[201] These conditions favor temporary free unions, but they also favor

prostitution. The reason is, according to Adolf Gerson (_Sexual-Probleme_,

September, 1908), that the woman of good class will not have free unions.

Partly moved by moral traditions, and partly by the feeling that a man

should be legally her property, she will not give herself out of love to a

man; and he therefore turns to the lower-class woman who gives herself for

money.

[202] Many girls, said Ellice Hopkins, get into mischief merely because

they have in them an element of the "black kitten," which must frolic and

play, but has no desire to get into danger. "Do you not think it a little

hard," she added, "that men should have dug by the side of her foolish

dancing feet a bottomless pit, and that she cannot have her jump and fun

in safety, and put on her fine feathers like the silly bird-witted thing

she is, without a single false step dashing her over the brink, and

leaving her with the very womanhood dashed out of her?"

[203] A. Sherwell, _Life in West London_, 1897, Ch. V.

[204] As quoted by Bloch, _Sexualleben Unserer Zeit_, p. 358. In Berlin

during recent years the number of prostitutes has increased at nearly

double the rate at which the general population has increased. It is no

doubt probable that the supply tends to increase the demand.

[205] Goncourt, _Journal_, vol. iii, p. 49.

[206] Vanderkiste, _The Dens of London_, 1854, p. 242.

[207] Bonger (_Criminalité et Conditions Economiques_, p. 406) refers to

the prevalence of prostitution among dressmakers and milliners, as well as

among servants, as showing the influence of contact with luxury, and adds

that the rich women, who look down on prostitution, do not always realize

that they are themselves an important factor of prostitution, both by

their luxury and their idleness; while they do not seem to be aware that

they would themselves act in the same way if placed under the same

conditions.

[208] H. Lippert, in his book on prostitution in Hamburg, laid much stress

on the craving for dress and adornment as a factor of prostitution, and

Bloch (_Das Sexualleben unsurer Zeit_, p. 372) considers that this factor

is usually underestimated, and that it exerts an especially powerful

influence on servants.

[209] Since this was written the influence of several generations of

town-life in immunizing a stock to the evils of that life (though without

reference to prostitution) has been set forth by Reibmayr, _Die

Entwicklungsgeschichte des Talentes und Genies_, 1908, vol. ii, pp. 73 _et

seq._

[210] In France this intimacy is embodied in the delicious privilege of

_tutoiement_. "The mystery of _tutoiement!_" exclaims Ernest La Jennesse

in _L'Holocauste:_ "Barriers broken down, veils drawn away, and the ease

of existence! At a time when I was very lonely, and trying to grow

accustomed to Paris and to misfortune, I would go miles--on foot,

naturally--to see a girl cousin and an aunt, merely to have something to

_tutoyer_. Sometimes they were not at home, and I had to come back with my

_tu_, my thirst for confidence and familiarity and brotherliness."

[211] For some facts and references to the extensive literature concerning

this trade, see, e.g., Bloch, _Das Sexualleben Unserer Zeit_, pp. 374-376;

also K.M. Baer, _Zeitschrift für Sexualwissenschaft_, Sept., 1908;

Paulucci de Calboli, _Nuova Antologia_, April, 1902.

[212] These considerations do not, it is true, apply to many kinds of

sexual perverts who form an important proportion of the clients of

brothels. These can frequently find what they crave inside a brothel much

more easily than outside.

[213] Thus Charles Booth, in his great work on _Life and Labor in London_,

final volume (p. 128), recommends that "houses of accommodation," instead

of being hunted out, should be tolerated as a step towards the suppression

of brothels.

[214] "Towns like Woolwich, Aldershot, Portsmouth, Plymouth," it has been

said, "abound with wretched, filthy monsters that bear no resemblance to

women; but it is drink, scorn, brutality and disease which have reduced

them to this state, not the mere fact of associating with men."

[215] "The contract of prostitution in the opinion of prostitutes

themselves," Bernaldo de Quirós and Llanas Aguilaniedo remark (_La Mala

Vida en Madrid_, p. 254), "cannot be assimilated to a sale, nor to a

contract of work, nor to any other form of barter recognized by the civil

law. They consider that in these pacts there always enters an element

which makes it much more like a gift in a matter in which no payment could

be adequate. 'A woman's body is without price' is an axiom of

prostitution. The money placed in the hands of her who procures the

satisfaction of sexual desire is not the price of the act, but an offering

which the priestess of Venus applies to her maintenance." To the Spaniard,

it is true, every transaction which resembles trade is repugnant, but the

principle underlying this feeling holds good of prostitution generally.

[216] _Journal des Goncourt_, vol. iii; this was in 1866.

[217] Rev. the Hon. C. Lyttelton, _Training of the Young in Laws of Sex_,

p. 42.

[218] See, e.g., R.W. Taylor, _Treatise on Sexual Disorders_, 1897, pp.

74-5. Georg Hirth (_Wege zur Heimat_, 1909, p. 619) narrates the case of a

young officer who, being excited by the caresses of his betrothed and

having too much respect for her to go further than this, and too much

respect for himself to resort to masturbation, knew nothing better than to

go to a prostitute. Syphilis developed a few days after the wedding. Hirth

adds, briefly, that the results were terrible.

[219] It is an oft-quoted passage, but can scarcely be quoted too often:

"You see that this wrought-iron plate is not quite flat: it sticks up a

little, here towards the left--'cockles,' as we say. How shall we flatten

it? Obviously, you reply, by hitting down on the part that is prominent.

Well, here is a hammer, and I give the plate a blow as you advise. Harder,

you say. Still no effect. Another stroke? Well, there is one, and another,

and another. The prominence remains, you see: the evil is as great as

ever--greater, indeed. But that is not all. Look at the warp which the

plate has got near the opposite edge. Where it was flat before it is now

curved. A pretty bungle we have made of it. Instead of curing the original

defect we have produced a second. Had we asked an artisan practiced in

'planishing,' as it is called, he would have told us that no good was to

be done, but only mischief, by hitting down on the projecting part. He

would have taught us how to give variously-directed and specially-adjusted

blows with a hammer elsewhere: so attacking the evil, not by direct, but

by indirect actions. The required process is less simple than you thought.

Even a sheet of metal is not to be successfully dealt with after those

common-sense methods in which you have so much confidence. What, then,

shall we say about a society?... Is humanity more readily straightened

than an iron plate?" (_The Study of Sociology_, p. 270.)

CHAPTER VIII.

THE CONQUEST OF THE VENEREAL DISEASES.

The Significance of the Venereal Diseases--The History of Syphilis--The

Problem of Its Origin--The Social Gravity of Syphilis--The Social Dangers

of Gonorrhoea--The Modern Change in the Methods of Combating

Venereal Diseases--Causes of the Decay of the System of Police

Regulation--Necessity of Facing the Facts--The Innocent Victims of

Venereal Diseases--Diseases Not Crimes--The Principle of Notification--The

Scandinavian System--Gratuitous Treatment--Punishment for Transmitting

Venereal Diseases--Sexual Education in Relation to Venereal

Diseases--Lectures, Etc.--Discussion in Novels and on the Stage--The

"Disgusting" Not the "Immoral."

It may, perhaps, excite surprise that in the preceding discussion of

prostitution scarcely a word has been said of venereal diseases. In the

eyes of many people, the question of prostitution is simply the question

of syphilis. But from the psychological point of view with which we are

directly concerned, as from the moral point of view with which we cannot

fail to be indirectly concerned, the question of the diseases which may

be, and so frequently are, associated with prostitution cannot be placed

in the first line of significance. The two questions, however intimately

they may be mingled, are fundamentally distinct. Not only would venereal

diseases still persist even though prostitution had absolutely ceased,

but, on the other hand, when we have brought syphilis under the same

control as we have brought the somewhat analogous disease of leprosy, the

problem of prostitution would still remain.

Yet, even from the standpoint which we here occupy, it is scarcely

possible to ignore the question of venereal disease, for the psychological

and moral aspects of prostitution, and even the whole question of the

sexual relationships, are, to some extent, affected by the existence of

the serious diseases which are specially liable to be propagated by sexual

intercourse.

Fournier, one of the leading authorities on this subject, has well said

that syphilis, alcoholism, and tuberculosis are the three modern plagues.

At a much earlier period (1851) Schopenhauer in _Parerga und Paralipomena_

had expressed the opinion that the two things which mark modern social

life, in distinction from that of antiquity, and to the advantage of the

latter, are the knightly principle of honor and venereal disease;

together, he added, they have poisoned life, and introduced a hostile and

even diabolical element into the relations of the sexes, which has

indirectly affected all other social relationships.[220] It is like a

merchandise, says Havelburg, of syphilis, which civilization has

everywhere carried, so that only a very few remote districts of the globe

(as in Central Africa and Central Brazil) are to-day free from it.[221]

It is undoubtedly true that in the older civilized countries the

manifestations of syphilis, though still severe and a cause of physical

deterioration in the individual and the race, are less severe than they

were even a generation ago.[222] This is partly the result of earlier and

better treatment, partly, it is possible, the result also of the

syphilization of the race, some degree of immunity having now become an

inherited possession, although it must be remembered that an attack of

syphilis does not necessarily confer immunity from the actual attack of

the disease even in the same individual. But it must be added that, even

though it has become less severe, syphilis, in the opinion of many, is

nevertheless still spreading, even in the chief centres of civilization;

this has been noted alike in Paris and in London.[223]

According to the belief which is now tending to prevail, syphilis was

brought to Europe at the end of the fifteenth century by the first

discoverers of America. In Seville, the chief European port for America,

it was known as the Indian disease, but when Charles VIII and his army

first brought it to Italy in 1495, although this connection with the

French was only accidental, it was called the Gallic disease, "a monstrous

disease," said Cataneus, "never seen in previous centuries and altogether

unknown in the world."

The synonyms of syphilis were at first almost innumerable. It was in his

Latin poem _Syphilis sive Morbus Gallicus_, written before 1521 and

published at Verona in 1530, that Fracastorus finally gave the disease its

now universally accepted name, inventing a romantic myth to account for

its origin.

Although the weight of authoritative opinion now seems to incline

towards the belief that syphilis was brought to Europe from

America, on the discovery of the New World, it is only within

quite recent years that that belief has gained ground, and it

scarcely even yet seems certain that what the Spaniards brought

back from America was really a disease absolutely new to the Old

World, and not a more virulent form of an old disease of which

the manifestations had become benign. Buret, for instance (_Le

Syphilis Aujourd'hui et chez les Anciens_, 1890), who some years

ago reached "the deep conviction that syphilis dates from the

creation of man," and believed, from a minute study of classic

authors, that syphilis existed in Rome under the Cæsars, was of

opinion that it has broken out at different places and at

different times, in epidemic bursts exhibiting different

combinations of its manifold symptoms, so that it passed

unnoticed at ordinary times, and at the times of its more intense

manifestation was looked upon as a hitherto unknown disease. It

was thus regarded in classic times, he considers, as coming from

Egypt, though he looked upon its real home as Asia. Leopold Glück

has likewise quoted (_Archiv für Dermatologie und Syphilis_,

January, 1899) passages from the medical epigrams of a sixteenth

century physician, Gabriel Ayala, declaring that syphilis is not

really a new disease, though popularly supposed to be so, but an

old disease which has broken out with hitherto unknown violence.

There is, however, no conclusive reason for believing that

syphilis was known at all in classic antiquity. A.V. Notthaft

("Die Legende von der Althertums-syphilis," in the Rindfleisch

_Festschrift_, 1907, pp. 377-592) has critically investigated the

passages in classic authors which were supposed by Rosenbaum,

Buret, Proksch and others to refer to syphilis. It is quite

true, Notthaft admits, that many of these passages might possibly

refer to syphilis, and one or two would even better fit syphilis

than any other disease. But, on the whole, they furnish no proof

at all, and no syphilologist, he concludes, has ever succeeded in

demonstrating that syphilis was known in antiquity. That belief

is a legend. The most damning argument against it, Notthaft

points out, is the fact that, although in antiquity there were

great physicians who were keen observers, not one of them gives

any description of the primary, secondary, tertiary, and

congenital forms of this disease. China is frequently mentioned

as the original home of syphilis, but this belief is also quite

without basis, and the Japanese physician, Okamura, has shown

(_Monatsschrift für praktische Dermatologie_, vol. xxviii, pp.

