Studies in the Psychology of Sex Volume Vi Part 20

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 const.i.tute 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 p.r.o.nounced 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 s.e.xual intercourse, both in and out of marriage,-and indeed, apart from s.e.xual intercourse altogether,-is a further stage of that s.e.xual 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 p.u.b.erty 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 s.e.xual instinct, actual or potential, begins that the risks, under some circ.u.mstances, 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-cla.s.s 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 grat.i.tude. 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 Prost.i.tution 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'Hygiene 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 a.s.sociation 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 gonorrha (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 gonorrhic 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 p.u.b.erty the parents, and especially the mother, are the proper instructors of their children in esoteric knowledge. But after p.u.b.erty 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 a.s.sistance 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 s.e.xual hygiene and venereal diseases for higher schools and educational inst.i.tutions, though attendance was not made compulsory. The courses now frequently given by medical men to the higher cla.s.ses in German secondary schools on the general principles of s.e.xual anatomy and physiology nearly always include s.e.xual hygiene with special reference to venereal diseases (see, e.g., s.e.xualpadagogik, 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 inst.i.tuted 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 s.e.xual hygiene, though they have to contend against a more obstinate degree of prejudice and prudery on the part of the middle cla.s.s than is to be found in the Germanic lands. The Commission Extraparlementaire du Regime des Murs, with the conjunction of Augagneur, Alfred Fournier, Yves Guyot, Gide, and other distinguished professors, teachers, etc., has lately p.r.o.nounced in favor of the official establishment of instruction in s.e.xual hygiene, to be given in the highest cla.s.ses at the lycees, or in the earliest cla.s.s 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 Societe Francaise de Prophylaxie Sanitaire et Morale, which delivers public lectures on s.e.xual hygiene. Fournier, Pinard, Burlureaux and other eminent physicians have written pamphlets on this subject for popular distribution (see, e.g., Le Progres Medical 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 cla.s.ses. 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. x.x.xii, 1907).

An important auxiliary method of carrying out the task of s.e.xual 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 gonorrhal patients. This plan has already been introduced at some hospitals, and it is so simple and un.o.bjectionable 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 prost.i.tute, 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 att.i.tude towards prost.i.tution. It was dramatized and played by Antoine at the Theatre 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 generale." 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 Deroulede, and the newspapers criticized a censure which permitted on the stage all the trivial indecencies which favor prost.i.tution, but cannot tolerate any attack on prost.i.tution. 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 Prost.i.tuee (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 prost.i.tute 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 a.s.sistance the author received from the Paris Prefecture 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 Avaries (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 prost.i.tutes, 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 Avaries 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 const.i.tuted 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 att.i.tude 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 prost.i.tution, 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 aesthetic is confused with the moral, and what arouses disgust is thus regarded as immoral. In France the novels of Zola, the most pedestria.n.a.lly 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 prost.i.tute 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 s.e.xual 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 s.e.xual ignorance. However concealed, suppressed, or deformed-usually by the misplaced and premature zeal of foolish parents and teachers-there arise at p.u.b.erty ideal impulses which, even though they may be rooted in s.e.x, yet in their scope transcend s.e.x. These are capable of becoming far more potent guides of the physical s.e.x 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 s.e.xual 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 s.e.x 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 gonorrha 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 a.s.sist 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 a.s.sist 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 compet.i.tion 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 s.e.xual hygiene which have so wide and significant a bearing on its own future, and that of the human race generally."[256]

[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 const.i.tuting his conception of the world and in confirming his const.i.tutional 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 a.s.serting positively that it is more prevalent to-day.

[224]

See, e.g., A. Neisser, Die experimentelle Syphilisforschung, 1906, and E. Hoffmann (who was a.s.sociated 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 circ.u.mstances, 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 Medicale, 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 emanc.i.p.ating 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 gonorrha 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 a.s.syria, referred to in the Old Testament, was treated by the priests for a disorder which, as described in the cuneiform doc.u.ments of the time, could only have been gonorrha. 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 fur 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 gonorrha 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 gynaecological cases revealed the presence of gonorrha. They were mostly poor respectable married women. This is probably a high proportion, as Liverpool is a busy seaport, but it is less than Sanger's estimate of 18 per cent.

[236]

E. H. Grandin, Medical Record, May 26, 1906.

[237]

E. W. Cushing, "Sociological Aspects of Gonorrha," 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 s.e.xes 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 a.s.sociation, December 22, 1906). The women in the brothels on the company's estate were of the lowest cla.s.s, 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 s.e.xualleben 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 ill.u.s.trated by the case of Mannheim. Here the regulation of prost.i.tution 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 prost.i.tutes. 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 s.e.xualpadagogik, the Proceedings of the Third German Congress for Combating Venereal Diseases, 1907, p. 295).

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A sixth less numerous cla.s.s 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 l.u.s.t, but superst.i.tion.

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For a discussion of inherited syphilis, see, e.g., Clement Lucas, Lancet, February 1, 1908.