birth, nevertheless the babe frequently suffers
with infected eyes, and not infrequently with blindness.
If the child's sad infection is syphilis, instead of gonorrhea, there are
still other miseries in store for it. If it is not so fortunate to be
stillborn, it may have infection that ranges from almost imperceptible
degrees to the most loathsome extent that it is possible for animal tissue
to harbor. Its brain may be so invaded by the syphilitic parasites that it
can never attain any degree of mentality; its spinal column maybe so
involved that paralytic conditions will surely result; and if these nerve
centers escape special involvement, other organs may be affected, such as
the stomach, bowels, and liver; if these escape, the bones may be so
deficient in vitality as to be incapable of sustaining the frame as
development proceeds; the skin only may be involved, or the mucous
membranes so affected as to make of the child a perpetual snuffler and
inefficient breather. In most cases of lesser as well as greater mental
defect, the tests show syphilitic infection. Endless are the complications
that may be visited upon the innocent progeny of syphilitic antecedents.
The gonorrheal infections occur in the mucous membranes lining the
cavities, especially those of the urethra and female genital tract. It is
in these tissues that the germ of gonorrhea finds lodgment, and once there
its development is hard to interrupt. Although the growth of the
gonorrheal germ produces acute symptoms, such as discharge and pain, these
pass off under treatment in a few weeks. Unfortunately the disease is far
from cured, for the microbe has found its natural habitat in the
inter-cellular structure of the genital mucus, from which it cannot
readily be dislodged, and from which it may invade other tissues. It may
remain in a state of latency for an indefinite time; then transferred to a
new field, it may resume its original activities. While in this stage of
latency it is difficult to destroy. At this time it is more likely to be
further disseminated, as the patient, ignorant of the condition, is more
likely to convey the disease, which so often occurs in married life after
a long forgotten infection.
The gonococcus (the microbe of gonorrhea) is a pus--producing bacterium,
occurring in pairs, resembling in form two coffee grains, generally with a
distinct interval of separation. Although its natural habitat is the
mucous membrane lining the genito-urinary tracts it may invade the
muscular and serous and other tissues. If often affects the Fallopian
tubes and ovaries and the serous lining of the pelvic and abdominal
cavities. The deeper sub-mucous tissues of the uterus and the male
genito-urinary tracts are also frequently involved, it being sometimes
impossible to eradicate it from these deeper retreats. From these deeper
tissues it is more commonly taken up by the circulation and deposited in
distant parts, frequently in the joints. When it becomes thus
systematically disseminated, the so-called secondary or metastatic lesions
are almost as numerous, though not as virulent, as syphilitic infection.
Recent pathological researchers have found that occasionally the
gonococcus becomes the causative factor in inflammations of the muscles,
tendons, and glands, and in inflammatory conditions of the lungs, kidneys,
heart, and even the brain, spinal cord, and the serous membranes
enveloping these great cranial and spinal viscera.
The individuality and characteristics of the syphilis microbe were not
positively determined until in 1905, Schaudinn, of Germany, convinced the
medical world that it was a spiral, corkscrew-like organism, from a
quarter to one millimeter in thickness, and from four to twelve
millimeters in length. It is not so discriminating as the gonococcus in
its points of inoculation, nor is it as vulnerable to attack; and it is
vastly more destructive to the tissues invaded. It spares no tissue in the
human frame, and resists destruction by any known drugs of vegetable
origin. When in a latent state its presence was often impossible to
determine until, two years after its discovery, a test was worked out by
Wasserman, also of Germany, by which diagnosis of the infection may be
made,--even in latent form,--as in a hereditary case where no clinical
manifestations have yet asserted themselves. There is another valuable
blood test worked out by Noguchi. With these two tests we are now able to
diagnose the disease, almost absolutely, and follow up the treatment till
cure is complete, except in some of the incurable brain and spinal cord
cases.
In 1909, Ehrlich determined, after a series of laboratory experiments on
animals inoculated with the syphilis germ (spirochæta pallida), that a
complex compound, with arsenic as its base, had the desired effect of
destroying the parasite, in a dose not poisonous to the animal. This
compound, first designated as "606," representing its number among his
many laboratory experiments, he later named "salvarsan." With the
assistance of his clinical friends, he soon demonstrated the action of his
compound on man, and gave it freely to the world. Although it is now
almost universally used, it has not proved to be the absolute cure that it
was hoped it would be, as some of the spirochætæ seem to be hidden away
where they are protected from the circulating poison,--to bring forth new
progeny,--thus producing so-called recurrence.