296 et seq.) that Chinese records reveal nothing relating to

syphilis earlier than the sixteenth century. At the Paris Academy

of Medicine in 1900 photographs from Egypt were exhibited by

Fouquet of human remains which date from B.C. 2400, showing bone

lesions which seemed to be clearly syphilitic; Fournier, however,

one of the greatest of authorities, considered that the diagnosis

of syphilis could not be maintained until other conditions liable

to produce somewhat similar bone lesions had been eliminated

(_British Medical Journal_, September 29, 1900, p. 946). In

Florida and various regions of Central America, in undoubtedly

pre-Columbian burial places, diseased bones have been found which

good authorities have declared could not be anything else than

syphilitic (e.g., _British Medical Journal_, November 20, 1897,

p. 1487), though it may be noted that so recently as 1899 the

cautious Virchow stated that pre-Columbian syphilis in America

was still for him an open question (_Zeitschrift für Ethnologie_,

Heft 2 and 3, 1899, p. 216). From another side, Seler, the

distinguished authority on Mexican antiquity, shows (_Zeitschrift

für Ethnologie_, 1895, Heft 5, p. 449) that the ancient Mexicans

were acquainted with a disease which, as they described it, might

well have been syphilis. It is obvious, however, that while the

difficulty of demonstrating syphilitic diseased bones in America

is as great as in Europe, the demonstration, however complete,

would not suffice to show that the disease had not already an

existence also in the Old World. The plausible theory of Ayala

that fifteenth century syphilis was a virulent recrudescence of

an ancient disease has frequently been revived in more modern

times. Thus J. Knott ("The Origin of Syphilis," _New York Medical

Journal_, October 31, 1908) suggests that though not new in

fifteenth century Europe, it was then imported afresh in a form

rendered more aggravated by coming from an exotic race, as is

believed often to be the case.

It was in the eighteenth century that Jean Astruc began the

rehabilitation of the belief that syphilis is really a

comparatively modern disease of American origin, and since then

various authorities of weight have given their adherence to this

view. It is to the energy and learning of Dr. Iwan Bloch, of

Berlin (the first volume of whose important work, _Der Ursprung

der Syphilis_, was published in 1901) that we owe the fullest

statement of the evidence in favor of the American origin of

syphilis. Bloch regards Ruy Diaz de Isla, a distinguished Spanish

physician, as the weightiest witness for the Indian origin of the

disease, and concludes that it was brought to Europe by

Columbus's men from Central America, more precisely from the

Island of Haiti, to Spain in 1493 and 1494, and immediately

afterwards was spread by the armies of Charles VIII in an

epidemic fashion over Italy and the other countries of Europe.

It may be added that even if we have to accept the theory that

the central regions of America constitute the place of origin of

European syphilis, we still have to recognize that syphilis has

spread in the North American continent very much more slowly and

partially than it has in Europe, and even at the present day

there are American Indian tribes among whom it is unknown.

Holder, on the basis of his own experiences among Indian tribes,

as well as of wide inquiries among agency physicians, prepared a

table showing that among some thirty tribes and groups of tribes,

eighteen were almost or entirely free from venereal disease,

while among thirteen it was very prevalent. Almost without

exception, the tribes where syphilis is rare or unknown refuse

sexual intercourse with strangers, while those among whom such

disease is prevalent are morally lax. It is the whites who are

the source of infection among these tribes (A.B. Holder, "Gynecic

Notes Among the American Indians," _American Journal of

Obstetrics_, 1892, No. 1).

Syphilis is only one, certainly the most important, of a group of three

entirely distinct "venereal diseases" which have only been distinguished

in recent times, and so far as their precise nature and causation are

concerned, are indeed only to-day beginning to be understood, although two

of them were certainly known in antiquity. It is but seventy years ago

since Ricord, the great French syphilologist, following Bassereau, first

taught the complete independence of syphilis both from gonorrhoea

and soft chancre, at the same time expounding clearly the three stages,

primary, secondary and tertiary, through which syphilitic manifestations

tend to pass, while the full extent of tertiary syphilitic symptoms is

scarcely yet grasped, and it is only to-day beginning to be generally

realized that two of the most prevalent and serious diseases of the brain

and nervous system--general paralysis and tabes dorsalis or locomotor

ataxia--have their predominant though not sole and exclusive cause in the

invasion of the syphilitic poison many years before. In 1879 a new stage

of more precise knowledge of the venereal diseases began with Neisser's

discovery of the gonococcus which is the specific cause of gonorrhoea.

This was followed a few years later by the discovery by Ducrey and Unna of

the bacillus of soft chancre, the least important of the venereal diseases

because exclusively local in its effects. Finally, in 1905--after

Metchnikoff had prepared the way by succeeding in carrying syphilis from

man to monkey, and Lassar, by inoculation, from monkey to monkey--Fritz

Schaudinn made his great discovery of the protozoal _Spirochoeta

pallida_ (since sometimes called _Treponema pallidum_), which is now

generally regarded as the cause of syphilis, and thus revealed the final

hiding place of one of the most dangerous and insidious foes of

humanity.[224]

There is no more subtle poison than that of syphilis. It is not, like

smallpox or typhoid, a disease which produces a brief and sudden storm, a

violent struggle with the forces of life, in which it tends, even without

treatment, provided the organism is healthy, to succumb, leaving little or

no traces of its ravages behind. It penetrates ever deeper and deeper into

the organism, with the passage of time leading to ever new manifestations,

and no tissue is safe from its attack. And so subtle is this all-pervading

poison that though its outward manifestations are amenable to prolonged

treatment, it is often difficult to say that the poison has been finally

killed out.[225]

The immense importance of syphilis, and the chief reason why it is

necessary to consider it here, lies in the fact that its results are not

confined to the individual himself, nor even to the persons to whom he may

impart it by the contagion due to contact in or out of sexual

relationships: it affects the offspring, and it affects the power to

produce offspring. It attacks men and women at the centre of life, as the

progenitors of the coming race, inflicting either sterility or the

tendency to aborted and diseased products of conception. The father alone

can perhaps transmit syphilis to his child, even though the mother escapes

infection, and the child born of syphilitic parents may come into the

world apparently healthy only to reveal its syphilitic origin after a

period of months or even years. Thus syphilis is probably a main cause of

the enfeeblement of the race.[226]

Alike in the individual and in his offspring syphilis shows its

deteriorating effects on all the structures of the body, but especially on

the brain and nervous system. There are, as has been pointed out by Mott,

a leading authority in this matter,[227] five ways in which syphilis

affects the brain and nervous system: (1) by moral shock; (2) by the

effects of the poison in producing anæmia and impaired general nutrition;

(3) by causing inflammation of the membranes and tissues of the brain; (4)

by producing arterial degeneration, leading on to brain-softening,

paralysis, and dementia; (5) as a main cause of the para-syphilitic

affections of general paralysis and tabes dorsalis.

It is only within recent years that medical men have recognized the

preponderant part played by acquired or inherited syphilis in producing

general paralysis, which so largely helps to fill lunatic asylums, and

tabes dorsalis which is the most important disease of the spinal cord.

Even to-day it can scarcely be said that there is complete agreement as

to the supreme importance of the factor of syphilis in these diseases.

There can, however, be little doubt that in about ninety-five per cent. at

least of cases of general paralysis syphilis is present.[228]

Syphilis is not indeed by itself an adequate cause of general paralysis

for among many savage peoples syphilis is very common while general

paralysis is very rare. It is, as Krafft-Ebing was accustomed to say,

syphilization and civilization working together which produce general

paralysis, perhaps in many cases, there is reason for thinking, on a

nervous soil that is hereditarily degenerated to some extent; this is

shown by the abnormal prevalence of congenital stigmata of degeneration

found in general paralytics by Näcke and others. "Paralyticus nascitur

atque fit," according to the dictum of Obersteiner. Once undermined by

syphilis, the deteriorated brain is unable to resist the jars and strains

of civilized life, and the result is general paralysis, truly described as

"one of the most terrible scourges of modern times." In 1902 the

Psychological Section of the British Medical Association, embodying the

most competent English authority on this question, unanimously passed a

resolution recommending that the attention of the Legislature and other

public bodies should be called to the necessity for immediate action in

view of the fact that "general paralysis, a very grave and frequent form

of brain disease, together with other varieties of insanity, is largely

due to syphilis, and is therefore preventable." Yet not a single step has

yet been taken in this direction.

The dangers of syphilis lie not alone in its potency and its persistence

but also in its prevalence. It is difficult to state the exact incidence

of syphilis, but a great many partial investigations have been made in

various countries, and it would appear that from five to twenty per cent.

of the population in European countries is syphilitic, while about fifteen

per cent. of the syphilitic cases die from causes directly or indirectly

due to the disease.[229] In France generally, Fournier estimates that

seventeen per cent. of the whole population have had syphilis, and at

Toulouse, Audry considers that eighteen per cent. of all his patients are

syphilitic. In Copenhagen, where notification is obligatory, over four per

cent. of the population are said to be syphilitic. In America a committee

of the Medical Society of New York, appointed to investigate the question,

reported as the result of exhaustive inquiry that in the city of New York

not less than a quarter of a million of cases of venereal disease occurred

every year, and a leading New York dermatologist has stated that among the

better class families he knows intimately at least one-third of the sons

have had syphilis. In Germany eight hundred thousand cases of venereal

disease are by one authority estimated to occur yearly, and in the larger

universities twenty-five per cent. of the students are infected every

term, venereal disease being, however, specially common among students.

The yearly number of men invalided in the German army by venereal diseases

equals a third of the total number wounded in the Franco-Prussian war. Yet

the German army stands fairly high as regards freedom from venereal

disease when compared with the British army which is more syphilized than

any other European army.[230] The British army, however, being

professional and not national, is less representative of the people than

is the case in countries where some form of conscription prevails. At one

London hospital it could be ascertained that ten per cent. of the patients

had had syphilis; this probably means a real proportion of about fifteen

per cent., a high though not extremely high ratio. Yet it is obvious that

even if the ratio is really lower than this the national loss in life and

health, in defective procreation and racial deterioration, must be

enormous and practically incalculable. Even in cash the venereal budget is

comparable in amount to the general budget of a great nation. Stritch

estimates that the cost to the British nation of venereal diseases in the

army, navy and Government departments alone, amounts annually to

£3,000,000, and when allowance is made for superannuations and sick-leave

indirectly occasioned through these diseases, though not appearing in the

returns as such, the more accurate estimate of the cost to the nation is

stated to be £7,000,000. The adoption of simple hygienic measures for the

prevention and the speedy cure of venereal diseases will be not only

indirectly but even directly a source of immense wealth to the nation.

Syphilis is the most obviously and conspicuously appalling of the venereal

diseases. Yet it is less frequent and in some respects less dangerously

insidious than the other chief venereal disease, gonorrhoea.[231]

At one time the serious nature of gonorrhoea, especially in women, was

little realized. Men accepted it with a light heart as a trivial accident;

women ignored it. This failure to realize the gravity of gonorrhoea, even

sometimes on the part of the medical profession--so that it has been

popularly looked upon, in Grandin's words, as of little more significance

than a cold in the nose--has led to a reaction on the part of some towards

an opposite extreme, and the risks and dangers of gonorrhoea have been

even unduly magnified. This is notably the case as regards sterility. The

inflammatory results of gonorrhoea are indubitably a potent cause of

sterility in both sexes; some authorities have stated that not only eighty

per cent. of the deaths from inflammatory diseases of the pelvic organs

and the majority of the cases of chronic invalidism in women, but ninety

per cent. of involuntary sterile marriages, are due to gonorrhoea.

