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 c