The possibility of the infection of innocent persons is always uppermost
in the mind of the medical man, and should equally concern the layman.
Contaminated articles and utensils, such as towels and common
drinking-cups, have caused many infections. This danger is greater from
syphilis than from gonorrhea, for the reason that the spirochæta pallida
is more virulent than the gonococcus. In our own fields, camps, and mines,
it is common for men to drink from one jug or dipper. Infection almost
surely follows if one of the crowd has a syphilitic sore on the lip. So
intense is the activity of the spirochæta pallida in the primary stage
that it may be borne to innocent parties by unwashed clothes and utensils
of any kind, that have been in recent contact with a primary syphilitic
sore. A dentist's or a doctor's instruments, for instance, are extremely
dangerous as infection carriers, if they are not thoroughly sterilized by
boiling. The danger of infection in syphilis and gonorrhea depends largely
upon the virulence of the individual infection. As some living tubercle
bacilli may be harbored and thrown off with impunity, while others will
destroy the strongest man, regardless of all treatment, so some spirochætæ
or gonococci may be safely disposed of, while others are most deadly.
Of all the sad instances of germ infection, the saddest are those from
venereal germs, for they are disseminated mostly in vice, and inoculated
into the innocent through ignorance. A common cause of infection of the
innocent is the false popular belief that venereal germs are transmitted
only in sexual congress. The truth is that any part of the body is in
danger of inoculation from syphilis if the germ be virulent. So may any
membranous point be infected by the gonococcus, whether conveyed by hand
or instrument or fabric. This explains the number of gonococcic infections
occurring in girl children. They come in membranous contact (at the outlet
of vagina or rectum, or in the eye) with a contaminated article of
clothing, or with the contaminated hands of an infected person. Ignorance
is the cause of nearly all venereal infections. Why, then, should venereal
infection not be eradicated? With adequate education, if there is not
eradication, there will at least be compensation, for the sacrifice will
be mainly of those who will not accept education--the unfit.
The possibility of recovery from syphilis is greater at present than it
has been in the past, but we cannot yet say that the disease is absolutely
curable in a given case. While most cases treated early with salvarsan,
and followed by judicious use of mercury, are curable, there are
nevertheless those which do not thus respond, and which in spite of all
treatment go from bad to worse, till the patient's miseries are ended in
insanity, paralysis, and death.
While the venereal diseases are the greatest physical evils to be
attributed to sex ignorance, there are others chargeable to the same
cause. There are, for instance, important physiological phenomena
pertaining to sex development, ignorance of which is often baneful to the
developing adolescent of either sex. When the boy's voice begins to
change, and hair begins to appear on his face and body, and more thrilling
sensations occasionally command his attention, he should be told, modestly
but distinctly, that a pure and manly function is developing within him,
the sole object of which is reproduction, and he must not consider it in a
vulgar way, nor discuss it with others than his parents or physician or
minister. Tell him that these physical changes of oncoming manhood are due
to the establishment of the secretion of the procreative fluid,--the
semen,--and will be safely cared for by nature. Fortify him against the
mental pollution of the quack advertisement, and the satanically false
teaching of ignorant associates that sexual intercourse is physiologically
necessary, by impressing him with the fact that nature cares for the
disposal of the seminal secretion. When clearly made aware of these simple
sex principles, and convinced that it is unmanly and depraved to consider
them vulgarly, the rapidly developing manly boy will not become a
masturbator or a frequenter of bawdy-houses and a victim of the gonococcic
or spirochætic infections; nor will he become a moral assassin, a seducer
of girls.
The sister, no less than the brother, needs pure, plain, non-prudish sex
education. If her mother is not qualified to impart it, she, like the boy,
should seek the aid of her minister, or physician, or a qualified school
teacher; better a few suggestions from an experienced, modest source than
many suggestions from inexperienced and often lewd companions. As the
brother was told of the physical phenomena accompanying his sex
development, so the sister should be apprised of the physiological
necessity of her periodical functions, and of nature's kindly care and
development of her delicate and wonderful sex mechanism, the sole purpose
of which is maternity. It will fortify her maidenliness to tell her that
much of the world is deceitful and degrading in sex matters, and that if
she would be a perfect woman, mentally and physically, she must vigilantly
guard her virtue, maintaining absolute purity, not only with persons of
the opposite sex, but with persons of her own sex, and the person of her
own self. Incalculable good can be done toward the uplift of wayward
humanity by sex education.