Neisser, a great authority, ascribes to this disease without doubt fifty

per cent, of such marriages. Even this estimate is in the experience of

some observers excessive. It is fully proved that the great majority of

men who have had gonorrhoea, even if they marry within two years of being

infected, fail to convey the disease to their wives, and even of the women

infected by their husbands more than half have children. This is, for

instance, the result of Erb's experience, and Kisch speaks still more

strongly in the same sense. Bumm, again, although regarding gonorrhoea as

one of the two chief causes of sterility in women, finds that it is not

the most frequent cause, being only responsible for about one-third of the

cases; the other two-thirds are due to developmental faults in the genital

organs. Dunning in America has reached results which are fairly concordant

with Bumm's.

With regard to another of the terrible results of gonorrhoea, the part it

plays in producing life-long blindness from infection of the eyes at

birth, there has long been no sort of doubt. The Committee of the

Ophthalmological Society in 1884, reported that thirty to forty-one per

cent. of the inmates of four asylums for the blind in England owed their

blindness to this cause.[232] In German asylums Reinhard found that thirty

per cent. lost their sight from the same cause. The total number of

persons blind from gonorrhoeal infection from their mothers at birth is

enormous. The British Royal Commission on the Condition of the Blind

estimated there were about seven thousand persons in the United Kingdom

alone (or twenty-two per cent. of the blind persons in the country) who

became blind as the result of this disease, and Mookerji stated in his

address on Ophthalmalogy at the Indian Medical Congress of 1894 that in

Bengal alone there were six hundred thousand totally blind beggars, forty

per cent. of whom lost their sight at birth through maternal gonorrhoea;

and this refers to the beggar class alone.

Although gonorrhoea is liable to produce many and various calamities,[233]

there can be no doubt that the majority of gonorrhoeal persons escape

either suffering or inflicting any very serious injury. The special reason

why gonorrhoea has become so peculiarly serious a scourge is its extreme

prevalence. It is difficult to estimate the proportion of men and women in

the general population who have had gonorrhoea, and the estimates vary

within wide limits. They are often set too high. Erb, of Heidelberg,

anxious to disprove exaggerated estimates of the prevalence of gonorrhoea,

went over the records of two thousand two hundred patients in his private

practice (excluding all hospital patients) and found the proportion of

those who had suffered from gonorrhoea was 48.5 per cent.

Among the working classes the disease is much less prevalent than among

higher-class people. In a Berlin Industrial Sick Club, 412 per 10,000 men

and 69 per 10,000 women had gonorrhoea in a year; taking a series of years

the Club showed a steady increase in the number of men, and decrease in

the number of women, with venereal infection; this seems to indicate that

the laboring classes are beginning to have intercourse more with

prostitutes and less with respectable girls.[234] In America Wood Ruggles

has given (as had Noggerath previously, for New York), the prevalence of

gonorrhoea among adult males as from 75 to 80 per cent.; Tenney places it

much lower, 20 per cent. for males and 5 per cent. for females. In

England, a writer in the _Lancet_, some years ago,[235] found as the

result of experience and inquiries that 75 per cent. adult males have had

gonorrhoea once, 40 per cent. twice, 15 per cent. three or more times.

According to Dulberg about twenty per cent. of new cases occur in married

men of good social class, the disease being comparatively rare among

married men of the working class in England.

Gonorrhoea in its prevalence is thus only second to measles and in the

gravity of its results scarcely second to tuberculosis. "And yet," as

Grandin remarks in comparing gonorrhoea to tuberculosis, "witness the

activity of the crusade against the latter and the criminal apathy

displayed when the former is concerned."[236] The public must learn to

understand, another writer remarks, that "gonorrhoea is a pest that

concerns its highest interests and most sacred relations as much as do

smallpox, cholera, diphtheria, or tuberculosis."[237]

It cannot fairly be said that no attempts have been made to beat back the

flood of venereal disease. On the contrary, such attempts have been made

from the first. But they have never been effectual;[238] they have never

been modified to changed condition; at the present day they are

hopelessly unscientific and entirely opposed alike to the social and the

individual demands of modern peoples. At the various conferences on this

question which have been held during recent years the only generally

accepted conclusion which has emerged is that all the existing systems

of interference or non-interference with prostitution are

unsatisfactory.[239]

The character of prostitution has changed and the methods of dealing with

it must change. Brothels, and the systems of official regulation which

grew up with special reference to brothels, are alike out of date; they

have about them a mediæval atmosphere, an antiquated spirit, which now

render them unattractive and suspected. The conspicuously distinctive

brothel is falling into disrepute; the liveried prostitute absolutely

under municipal control can scarcely be said to exist. Prostitution tends

to become more diffused, more intimately mingled with social life

generally, less easily distinguished as a definitely separable part of

life. We can nowadays only influence it by methods of permeation which

bear upon the whole of our social life.

The objection to the regulation of prostitution is still of slow

growth, but it is steadily developing everywhere, and may be

traced equally in scientific opinion and in popular feeling. In

France the municipalities of some of the largest cities have

either suppressed the system of regulation entirely or shown

their disapproval of it, while an inquiry among several hundred

medical men showed that less than one-third were in favor of

maintaining regulation (_Die Neue Generation_, June, 1909, p.

244). In Germany, where there is in some respects more patient

endurance of interference with the liberty of the individual than

in France, England, or America, various elaborate systems for

organizing prostitution and dealing with venereal disease

continue to be maintained, but they cannot be completely carried

out, and it is generally admitted that in any case they could not

accomplish the objects sought. Thus in Saxony no brothels are

officially tolerated, though as a matter of fact they

nevertheless exist. Here, as in many other parts of Germany, most

minute and extensive regulations are framed for the use of

prostitutes. Thus at Leipzig they must not sit on the benches in

public promenades, nor go to picture galleries, or theatres, or

concerts, or restaurants, nor look out of their windows, nor

stare about them in the street, nor smile, nor wink, etc., etc.

In fact, a German prostitute who possesses the heroic

self-control to carry out conscientiously all the self-denying

ordinances officially decreed for her guidance would seem to be

entitled to a Government pension for life.

Two methods of dealing with prostitution prevail in Germany. In

some cities public houses of prostitution are tolerated (though

not licensed); in other cities prostitution is "free," though

"secret." Hamburg is the most important city where houses of

prostitution are tolerated and segregated. But, it is stated,

"everywhere, by far the larger proportion of the prostitutes

belong to the so-called 'secret' class." In Hamburg, alone, are

suspected men, when accused of infecting women, officially

examined; men of every social class must obey a summons of this

kind, which is issued secretly, and if diseased, they are bound

to go under treatment, if necessary under compulsory treatment in

the city hospital, until no longer dangerous to the community.

In Germany it is only when a woman has been repeatedly observed

to act suspiciously in the streets that she is quietly warned; if

the warning is disregarded she is invited to give her name and

address to the police, and interviewed. It is not until these

methods fail that she is officially inscribed as a prostitute.

The inscribed women, in some cities at all events, contribute to

a sick benefit fund which pays their expenses when in hospital.

The hesitation of the police to inscribe a woman on the official

list is legitimate and inevitable, for no other course would be

tolerated; yet the majority of prostitutes begin their careers

very young, and as they tend to become infected very early after

their careers begin, it is obvious that this delay contributes to

render the system of regulation ineffective. In Berlin, where

there are no officially recognized brothels, there are some six

thousand inscribed prostitutes, but it is estimated that there

are over sixty thousand prostitutes who are not inscribed. (The

foregoing facts are taken from a series of papers describing

personal investigations in Germany made by Dr. F. Bierhoff, of

New York, "Police Methods for the Sanitary Control of

Prostitution," _New York Medical Journal_, August, 1907.) The

estimation of the amount of clandestine prostitution can indeed

never be much more than guesswork; exactly the same figure of

sixty thousand is commonly brought forward as the probable number

of prostitutes not only in Berlin, but also in London and in New

York. It is absolutely impossible to say whether it is under or

over the real number, for secret prostitution is quite

intangible. Even if the facts were miraculously revealed there

would still remain the difficulty of deciding what is and what is

not prostitution. The avowed and public prostitute is linked by

various gradations on the one side to the respectable girl living

at home who seeks some little relief from the oppression of her

respectability, and on the other hand to the married woman who

has married for the sake of a home. In any case, however, it is

very certain that public prostitutes living entirely on the

earnings of prostitution form but a small proportion of the vast

army of women who may be said, in a wide sense of the word, to be

prostitutes, i.e., who use their attractiveness to obtain from

men not love alone, but money or goods.

"The struggle against syphilis is only possible if we agree to regard its

victims as unfortunate and not as guilty.... We must give up the prejudice

which has led to the creation of the term 'shameful diseases,' and which

commands silence concerning this scourge of the family and of humanity."

In these words of Duclaux, the distinguished successor of Pasteur at the

Pasteur Institute, in his noble and admirable work _L'Hygiène Sociale_, we

have indicated to us, I am convinced, the only road by which we can

approach the rational and successful treatment of the great social problem

of venereal disease.

The supreme importance of this key to the solution of a problem

which has often seemed insoluble is to-day beginning to become

recognized in all quarters, and in every country. Thus a

distinguished German authority, Professor Finger (_Geschlecht und

Gesellschaft_, Bd. i, Heft 5) declares that venereal disease must

not be regarded as the well-merited punishment for a debauched

life, but as an unhappy accident. It seems to be in France,

however, that this truth has been proclaimed with most courage

and humanity, and not alone by the followers of science and

medicine, but by many who might well be excused from interfering

with so difficult and ungrateful a task. Thus the brothers, Paul

and Victor Margueritte, who occupy a brilliant and honorable

place in contemporary French letters, have distinguished

themselves by advocating a more humane attitude towards

prostitutes, and a more modern method of dealing with the

question of venereal disease. "The true method of prevention is

that which makes it clear to all that syphilis is not a

mysterious and terrible thing, the penalty of the sin of the

flesh, a sort of shameful evil branded by Catholic malediction,

but an ordinary disease which may be treated and cured." It may

be remarked that the aversion to acknowledge venereal disease is

at least as marked in France as in any other country; "maladies

honteuses" is a consecrated French term, just as "loathsome

disease" is in English; "in the hospital," says Landret, "it

requires much trouble to obtain an avowal of gonorrhoea,

and we may esteem ourselves happy if the patient acknowledges the

fact of having had syphilis."

No evils can be combated until they are recognized, simply and frankly,

and honestly discussed. It is a significant and even symbolic fact that

the bacteria of disease rarely flourish when they are open to the free

currents of pure air. Obscurity, disguise, concealment furnish the best

conditions for their vigor and diffusion, and these favoring conditions we

have for centuries past accorded to venereal diseases. It was not always

so, as indeed the survival of the word 'venereal' itself in this

connection, with its reference to a goddess, alone suffices to show. Even

the name "syphilis" itself, taken from a romantic poem in which

Fracastorus sought a mythological origin for the disease, bears witness to

the same fact. The romantic attitude is indeed as much out of date as that

of hypocritical and shamefaced obscurantism. We need to face these

diseases in the same simple, direct, and courageous way which has already

been adopted successfully in the ease of smallpox, a disease which, of

old, men thought analogous to syphilis and which was indeed once almost as

terrible in its ravages.

At this point, however, we encounter those who say that it is unnecessary

to show any sort of recognition of venereal diseases, and immoral to do

anything that might seem to involve indulgence to those who suffer from

such diseases; they have got what they deserve and may well be left to

perish. Those who take this attitude place themselves so far outside the

pale of civilization--to say nothing of morality or religion--that they

might well be disregarded. The progress of the race, the development of

humanity, in fact and in feeling, has consisted in the elimination of an

attitude which it is an insult to primitive peoples to term savage. Yet

it is an attitude which should not be ignored for it still carries weight

with many who are too weak to withstand those who juggle with fine moral

phrases. I have even seen in a medical quarter the statement that venereal

disease cannot be put on the same level with other infectious diseases

because it is "the result of voluntary action." But all the diseases,

indeed all the accidents and misfortunes of suffering human beings, are

equally the involuntary results of voluntary actions. The man who is run

over in crossing the street, the family poisoned by unwholesome food, the

mother who catches the disease of the child she is nursing, all these

suffer as the involuntary result of the voluntary act of gratifying some

fundamental human instinct--the instinct of activity, the instinct of

nutrition, the instinct of affection. The instinct of sex is as

fundamental as any of these, and the involuntary evils which may follow

the voluntary act of gratifying it stand on exactly the same level. This

is the essential fact: a human being in following the human instincts

implanted within him has stumbled and fallen. Any person who sees, not

this essential fact but merely some subsidiary aspect of it, reveals a

mind that is twisted and perverted; he has no claim to arrest our

attention.

