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