But even if we were to adopt the standpoint of the would-be moralist, and

to agree that everyone must be left to suffer his deserts, it is far

indeed from being the fact that all those who contract venereal diseases

are in any sense receiving their deserts. In a large number of cases the

disease has been inflicted on them in the most absolutely involuntary

manner. This is, of course, true in the case of the vast number of infants

who are infected at conception or at birth. But it is also true in a

scarcely less absolute manner of a large proportion of persons infected in

later life.

_Syphilis insontium_, or syphilis of the innocent, as it is commonly

called, may be said to fall into five groups: (1) the vast army of

congenitally syphilitic infants who inherit the disease from father or

mother; (2) the constantly occurring cases of syphilis contracted, in the

course of their professional duties, by doctors, midwives and wet-nurses;

(3) infection as a result of affection, as in simple kissing; (4)

accidental infection from casual contacts and from using in common the

objects and utensils of daily life, such as cups, towels, razors, knives

(as in ritual circumcision), etc; (5) the infection of wives by their

husbands.[240]

Hereditary congenital syphilis belongs to the ordinary pathology of the

disease and is a chief element in its social danger since it is

responsible for an enormous infantile mortality.[241] The risks of

extragenital infection in the professional activity of doctors, midwives

and wet-nurses is also universally recognized. In the case of wet-nurses

infected by their employers' syphilitic infants at their breast, the

penalty inflicted on the innocent is peculiarly harsh and unnecessary. The

influence of infected low-class midwives is notably dangerous, for they

may inflict widespread injury in ignorance; thus the case has been

recorded of a midwife, whose finger became infected in the course of her

duties, and directly or indirectly contaminated one hundred persons.

Kissing is an extremely common source of syphilitic infection, and of all

extragenital regions the mouth is by far the most frequent seat of primary

syphilitic sores. In some cases, it is true, especially in prostitutes,

this is the result of abnormal sexual contacts. But in the majority of

cases it is the result of ordinary and slight kisses as between young

children, between parents and children, between lovers and friends and

acquaintances. Fairly typical examples, which have been reported, are

those of a child, kissed by a prostitute, who became infected and

subsequently infected its mother and grandmother; of a young French bride

contaminated on her wedding-day by one of the guests who, according to

French custom, kissed her on the cheek after the ceremony; of an American

girl who, returning from a ball, kissed, at parting, the young man who had

accompanied her home, thus acquiring the disease which she not long

afterwards imparted in the same way to her mother and three sisters. The

ignorant and unthinking are apt to ridicule those who point out the

serious risks of miscellaneous kissing. But it remains nevertheless true

that people who are not intimate enough to know the state of each other's

health are not intimate enough to kiss each other. Infection by the use of

domestic utensils, linen, etc., while comparatively rare among the better

social classes, is extremely common among the lower classes and among the

less civilized nations; in Russia, according to Tarnowsky, the chief

authority, seventy per cent. of all cases of syphilis in the rural

districts are due to this cause and to ordinary kissing, and a special

conference in St. Petersburg in 1897, for the consideration of the methods

of dealing with venereal disease, recorded its opinion to the same effect;

much the same seems to be true regarding Bosnia and various parts of the

Balkan peninsula where syphilis is extremely prevalent among the

peasantry. As regards the last group, according to Bulkley in America,

fifty per cent. of women generally contract syphilis innocently, chiefly

from their husbands, while Fournier states that in France seventy-five per

cent. of married women with syphilis have been infected by their husbands,

most frequently (seventy per cent.) by husbands who were themselves

infected before marriage and supposed that they were cured. Among men the

proportion of syphilitics who have been accidentally infected, though less

than among women, is still very considerable; it is stated to be at least

ten per cent., and possibly it is a much larger proportion of cases. The

scrupulous moralist who is anxious that all should have their deserts

cannot fail to be still more anxious to prevent the innocent from

suffering in place of the guilty. But it is absolutely impossible for him

to combine these two aims; syphilis cannot be at the same time perpetuated

for the guilty and abolished for the innocent.

I have been taking only syphilis into account, but nearly all

that is said of the accidental infection of syphilis applies with

equal or greater force to gonorrhoea, for though gonorrhoea does

not enter into the system by so many channels as syphilis, it is

a more common as well as a more subtle and elusive disease.

The literature of Syphilis Insontium is extremely extensive.

There is a bibliography at the end of Duncan Bulkley's _Syphilis

in the Innocent_, and a comprehensive summary of the question in

a Leipzig Inaugural Dissertation by F. Moses, _Zur Kasuistik der

Extragenitalen Syphilis-infektion_, 1904.

Even, however, when we have put aside the vast number of venereally

infected people who may be said to be, in the narrowest and most

conventionally moral sense, "innocent" victims of the diseases they have

contracted, there is still much to be said on this question. It must be

remembered that the majority of those who contract venereal diseases by

illegitimate sexual intercourse are young. They are youths, ignorant of

life, scarcely yet escaped from home, still undeveloped, incompletely

educated, and easily duped by women; in many cases they have met, as they

thought, a "nice" girl, not indeed strictly virtuous but, it seemed to

them, above all suspicion of disease, though in reality she was a

clandestine prostitute. Or they are young girls who have indeed ceased to

be absolutely chaste, but have not yet lost all their innocence, and who

do not consider themselves, and are not by others considered, prostitutes;

that indeed, is one of the rocks on which the system of police regulation

of prostitution comes to grief, for the police cannot catch the prostitute

at a sufficiently early stage. Of women who become syphilitic, according

to Fournier, twenty per cent. are infected before they are nineteen; in

hospitals the proportion is as high as forty per cent.; and of men fifteen

per cent. cases occur between eleven and twenty-one years of age. The age

of maximum frequency of infection is for women twenty years (in the rural

population eighteen), and for men twenty-three years. In Germany Erb

finds that as many as eighty-five per cent men with gonorrhoea

contracted the disease between the ages of sixteen and twenty-five, a very

small percentage being infected after thirty. These young things for the

most part fell into a trap which Nature had baited with her most

fascinating lure; they were usually ignorant; not seldom they were

deceived by an attractive personality; often they were overcome by

passion; frequently all prudence and reserve had been lost in the fumes of

wine. From a truly moral point of view they were scarcely less innocent

than children.

"I ask," says Duclaux, "whether when a young man, or a young

girl, abandon themselves to a dangerous caress society has done

what it can to warn them. Perhaps its intentions were good, but

when the need came for precise knowledge a silly prudery has held

it back, and it has left its children without _viaticum_.... I

will go further, and proclaim that in a large number of cases the

husbands who contaminate their wives are innocent. No one is

responsible for the evil which he commits without knowing it and

without willing it." I may recall the suggestive fact, already

referred to, that the majority of husbands who infect their wives

contracted the disease before marriage. They entered on marriage

believing that their disease was cured, and that they had broken

with their past. Doctors have sometimes (and quacks frequently)

contributed to this result by too sanguine an estimate of the

period necessary to destroy the poison. So great an authority as

Fournier formerly believed that the syphilitic could safely be

allowed to marry three or four years after the date of infection,

but now, with increased experience, he extends the period to four

or five years. It is undoubtedly true that, especially when

treatment has been thorough and prompt, the diseased

constitution, in a majority of cases, can be brought under

complete control in a shorter period than this, but there is

always a certain proportion of cases in which the powers of

infection persist for many years, and even when the syphilitic

husband is no longer capable of infecting his wife he may still

perhaps be in a condition to effect a disastrous influence on the

offspring.

In nearly all these cases there was more or less ignorance--which is but

another word for innocence as we commonly understand innocence--and when

at last, after the event, the facts are more or less bluntly explained to

the victim he frequently exclaims: "Nobody told me!" It is this fact which

condemns the pseudo-moralist. If he had seen to it that mothers began to

explain the facts of sex to their little boys and girls from childhood, if

he had (as Dr. Joseph Price urges) taught the risks of venereal disease in

the Sunday-school, if he had plainly preached on the relations of the

sexes from the pulpit, if he had seen to it that every youth at the

beginning of adolescence received some simple technical instruction from

his family doctor concerning sexual health and sexual disease--then,

though there would still remain the need of pity for those who strayed

from a path that must always be difficult to walk in, the would-be

moralist at all events would in some measure be exculpated. But he has

seldom indeed lifted a finger to do any of these things.

Even those who may be unwilling to abandon an attitude of private moral

intolerance towards the victims of venereal diseases may still do well to

remember that since the public manifestation of their intolerance is

mischievous, and at the best useless, it is necessary for them to restrain

it in the interests of society. They would not be the less free to order

their own personal conduct in the strictest accordance with their superior

moral rigidity; and that after all is for them the main thing. But for the

sake of society it is necessary for them to adopt what they may consider

the convention of a purely hygienic attitude towards these diseases. The

erring are inevitably frightened by an attitude of moral reprobation into

methods of concealment, and these produce an endless chain of social evils

which can only be dissipated by openness. As Duclaux has so earnestly

insisted, it is impossible to grapple successfully with venereal disease

unless we consent not to introduce our prejudices, or even our morals and

religion, into the question, but treat it purely and simply as a sanitary

question. And if the pseudo-moralist still has difficulty in coöperating

towards the healing of this social sore he may be reminded that he

himself--like every one of us little though we may know it--has certainly

had a great army of syphilitic and gonorrhoeal persons among his own

ancestors during the past four centuries. We are all bound together, and

it is absurd, even when it is not inhuman, to cast contempt on our own

flesh and blood.

I have discussed rather fully the attitude of those who plead morality as

a reason for ignoring the social necessity of combating venereal disease,

because although there may not be many who seriously and understandingly

adopt so anti-social and inhuman an attitude there are certainly many who

are glad at need of the existence of so fine an excuse for their moral

indifference or their mental indolence.[242] When they are confronted by

this great and difficult problem they find it easy to offer the remedy of

conventional morality, although they are well aware that on a large scale

that remedy has long been proved to be ineffectual. They ostentatiously

affect to proffer the useless thick end of the wedge at a point where it

is only possible with much skill and prudence to insinuate the thin

working end.

The general acceptance of the fact that syphilis and gonorrhoea

are diseases, and not necessarily crimes or sins, is the condition for any

practical attempt to deal with this question from the sanitary point of

view which is now taking the place of the antiquated and ineffective

police point of view. The Scandinavian countries of Europe have been the

pioneers in practical modern hygienic methods of dealing with venereal

disease. There are several reasons why this has come about. All the

problems of sex--of sexual love as well as of sexual disease--have long

been prominent in these countries, and an impatience with prudish

hypocrisy seems here to have been more pronounced than elsewhere; we see

this spirit, for instance, emphatically embodied in the plays of Ibsen,

and to some extent in Björnson's works. The fearless and energetic temper

of the people impels them to deal practically with sexual difficulties,

while their strong instincts of independence render them averse to the

bureaucratic police methods which have flourished in Germany and France.

The Scandinavians have thus been the natural pioneers of the methods of

combating venereal diseases which are now becoming generally recognized

to be the methods of the future, and they have fully organized the system

of putting venereal diseases under the ordinary law and dealing with them

as with other contagious diseases.

The first step in dealing with a contagious disease is to apply to it the

recognized principles of notification. Every new application of the

principle, it is true, meets with opposition. It is without practical

result, it is an unwarranted inquisition into the affairs of the

individual, it is a new tax on the busy medical practitioner, etc.

Certainly notification by itself will not arrest the progress of any

infectious disease. But it is an essential element in every attempt to

deal with the prevention of disease. Unless we know precisely the exact

incidence, local variations, and temporary fluctuations of a disease we

are entirely in the dark and can only beat about at random. All progress

in public hygiene has been accompanied by the increased notification of

disease, and most authorities are agreed that such notification must be

still further extended, any slight inconvenience thus caused to

individuals being of trifling importance compared to the great public

interests at stake. It is true that so great an authority as Neisser has

expressed doubt concerning the extension of notification to gonorrhoea;

the diagnosis cannot be infallible, and the patients often give false

names. These objections, however, seem trivial; diagnosis can very seldom

be infallible (though in this field no one has done so much for exact

diagnosis as Neisser himself), and names are not necessary for

notification, and are not indeed required in the form of compulsory

notification of venereal disease which existed a few years ago in Norway.

The principle of the compulsory notification of venereal diseases seems to

have been first established in Prussia, where it dates from 1835. The

system here, however, is only partial, not being obligatory in all cases

but only when in the doctor's opinion secrecy might be harmful to the

patient himself or to the community; it is only obligatory when the

patient is a soldier. This method of notification is indeed on a wrong

basis, it is not part of a comprehensive sanitary system but merely an

auxiliary to police methods of dealing with prostitution. According to

the Scandinavian system, notification, though not an essential part of

this system, rests on an entirely different basis.

The Scandinavian plan in a modified form has lately been established in

Denmark. This little country, so closely adjoining Germany, for some time

followed in this matter the example of its great neighbor and adopted the

police regulation of prostitution and venereal disease. The more

fundamental Scandinavian affinities of Denmark were, however, eventually

asserted, and in 1906, the system of regulation was entirely abandoned and

Denmark resolved to rely on thorough and systematic application of the

sanitary principle already accepted in the country, although something of

German influence still persists in the strict regulation of the streets

and the penalties imposed upon brothel-keepers, leaving prostitution

itself free. The decisive feature of the present system is, however, that

the sanitary authorities are now exclusively medical. Everyone, whatever

his social or financial position, is entitled to the free treatment of

venereal disease. Whether he avails himself of it or not, he is in any

case bound to undergo treatment. Every diseased person is thus, so far as

it can be achieved, in a doctor's hands. All doctors have their

instructions in regard to such cases, they have not only to inform their

patients that they cannot marry so long as risks of infection are

estimated to be present, but that they are liable for the expenses of

treatment, as well as the dangers suffered, by any persons whom they may

infect. Although it has not been possible to make the system at every

point thoroughly operative, its general success is indicated by the entire

reliance now placed on it, and the abandonment of the police regulation of

prostitution. A system very similar to that of Denmark was established

some years previously in Norway. The principle of the treatment of

venereal disease at the public expense exists also in Sweden as well as in

Finland, where treatment is compulsory.[243]

It can scarcely be said that the principle of notification has yet been

properly applied on a large scale to venereal diseases. But it is

constantly becoming more widely advocated, more especially in England and

the United States,[244] where national temperament and political

traditions render the system of the police regulation of prostitution

impossible--even if it were more effective than it practically is--and

where the system of dealing with venereal disease on the basis of public

health has to be recognized as not only the best but the only possible

system.[245]

In association with this, it is necessary, as is also becoming ever more

widely recognized, that there should be the most ample facilities for the

gratuitous treatment of venereal diseases; the general establishment of

free dispensaries, open in the evenings, is especially necessary, for many

can only seek advice and help at this time. It is largely to the

systematic introduction of facilities for gratuitous treatment that the

enormous reduction in venereal disease in Sweden, Norway, and Bosnia is

attributed. It is the absence of the facilities for treatment, the implied

feeling that the victims of venereal disease are not sufferers but merely

offenders not entitled to care, that has in the past operated so

disastrously in artificially promoting the dissemination of preventable

diseases which might be brought under control.

If we dispense with the paternal methods of police regulation, if we rely

on the general principles of medical hygiene, and for the rest allow the

responsibility for his own good or bad actions to rest on the individual

himself, there is a further step, already fully recognized in principle,

which we cannot neglect to take: We must look on every person as

accountable for the venereal diseases he transmits. So long as we refuse

to recognize venereal diseases as on the same level as other infectious

diseases, and so long as we offer no full and fair facilities for their

treatment, it is unjust to bring the individual to account for spreading

them. But if we publicly recognize the danger of infectious venereal

diseases, and if we leave freedom to the individual, we must inevitably

declare, with Duclaux, that every man or woman must be held responsible

for the diseases he or she communicates.

According to the Oldenburg Code of 1814 it was a punishable offence for a

venereally diseased person to have sexual intercourse with a healthy

person, whether or not infection resulted. In Germany to-day, however,

there is no law of this kind, although eminent German legal authorities,

notably Von Liszt, are of opinion that a paragraph should be added to the

Code declaring that sexual intercourse on the part of a person who knows

that he is diseased should be punishable by imprisonment for a period not

exceeding two years, the law not to be applied as between married couples

except on the application of one of the parties. At the present time in

Germany the transmission of venereal disease is only punishable as a

special case of the infliction of bodily injury.[246] In this matter

Germany is behind most of the Scandinavian countries where individual

responsibility for venereal infection is well recognized and actively

enforced.

In France, though the law is not definite and satisfactory, actions for

the transmission of syphilis are successfully brought before the courts.

Opinion seems to be more decisively in favor of punishment for this

offense than it is in Germany. In 1883 Després discussed the matter and

considered the objections. Few may avail themselves of the law, he

remarks, but all would be rendered more cautious by the fear of infringing

it; while the difficulties of tracing and proving infection are not

greater, he points out, than those of tracing and proving paternity in the

case of illegitimate children. Després would punish with imprisonment for

not more than two years any person, knowing himself to be diseased, who

transmitted a venereal disease, and would merely fine those who

communicated the contagion by imprudence, not realizing that they were

diseased.[247] The question has more recently been discussed by Aurientis

in a Paris thesis. He states that the present French law as regards the

transmission of sexual diseases is not clearly established and is

difficult to act upon, but it is certainly just that those who have been

contaminated and injured in this way should easily be able to obtain

reparation. Although it is admitted in principle that the communication of

syphilis is an offence even under common law he is in agreement with those

who would treat it as a special offence, making a new and more practical

law.[248] Heavy damages are even at the present time obtained in the

French courts from men who have infected young women in sexual

intercourse, and also from the doctors as well as the mothers of

syphilitic infants who have infected the foster-mothers they were

entrusted to. Although the French Penal Code forbids in general the

disclosure of professional secrets, it is the duty of the medical

practitioner to warn the foster-mother in such a case of the danger she is

incurring, but without naming the disease; if he neglects to give this

warning he may be held liable.

In England, as well as in the United States, the law is more

unsatisfactory and more helpless, in relation to this class of offences,

than it is in France. The mischievous and barbarous notion, already dealt

with, according to which venereal disease is the result of illicit

intercourse and should be tolerated as a just visitation of God, seems

still to flourish in these countries with fatal persistency. In England

the communication of venereal disease by illicit intercourse is not an

actionable wrong if the act of intercourse has been voluntary, even

although there has been wilful and intentional concealment of the disease.

_Ex turpi causâ non oritur actio_, it is sententiously said; for there is

much dormitative virtue in a Latin maxim. No legal offence has still been

committed if a husband contaminates his wife, or a wife her husband.[249]

The "freedom" enjoyed in this matter by England and the United States is

well illustrated by an American case quoted by Dr. Isidore Dyer, of New

Orleans, in his report to the Brussels Conference on the Prevention of

Venereal Diseases, in 1899: "A patient with primary syphilis refused even

charitable treatment and carried a book wherein she kept the number of men

she had inoculated. When I first saw her she declared the number had

reached two hundred and nineteen and that she would not be treated until

she had had revenge on five hundred men." In a community where the most

elementary rules of justice prevailed facilities would exist to enable

this woman to obtain damages from the man who had injured her or even to

secure his conviction to a term of imprisonment. In obtaining some

indemnity for the wrong done her, and securing the "revenge" she craved,

she would at the same time have conferred a benefit on society. She is

shut out from any action against the one person who injured her; but as a

sort of compensation she is allowed to become a radiating focus of

disease, to shorten many lives, to cause many deaths, to pile up

incalculable damages; and in so doing she is to-day perfectly within her

legal rights. A community which encourages this state of things is not

only immoral but stupid.

There seems, however, to be a growing body of influential opinion, both in

England and in the United States, in favor of making the transmission of

venereal disease an offence punishable by heavy fine or by

imprisonment.[250] In any enactment no stress should be put on the

infection being conveyed "knowingly." Any formal limitation of this kind

is unnecessary, as in such a case the Court always takes into account the

offender's ignorance or mere negligence, and it is mischievous because it

tends to render an enactment ineffective and to put a premium on

ignorance; the husbands who infect their wives with gonorrhoea

immediately after marriage have usually done so from ignorance, and it

should be at least necessary for them to prove that they have been

fortified in their ignorance by medical advice. It is sometimes said that

the existing law could be utilized for bringing actions of this kind, and

that no greater facilities should be offered for fear of increasing

attempts at blackmail. The inutility of the law at present for this

purpose is shown by the fact that it seldom or never happens that any

attempt is made to utilize it, while not only are there a number of

existing punishable offences which form the subject of attempts at

blackmail, but blackmail can still be demanded even in regard to

disreputable actions that are not legally punishable at all. Moreover, the

attempt to levy blackmail is itself an offence always sternly dealt with

in the courts.

It is possible to trace the beginning of a recognition that the

transmission of a venereal disease is a matter of which legal cognizance

may be taken in the English law courts. It is now well settled that the

infection of a wife by her husband may be held to constitute the legal

cruelty which, according to the present law, must be proved, in addition

to adultery, before a wife can obtain divorce from her husband. In 1777

Restif de la Bretonne proposed in his _Gynographes_ that the communication

of a venereal disease should itself be an adequate ground for divorce;

this, however, is not at present generally accepted.[251]

It is sometimes said that it is very well to make the individual legally

responsible for the venereal disease he communicates, but that the

difficulties of bringing that responsibility home would still remain. And

those who admit these difficulties frequently reply that at the worst we

should have in our hands a means of educating responsibility; the man who

deliberately ran the risk of transmitting such infection would be made to

feel that he was no longer fairly within his legal rights but had done a

bad action. We are thus led on finally to what is now becoming generally

recognized as the chief and central method of combating venereal disease,

if we are to accept the principle of individual responsibility as ruling

in this sphere of life. Organized sanitary and medical precautions, and

proper legal protection for those who have been injured, are inoperative

without the educative influence of elementary hygienic instruction placed

in the possession of every young man and woman. In a sphere that is

necessarily so intimate medical organization and legal resort can never be

all-sufficing; knowledge is needed at every step in every individual to

guide and even to awaken that sense of personal moral responsibility which

must here always rule. Wherever the importance of these questions is

becoming acutely realized--and notably at the Congresses of the German

Society for Combating Venereal Disease--the problem is resolving itself

mainly into one of education.[252] And although opinion and practice in

this matter are to-day more advanced in Germany than elsewhere the

conviction of this necessity is becoming scarcely less pronounced in all

other civilized countries, in England and America as much as in France and

the Scandinavian lands.

A knowledge of the risks of disease by sexual intercourse, both in and out

of marriage,--and indeed, apart from sexual intercourse altogether,--is a

further stage of that sexual education which, as we have already seen,

must begin, so far as the elements are concerned, at a very early age.

Youths and girls should be taught, as the distinguished Austrian

economist, Anton von Menger wrote, shortly before his death, in his

excellent little book, _Neue Sittenlehre_, that the production of children

is a crime when the parents are syphilitic or otherwise incompetent

through transmissible chronic diseases. Information about venereal disease

should not indeed be given until after puberty is well established. It is

unnecessary and undesirable to impart medical knowledge to young boys and

girls and to warn them against risks they are yet little liable to be

exposed to. It is when the age of strong sexual instinct, actual or

potential, begins that the risks, under some circumstances, of yielding to

it, need to be clearly present to the mind. No one who reflects on the

actual facts of life ought to doubt that it is in the highest degree

desirable that every adolescent youth and girl ought to receive some

elementary instruction in the general facts of venereal disease,

tuberculosis, and alcoholism. These three "plagues of civilization" are so

widespread, so subtle and manifold in their operation, that everyone comes

in contact with them during life, and that everyone is liable to suffer,

even before he is aware, perhaps hopelessly and forever, from the results

of that contact. Vague declamation about immorality and vaguer warnings

against it have no effect and possess no meaning, while rhetorical

exaggeration is unnecessary. A very simple and concise statement of the

actual facts concerning the evils that beset life is quite sufficient and

adequate, and quite essential. To ignore this need is only possible to

those who take a dangerously frivolous view of life.

It is the young woman as much as the youth who needs this enlightenment.

There are still some persons so ill-informed as to believe that though it

may be necessary to instruct the youth it is best to leave his sister

unsullied, as they consider it, by a knowledge of the facts of life. This

is the very reverse of the truth. It is desirable indeed that all should

be acquainted with facts so vital to humanity, even although not

themselves personally concerned. But the girl is even more concerned than

the youth. A man has the matter more within his own grasp, and if he so

chooses he may avoid all the grosser risks of contact with venereal

disease. But it is not so with the woman. Whatever her own purity, she

cannot be sure that she may not have to guard against the possibility of

disease in her future husband as well as in those to whom she may entrust

her child. It is a possibility which the educated woman, so far from

being dispensed from, is more liable to encounter than is the

working-class woman, for venereal disease is less prevalent among the poor

than the rich.[253] The careful physician, even when his patient is a

minister of religion, considers it his duty to inquire if he has had

syphilis, and the clergyman of most severely correct life recognizes the

need of such inquiry and may perhaps smile, but seldom feels himself

insulted. The relationship between husband and wife is even much more

intimate and important than that between doctor and patient, and a woman

is not dispensed from the necessity of such inquiry concerning her future

husband by the conviction that the reply must surely be satisfactory.

Moreover, it may well be in some cases that, if she is adequately

enlightened, she may be the means of saving him, before it is too late,

from the guilt of premature marriage and its fateful consequences, so

deserving to earn his everlasting gratitude. Even if she fails in winning

that, she still has her duty to herself and to the future race which her

children will help to form.

In most countries there is a growing feeling in favor of the

enlightenment of young women equally with young men as regards

venereal diseases. Thus in Germany Max Flesch, in his

_Prostitution und Frauenkrankheiten_, considers that at the end

of their school days all girls should receive instruction

concerning the grave physical and social dangers to which women

are exposed in life. In France Duclaux (in his _L'Hygiène

Sociale_) is emphatic that women must be taught. "Already," he

states, "doctors who by custom have been made, in spite of

themselves, the husband's accomplices, will tell you of the

ironical gaze they sometimes encounter when they seek to lead a

wife astray concerning the causes of her ills. The day is

approaching of a revolt against the social lie which has made so

many victims, and you will be obliged to teach women what they

need to know in order to guard themselves against you." It is the

same in America. Reform in this field, Isidore Dyer declares,

must emblazon on its flag the motto, "Knowledge is Health," as

well of mind as of body, for women as well as for men. In a

discussion introduced by Denslow Lewis at the annual meeting of

the American Medical Association in 1901 on the limitation of

venereal diseases (_Medico-Legal Journal_, June and September,

1903), there was a fairly general agreement among all the

speakers that almost or quite the chief method of prevention lay

in education, the education of women as much as of men.

"Education lies at the bottom of the whole thing," declared one

speaker (Seneca Egbert, of Philadelphia), "and we will never gain

much headway until every young man, and every young woman, even

before she falls in love and becomes engaged, knows what these

diseases are, and what it will mean if she marries a man who has

contracted them." "Educate father and mother, and they will

educate their sons and daughters," exclaims Egbert Grandin, more

especially in regard to gonorrhoea (_Medical Record_, May 26,

1906); "I lay stress on the daughter because she becomes the

chief sufferer from inoculation, and it is her right to know that

she should protect herself against the gonorrhoeic as well as

against the alcoholic."

We must fully face the fact that it is the woman herself who must be

accounted responsible, as much as a man, for securing the right conditions

of a marriage she proposes to enter into. In practice, at the outset, that

responsibility may no doubt be in part delegated to parents or guardians.

It is unreasonable that any false delicacy should be felt about this

matter on either side. Questions of money and of income are discussed

before marriage, and as public opinion grows sounder none will question

the necessity of discussing the still more serious question of health,

alike that of the prospective bridegroom and of the bride. An incalculable

amount of disease and marital unhappiness would be prevented if before an

engagement was finally concluded each party placed himself or herself in

the hands of a physician and authorized him to report to the other party.

Such a report would extend far beyond venereal disease. If its necessity

became generally recognized it would put an end to much fraud which now

takes place when entering the marriage bond. It constantly happens at

present that one party or the other conceals the existence of some serious

disease or disability which is speedily discovered after marriage,

sometimes with a painful and alarming shock--as when a man discovers his

wife in an epileptic fit on the wedding night--and always with the bitter

and abiding sense of having been duped. There can be no reasonable doubt

that such concealment is an adequate cause of divorce. Sir Thomas More

doubtless sought to guard against such frauds when he ordained in his

_Utopia_ that each party should before marriage be shown naked to the

other. The quaint ceremony he describes was based on a reasonable idea,

for it is ludicrous, if it were not often tragic in its results, that any

person should be asked to undertake to embrace for life a person whom he

or she has not so much as seen.

It may be necessary to point out that every movement in this direction

must be the spontaneous action of individuals directing their own lives

according to the rules of an enlightened conscience, and cannot be

initiated by the dictation of the community as a whole enforcing its

commands by law. In these matters law can only come in at the end, not at

the beginning. In the essential matters of marriage and procreation laws

are primarily made in the brains and consciences of individuals for their

own guidance. Unless such laws are already embodied in the actual practice

of the great majority of the community it is useless for parliaments to

enact them by statute. They will be ineffective or else they will be worse

than ineffective by producing undesigned mischiefs. We can only go to the

root of the matter by insisting on education in moral responsibility and

instruction, in matters of fact.

The question arises as to the best person to impart this instruction. As

we have seen there can be little doubt that before puberty the parents,

and especially the mother, are the proper instructors of their children in

esoteric knowledge. But after puberty the case is altered. The boy and the

girl are becoming less amenable to parental influence, there is greater

shyness on both sides, and the parents rarely possess the more technical

knowledge that is now required. At this stage it seems that the assistance

of the physician, of the family doctor if he has the proper qualities for

the task, should be called in. The plan usually adopted, and now widely

carried out, is that of lectures setting forth the main facts concerning

venereal diseases, their dangers, and allied topics.[254] This method is

quite excellent. Such lectures should be delivered at intervals by medical

lecturers at all urban, educational, manufacturing, military, and naval

centres, wherever indeed a large number of young persons are gathered

together. It should be the business of the central educational authority

either to carry them out or to enforce on those controlling or employing

young persons the duty of providing such lectures. The lectures should be

free to all who have attained the age of sixteen.

In Germany the principle of instruction by lectures concerning

venereal diseases seems to have become established, at all events

so far as young men are concerned, and such lectures are

constantly becoming more usual. In 1907 the Minister of Education

established courses of lectures by doctors on sexual hygiene and

venereal diseases for higher schools and educational

institutions, though attendance was not made compulsory. The

courses now frequently given by medical men to the higher classes

in German secondary schools on the general principles of sexual

anatomy and physiology nearly always include sexual hygiene with

special reference to venereal diseases (see, e.g.,

_Sexualpädagogik_, pp. 131-153). In Austria, also, lectures on

personal hygiene and the dangers of venereal disease are

delivered to students about to leave the gymnasium for the

university; and the working men's clubs have instituted regular

courses of lectures on the same subjects delivered by physicians.

In France many distinguished men, both inside and outside the

medical profession, are working for the cause of the instruction

of the young in sexual hygiene, though they have to contend

against a more obstinate degree of prejudice and prudery on the

part of the middle class than is to be found in the Germanic

lands. The Commission Extraparlementaire du Régime des Moeurs,

with the conjunction of Augagneur, Alfred Fournier, Yves Guyot,

Gide, and other distinguished professors, teachers, etc., has

lately pronounced in favor of the official establishment of

instruction in sexual hygiene, to be given in the highest classes

at the lycées, or in the earliest class at higher educational

colleges; such instruction, it is argued, would not only furnish

needed enlightenment, but also educate the sense of moral

responsibility. There is in France, also, an active and

distinguished though unofficial Société Française de Prophylaxie

Sanitaire et Morale, which delivers public lectures on sexual

hygiene. Fournier, Pinard, Burlureaux and other eminent

physicians have written pamphlets on this subject for popular

distribution (see, e.g., _Le Progrès Médical_ of September,

1907). In England and the United States very little has yet been

done in this direction, but in the United States, at all events,

opinion in favor of action is rapidly growing (see, e.g., W.A.

Funk, "The Venereal Peril," _Medical Record_, April 13, 1907).

The American Society of Sanitary and Moral Prophylaxis (based on

the parent society founded in Paris in 1900 by Fournier) was

established in New York in 1905. There are similar societies in

Chicago and Philadelphia. The main object is to study venereal

diseases and to work toward their social control. Doctors,

laymen, and women are members. Lectures and short talks are now

given under the auspices of these societies to small groups of

young women in social settlements, and in other ways, with

encouraging success; it is found to be an excellent method of

reaching the young women of the working classes. Both men and

women physicians take part in the lectures (Clement Cleveland,

Presidential Address on "Prophylaxis of Venereal Diseases,"

_Transactions American Gynecological Society_, Philadelphia, vol.

xxxii, 1907).

An important auxiliary method of carrying out the task of sexual

hygiene, and at the same time of spreading useful enlightenment,

is furnished by the method of giving to every syphilitic patient

in clinics where such cases are treated a card of instruction for

his guidance in hygienic matters, together with a warning of the

risks of marriage within four or five years after infection, and

in no case without medical advice. Such printed instruction, in

clear, simple, and incisive language, should be put into the

hands of every syphilitic patient as a matter of routine, and it

might be as well to have a corresponding card for gonorrhoeal

patients. This plan has already been introduced at some

hospitals, and it is so simple and unobjectionable a precaution

that it will, no doubt, be generally adopted. In some countries

this measure is carried out on a wider scale. Thus in Austria, as

the result of a movement in which several university professors

have taken an active part, leaflets and circulars, explaining

briefly the chief symptoms of venereal diseases and warning

against quacks and secret remedies, are circulated among young

laborers and factory hands, matriculating students, and scholars

who are leaving trade schools.

In France, where great social questions are sometimes faced with

a more chivalrous daring than elsewhere, the dangers of syphilis,

and the social position of the prostitute, have alike been dealt

with by distinguished novelists and dramatists. Huysmans

inaugurated this movement with his first novel, _Marthe_, which

was immediately suppressed by the police. Shortly afterwards

Edmond de Goncourt published _La Fille Elisa_, the first notable

novel of the kind by a distinguished author. It was written with

much reticence, and was not indeed a work of high artistic

value, but it boldly faced a great social problem and clearly set

forth the evils of the common attitude towards prostitution. It

was dramatized and played by Antoine at the Théâtre Libre, but

when, in 1891, Antoine wished to produce it at the

Porte-Saint-Martin Theatre, the censor interfered and prohibited

the play on account of its "contexture générale." The Minister of

Education defended this decision on the ground that there was

much in the play that might arouse repugnance and disgust.

"Repugnance here is more moral than attraction," exclaimed M.

Paul Déroulède, and the newspapers criticized a censure which

permitted on the stage all the trivial indecencies which favor

prostitution, but cannot tolerate any attack on prostitution. In

more recent years the brothers Margueritte, both in novels and in

journalism, have largely devoted their distinguished abilities

and high literary skill to the courageous and enlightened

advocacy of many social reforms. Victor Margueritte, in his

_Prostituée_ (1907)--a novel which has attracted wide attention

and been translated into various languages--has sought to

represent the condition of women in our actual society, and more

especially the condition of the prostitute under what he regards

as the odious and iniquitous system still prevailing. The book is

a faithful picture of the real facts, thanks to the assistance

the author received from the Paris Préfecture of Police, and

largely for that reason is not altogether a satisfactory work of

art, but it vividly and poignantly represents the cruelty,

indifference, and hypocrisy so often shown by men towards women,

and is a book which, on that account, cannot be too widely read.

One of the most notable of modern plays is Brieux's _Les Avariés_

(1902). This distinguished dramatist, himself a medical man,

dedicates his play to Fournier, the greatest of syphilographers.

"I think with you," he writes here, "that syphilis will lose much

of its danger when it is possible to speak openly of an evil

which is neither a shame nor a punishment, and when those who

suffer from it, knowing what evils they may propagate, will

better understand their duties towards others and towards

themselves." The story developed in the drama is the old and

typical story of the young man who has spent his bachelor days in

what he considers a discrete and regular manner, having only had

two mistresses, neither of them prostitutes, but at the end of

this period, at a gay supper at which he bids farewell to his

bachelor life, he commits a fatal indiscretion and becomes

infected by syphilis; his marriage is approaching and he goes to

a distinguished specialist who warns him that treatment takes

time, and that marriage is impossible for several years; he finds

a quack, however, who undertakes to cure him in six months; at

the end of the time he marries; a syphilitic child is born; the

wife discovers the state of things and forsakes her home to

return to her parents; her indignant father, a deputy in

Parliament, arrives in Paris; the last word is with the great

specialist who brings finally some degree of peace and hope into

the family. The chief morals Brieux points out are that it is the

duty of the bride's parents before marriage to ascertain the

bridegroom's health; that the bridegroom should have a doctor's

certificate; that at every marriage the part of the doctors is at

least as important as that of the lawyers. Even if it were a less

accomplished work of art than it is, _Les Avariés_ is a play

which, from the social and educative point of view alone, all who

have reached the age of adolescence should be compelled to see.

Another aspect of the same problem has been presented in _Plus

Fort que le Mal_, a book written in dramatic form (though not as

a properly constituted play intended for the stage) by a

distinguished French medical author who here adopts the name of

Espy de Metz. The author (who is not, however, pleading _pro

domo_) calls for a more sympathetic attitude towards those who

suffer from syphilis, and though he writes with much less

dramatic skill than Brieux, and scarcely presents his moral in so

unequivocal a form, his work is a notable contribution to the

dramatic literature of syphilis.

It will probably be some time before these questions, poignant as

they are from the dramatic point of view, and vitally important

from the social point of view, are introduced on the English or

the American stage. It is a remarkable fact that, notwithstanding

the Puritanic elements which still exist in Anglo-Saxon thought

and feeling generally, the Puritanic aspect of life has never

received embodiment in the English or American drama. On the

English stage it is never permitted to hint at the tragic side of

wantonness; vice must always be made seductive, even though a

_deus ex machina_ causes it to collapse at the end of the

performance. As Mr. Bernard Shaw has said, the English theatrical

method by no means banishes vice; it merely consents that it

shall be made attractive; its charms are advertised and its

penalties suppressed. "Now, it is futile to plead that the stage

is not the proper place for the representation and discussion of

illegal operations, incest, and venereal disease. If the stage is

the proper place for the exhibition and discussion of seduction,

adultery, promiscuity, and prostitution, it must be thrown open

to all the consequences of these things, or it will demoralize

the nation."

The impulse to insist that vice shall always be made attractive

is not really, notwithstanding appearances, a vicious impulse. It

arises from a mental confusion, a common psychic tendency, which

is by no means confined to Anglo-Saxon lands, and is even more

well marked among the better educated in the merely literary

sense, than among the worse educated people. The æsthetic is

confused with the moral, and what arouses disgust is thus

regarded as immoral. In France the novels of Zola, the most

pedestrianally moralistic of writers, were for a long time

supposed to be immoral because they were often disgusting. The

same feeling is still more widespread in England. If a

prostitute is brought on the stage, and she is pretty,

well-dressed, seductive, she may gaily sail through the play and

every one is satisfied. But if she were not particularly pretty,

well-dressed, or seductive, if it were made plain that she was

diseased and was reckless in infecting others with that disease,

if it were hinted that she could on occasion be foul-mouthed, if,

in short, a picture were shown from life--then we should hear

that the unfortunate dramatist had committed something that was

"disgusting" and "immoral." Disgusting it might be, but, on that

very account, it would be moral. There is a distinction here that

the psychologist cannot too often point out or the moralist too

often emphasize.

It is not for the physician to complicate and confuse his own task as

teacher by mixing it up with considerations which belong to the spiritual

sphere. But in carrying out impartially his own special work of

enlightenment he will always do well to remember that there is in the

adolescent mind, as it has been necessary to point out in a previous

chapter, a spontaneous force working on the side of sexual hygiene. Those

who believe that the adolescent mind is merely bent on sensual indulgence

are not less false and mischievous in their influence than are those who

think it possible and desirable for adolescents to be preserved in sheer

sexual ignorance. However concealed, suppressed, or deformed--usually by

the misplaced and premature zeal of foolish parents and teachers--there

arise at puberty ideal impulses which, even though they may be rooted in

sex, yet in their scope transcend sex. These are capable of becoming far

more potent guides of the physical sex impulse than are merely material or

even hygienic considerations.

It is time to summarize and conclude this discussion of the prevention of

venereal disease, which, though it may seem to the superficial observer to

be merely a medical and sanitary question outside the psychologist's

sphere, is yet seen on closer view to be intimately related even to the

most spiritual conception of the sexual relationships. Not only are

venereal diseases the foes to the finer development of the race, but we

cannot attain to any wholesome and beautiful vision of the relationships

of sex so long as such relationships are liable at every moment to be

corrupted and undermined at their source. We cannot yet precisely measure

the interval which must elapse before, so far as Europe at least is

concerned, syphilis and gonorrhoea are sent to that limbo of monstrous old

dead diseases to which plague and leprosy have gone and smallpox is

already drawing near. But society is beginning to realize that into this

field also must be brought the weapons of light and air, the sword and the

breastplate with which all diseases can alone be attacked. As we have

seen, there are four methods by which in the more enlightened countries

venereal disease is now beginning to be combated.[255] (1) By proclaiming

openly that the venereal diseases are diseases like any other disease,

although more subtle and terrible than most, which may attack anyone from

the unborn baby to its grandmother, and that they are not, more than other

diseases, the shameful penalties of sin, from which relief is only to be

sought, if at all, by stealth, but human calamities; (2) by adopting

methods of securing official information concerning the extent,

distribution, and variation of venereal disease, through the already

recognized plan of notification and otherwise, and by providing such

facilities for treatment, especially for free treatment, as may be found

necessary; (3) by training the individual sense of moral responsibility,

so that every member of the community may realize that to inflict a

serious disease on another person, even only as a result of reckless

negligence, is a more serious offence than if he or she had used the knife

or the gun or poison as the method of attack, and that it is necessary to

introduce special legal provision in every country to assist the recovery

of damages for such injuries and to inflict penalties by loss of liberty

or otherwise; (4) by the spread of hygienic knowledge, so that all

adolescents, youths and girls alike, may be furnished at the outset of

adult life with an equipment of information which will assist them to

avoid the grosser risks of contamination and enable them to recognize and

avoid danger at the earliest stages.

A few years ago, when no method of combating venereal disease was known

except that system of police regulation which is now in its decadence, it

would have been impossible to bring forward such considerations as these;

they would have seemed Utopian. To-day they are not only recognizable as

practical, but they are being actually put into practice, although, it is

true, with very varying energy and insight in different countries. Yet it

is certain that in the competition of nationalities, as Max von Niessen

has well said, "that country will best take a leading place in the march

of civilization which has the foresight and courage to introduce and carry

through those practical movements of sexual hygiene which have so wide and

significant a bearing on its own future, and that of the human race

generally."[256]

FOOTNOTES:

[220] It is probable that Schopenhauer felt a more than merely speculative

interest in this matter. Bloch has shown good reason for believing that

Schopenhauer himself contracted syphilis in 1813, and that this was a

factor in constituting his conception of the world and in confirming his

constitutional pessimism (_Medizinische Klinik_, Nos. 25 and 26, 1906).

[221] Havelburg, in Senator and Kaminer, _Health and Disease in Relation

to Marriage_, vol. i, pp. 186-189.

[222] This is the very definite opinion of Lowndes after an experience of

fifty-four years in the treatment of venereal diseases in Liverpool

(_British Medical Journal_, Feb. 9, 1907, p. 334). It is further indicated

by the fact (if it is a real fact) that since 1876 there has been a

decline of both the infantile and general mortality from syphilis in

England.

[223] "There is no doubt whatever that syphilis is on the increase in

London, judging from hospital work alone," says Pernet (_British Medical

Journal_, March 30, 1907). Syphilis was evidently very prevalent, however,

a century or two ago, and there is no ground for asserting positively that

it is more prevalent to-day.

[224] See, e.g., A. Neisser, _Die experimentelle Syphilisforschung_, 1906,

and E. Hoffmann (who was associated with Schaudinn's discovery), _Die

Aetiologie der Syphilis_, 1906; D'Arcy Power, _A System of Syphilis_,

1908, etc.; F.W. Mott, "Pathology of Syphilis in the Light of Modern

Research," _British Medical Journal_, February 20, 1909; also, _Archives

of Neurology and Psychiatry_, vol. iv, 1909.

[225] There is some difference of opinion on this point, and though it

seems probable that early and thorough treatment usually cures the disease

in a few years and renders further complications highly improbable, it is

not possible, even under the most favorable circumstances, to speak with

absolute certainty as to the future.

[226] "That syphilis has been, and is, one of the chief causes of physical

degeneration in England cannot be denied, and it is a fact that is

acknowledged on all sides," writes Lieutenant-Colonel Lambkin, the medical

officer in command of the London Military Hospital for Venereal Diseases.

"To grapple with the treatment of syphilis among the civil population of

England ought to be the chief object of those interested in that most

burning question, the physical degeneration of our race" (_British Medical

Journal_, August 19, 1905).

[227] F.W. Mott, "Syphilis as a Cause of Insanity," _British Medical

Journal_, October 18, 1902.

[228] It can seldom be proved in more than eighty per cent. of cases, but

in twenty per cent. of old syphilitic cases it is commonly impossible to

find traces of the disease or to obtain a history of it. Crocker found

that it was only in eighty per cent. of cases of absolutely certain

syphilitic skin diseases that he could obtain a history of syphilitic

infection, and Mott found exactly the same percentage in absolutely

certain syphilitic lesions of the brain; Mott believes (e.g., "Syphilis in

Relation to the Nervous System," _British Medical Journal_, January 4,

1908) that syphilis is the essential cause of general paralysis and tabes.

[229] Audry. _La Semaine Médicale_, June 26, 1907. When Europeans carry

syphilis to lands inhabited by people of lower race, the results are often

very much worse than this. Thus Lambkin, as a result of a special mission

to investigate syphilis in Uganda, found that in some districts as many as

ninety per cent, of the people suffer from syphilis, and fifty to sixty

per cent, of the infant mortality is due to this cause. These people are

Baganda, a highly intelligent, powerful, and well-organized tribe before

they received, in the gift of syphilis, the full benefit of civilization

and Christianity, which (Lambkin points out) has been largely the cause of

the spread of the disease by breaking down social customs and emancipating

the women. Christianity is powerful enough to break down the old morality,

but not powerful enough to build up a new morality (_British Medical

Journal_, October 3, 1908, p. 1037).

[230] Even within the limits of the English army it is found In India

(H.C. French, _Syphilis in the Army_, 1907) that venereal disease is ten

times more frequent among British troops than among Native troops. Outside

of national armies it is found, by admission to hospital and death rates,

that the United States stands far away at the head for frequency of

venereal disease, being followed by Great Britain, then France and

Austria-Hungary, Russia, and Germany.

[231] There is no dispute concerning the antiquity of gonorrhoea in the

Old World as there is regarding syphilis. The disease was certainly known

at a very remote period. Even Esarhaddon, the famous King of Assyria,

referred to in the Old Testament, was treated by the priests for a

disorder which, as described in the cuneiform documents of the time, could

only have been gonorrhoea. The disease was also well known to the ancient

Egyptians, and evidently common, for they recorded many prescriptions for

its treatment (Oefele, "Gonorrhoe 1350 vor Christi Geburt," _Monatshefte

für Praktische Dermatologie_, 1899, p. 260).

[232] Cf. Memorandum by Sydney Stephenson, Report of Ophthalmia Neonatorum

Committee, _British Medical Journal_, May 8, 1909.

[233] The extent of these evils is set forth, e.g., in a comprehensive

essay by Taylor, _American Journal Obstetrics_, January, 1908.

[234] Neisser brings together figures bearing on the prevalence of

gonorrhoea in Germany, Senator and Kaminer, _Health and Disease in

Relation to Marriage_, vol. ii, pp. 486-492.

[235] _Lancet_, September 23, 1882. As regards women, Dr. Frances Ivens

(_British Medical Journal_, June 19, 1909) has found at Liverpool that 14

per cent. of gynæcological cases revealed the presence of gonorrhoea. They

were mostly poor respectable married women. This is probably a high

proportion, as Liverpool is a busy seaport, but it is less than Sänger's

estimate of 18 per cent.

[236] E.H. Grandin, _Medical Record_, May 26, 1906.

[237] E.W. Cushing, "Sociological Aspects of Gonorrhoea," _Transactions

American Gynecological Society_, vol. xxii, 1897.

[238] It is only in very small communities ruled by an autocratic power

with absolute authority to control conditions and to examine persons of

both sexes that reglementation becomes in any degree effectual. This is

well shown by Dr. W.E. Harwood, who describes the system he organized in

the mines of the Minnesota Iron Company (_Journal American Medical

Association_, December 22, 1906). The women in the brothels on the

company's estate were of the lowest class, and disease was very prevalent.

Careful examination of the women was established, and control of the men,

who, immediately on becoming diseased, were bound to declare by what woman

they had been infected. The woman was responsible for the medical bill of

the man she infected, and even for his board, if incapacitated, and the

women were compelled to maintain a fund for their own hospital expenses

when required. In this way venereal disease, though not entirely uprooted,

was very greatly diminished.

[239] A clear and comprehensive statement of the present position of the

question is given by Iwan Bloch, _Das Sexualleben Unserer Zeit_, Chs.

XIII-XV. How ineffectual the system of police regulation is, even in

Germany, where police interference is tolerated to so marked a degree, may

be illustrated by the case of Mannheim. Here the regulation of

prostitution is very severe and thorough, yet a careful inquiry in 1905

among the doctors of Mannheim (ninety-two of whom sent in detailed

returns) showed that of six hundred cases of venereal disease in men,

nearly half had been contracted from prostitutes. About half the remaining

cases (nearly a quarter of the whole) were due to waitresses and

bar-maids; then followed servant-girls (Lion and Loeb, in

_Sexualpädagogik_, the Proceedings of the Third German Congress for

Combating Venereal Diseases, 1907, p. 295).

[240] A sixth less numerous class might be added of the young girls, often

no more than children, who have been practically raped by men who believe

that intercourse with a virgin is a cure for obstinate venereal disease.

In America this belief is frequently held by Italians, Chinese, negroes,

etc. W. Travis Gibb, Examining Physician of the New York Society for the

Prevention of Cruelty to Children, has examined over 900 raped children

(only a small proportion, he states, of the cases actually occurring), and

finds that thirteen per cent have venereal diseases. A fairly large

proportion of these cases, among girls from twelve to sixteen, are, he

states, willing victims. Dr. Flora Pollack, also, of the Johns Hopkins

Hospital Dispensary, estimates that in Baltimore alone from 800 to 1,000

children between the ages of one and fifteen are venereally infected every

year. The largest number, she finds, is at the age of six, and the chief

cause appears to be, not lust, but superstition.

[241] For a discussion of inherited syphilis, see, e.g., Clement Lucas,

_Lancet_, February 1, 1908.

[242] Much harm has been done in some countries by the foolish and

mischievous practice of friendly societies and sick clubs of ignoring

venereal diseases, and not according free medical aid or sick pay to those

members who suffer from them. This practice prevailed, for instance, in

Vienna until 1907, when a more humane and enlightened policy was

inaugurated, venereal diseases being placed on the same level as other

diseases.

[243] Active measures against venereal disease were introduced in Sweden

early in the last century, and compulsory and gratuitous treatment

established. Compulsory notification was introduced many years ago in

Norway, and by 1907 there was a great diminution in the prevalence of

venereal diseases; there is compulsory treatment.

[244] See, e.g., Morrow, _Social Diseases and Marriage_, Ch. XXXVII.

[245] A committee of the Medical Society of New York, appointed in 1902 to

consider this question, reported in favor of notification without giving

names and addresses, and Dr. C.R. Drysdale, who took an active part in the

Brussels International Conference of 1899, advocated a similar plan in

England, _British Medical Journal_, February 3, 1900.

[246] Thus in Munich, in 1908, a man who had given gonorrhoea to a

servant-girl was sent to prison for ten months on this ground. The state

of German opinion to-day on this subject is summarized by Bloch,

_Sexualleben unserer Zeit_, p. 424.

[247] A. Després, _La Prostitution à Paris_, p. 191.

[248] F. Aurientis, _Etude Medico-légale sur la jurisprudence actuelle à

propos de la Transmission des Maladies Venériennes_, Thèse de Paris, 1906.

[249] In England at present "a husband knowingly and wilfully infecting

his wife with the venereal disease, cannot be convicted criminally, either

under a charge of assault or of inflicting grievous bodily harm" (N.

Geary, _The Law of Marriage_, p. 479). This was decided in 1888 in the

case of _R. v. Clarence_ by nine judges to four judges in the Court for

the Consideration of Crown Cases Reserved.

[250] Modern democratic sentiment is opposed to the sequestration of a

prostitute merely because she is diseased. But there can be no reasonable

doubt whatever that if a diseased prostitute infects another person, and

is unable to pay the very heavy damages which should be demanded in such a

case, she ought to be secluded and subjected to treatment. That is

necessary in the interests of the community. But it is also necessary, to

avoid placing a premium on the commission of an offence which would ensure

gratuitous treatment and provision for a prostitute without means, that

she should be furnished with facilities for treatment in any case.

[251] It has, however, been decided by the Paris Court of Appeal that for

a husband to marry when knowingly suffering from a venereal disease and to

communicate that disease to his wife is a sufficient cause for divorce

(_Semaine Médicale_, May, 1896).

[252] The large volume, entitled _Sexualpädagogik_, containing the

Proceedings of the Third of these Congresses, almost ignores the special

subject of venereal disease, and is devoted to the questions involved by

the general sexual education of the young, which, as many of the speakers

maintained, must begin with the child at his mother's knee.

[253] "Workmen, soldiers, and so on," Neisser remarks (Senator and

Kaminer, _Health and Disease in Relation to Marriage_, vol. ii, p. 485),

"can more easily find non-prostitute girls of their own class willing to

enter into amorous relations with them which result in sexual intercourse,

and they are therefore less exposed to the danger of infection than those

men who have recourse almost exclusively to prostitutes" (see also Bloch,

_Sexualleben unserer Zeit_, p. 437).

[254] The character and extent of such lectures are fully discussed in the

Proceedings of the Third Congress of the German Society for Combating

Venereal Diseases, _Sexualpädagogik_, 1907.

[255] I leave out of account, as beyond the scope of the present work, the

auxiliary aids to the suppression of venereal diseases furnished by the

promising new methods, only now beginning to be understood, of treating or

even aborting such diseases (see, e.g., Metchnikoff, _The New Hygiene_,

1906).

[256] Max von Niessen, "Herr Doktor, darf ich heiraten?" _Mutterschutz_,

1906, p. 352.

CHAPTER IX.

SEXUAL MORALITY.

Prostitution in Relation to Our Marriage System--Marriage and

Morality--The Definition of the Term "Morality"--Theoretical Morality--Its

Division Into Traditional Morality and Ideal Morality--Practical

Morality--Practical Morality Based on Custom--The Only Subject of

Scientific Ethics--The Reaction Between Theoretical and Practical

Morality--Sexual Morality in the Past an Application of Economic

Morality--The Combined Rigidity and Laxity of This Morality--The

Growth of a Specific Sexual Morality and the Evolution of Moral

Ideals--Manifestations of Sexual Morality--Disregard of the Forms of

Marriage--Trial Marriage--Marriage After Conception of Child--Phenomena in

Germany, Anglo-Saxon Countries, Russia, etc.--The Status of Woman--The

Historical Tendency Favoring Moral Equality of Women with Men--The Theory

of the Matriarchate--Mother-Descent--Women in Babylonia--Egypt--Rome--The

Eighteenth and Nineteenth Centuries--The Historical Tendency

Favoring Moral Inequality of Woman--The Ambiguous Influence of

Christianity--Influence of Teutonic Custom and Feudalism--Chivalry--Woman

in England--The Sale of Wives--The Vanishing Subjection of

Woman--Inaptitude of the Modern Man to Domineer--The Growth of Moral

Responsibility in Women--The Concomitant Development of Economic

Independence--The Increase of Women Who Work--Invasion of the Modern

Industrial Field by Women--In How Far This Is Socially Justifiable--The

Sexual Responsibility of Women and Its Consequences--The Alleged Moral

Inferiority of Women--The "Self-Sacrifice" of Women--Society Not Concerned

with Sexual Relationships--Procreation the Sole Sexual Concern of the

State--The Supreme Importance of Maternity.

It has been necessary to deal fully with the phenomena of prostitution

because, however aloof we may personally choose to hold ourselves from

those phenomena, they really bring us to the heart of the sexual question

in so far as it constitutes a social problem. If we look at prostitution

from the outside, as an objective phenomenon, as a question of social

dynamics, it is seen to be not a merely accidental and eliminable incident

of our present marriage system but an integral part of it, without which

it would fall to pieces. This will probably be fairly clear to all who

have followed the preceding exposition of prostitutional phenomena. There

is, however, more than this to be said. Not only is prostitution to-day,

as it has been for more than two thousand years, the buttress of our

marriage system, but if we look at marriage, not from the outside as a

formal institution, but from the inside with relation to the motives that

constitute it, we find that marriage in a large proportion of cases is

itself in certain respects a form of prostitution. This has been

emphasized so often and from so many widely different standpoints that it

may seem hardly necessary to labor the point here. But the point is one of

extreme importance in relation to the question of sexual morality. Our

social conditions are unfavorable to the development of a high moral

feeling in woman. The difference between the woman who sells herself in

prostitution and the woman who sells herself in marriage, according to the

saying of Marro already quoted, "is only a difference in price and

duration of the contract." Or, as Forel puts it, marriage is "a more

fashionable form of prostitution," that is to say, a mode of obtaining, or

disposing of, for monetary considerations, a sexual commodity. Marriage

is, indeed, not merely a more fashionable form of prostitution, it is a

form sanctified by law and religion, and the question of morality is not

allowed to intrude. Morality may be outraged with impunity provided that

law and religion have been invoked. The essential principle of

prostitution is thus legalized and sanctified among us. That is why it is

so difficult to arouse any serious indignation, or to maintain any

reasoned objections, against our prostitution considered by itself. The

most plausible ground is that of those[257] who, bringing marriage down to

the level of prostitution, maintain that the prostitute is a "blackleg"

who is accepting less than the "market rate of wages," i.e., marriage, for

the sexual services she renders. But even this low ground is quite unsafe.

The prostitute is really paid extremely well considering how little she

gives in return; the wife is really paid extremely badly considering how

much she often gives, and how much she necessarily gives up. For the sake

of the advantage of economic dependence on her husband, she must give up,

as Ellen Key observes, those rights over her children, her property, her

work, and her own person which she enjoys as an unmarried woman, even, it

may be added, as a prostitute. The prostitute never signs away the right

over her own person, as the wife is compelled to do; the prostitute,

unlike the wife, retains her freedom and her personal rights, although

these may not often be of much worth. It is the wife rather than the

prostitute who is the "blackleg."