The Third Great Plague Part 6

+Articles of Personal Use.+--Persons with a tendency to recurrences in the mouth or elsewhere should report to the physician any sore they may discover and should watch for them. Persons with syphilitic sores in the mouth or elsewhere should have their own dishes, towels, toilet articles, shaving tools, pipes, silverware, and personal articles, and should not exchange or permit others to use them.

+Secrecy.+--Professional secrecy is something to which the syphilitic is most certainly ent.i.tled when it can be had without danger to the public health. So long as a syphilitic in the contagious period carefully observes the principles which ought to govern him in his relations to others, his condition is his own concern. But there is one person within the family who should, as a rule, know of his infection if it is still in the contagious period, since it is almost impossible to secure cooperation otherwise. No matter how painful it may be, a person with syphilis, if advised to do so by his physician, should tell husband or wife the true state of affairs. There is no harder duty, often, and none which, if manfully performed, should inspire more respect. For those who will not follow his advice in this matter the physician cannot a.s.sume any responsibility, and is fully justified, and in fact wise, if he decline to undertake the case.

+Re-infection.+--Since it is a common misconception, it cannot be said too forcibly that no person with syphilis should forget that his having had the disease does not confer any immunity, and that as soon as he is cured he may acquire it again. It is possible, by a single exposure to infection, to undo the whole effect of what has been done, just after a cure is accomplished. There can be only one safe rule for infected as well as uninfected persons--to keep away from the risk of syphilis.

+Quacks and Self-treatment.--Hot Springs.+--The temptation to take up quack forms of treatment or to treat himself without the advice of a physician besets the path of the syphilitic throughout the course of the disease; an enormous number of fraudulent enterprises thrive on the credulity of its victims. Most of them are of the patent medicine specific type. Others, however, have a tinge of respectability and are dangerous simply because they are insufficient and not carried out under proper direction. Many popular superst.i.tions as to the value of baths in syphilis and of the usefulness of a short course of rubs with bathing, or a "trip to the springs," are of this kind. Enough has been said in the foregoing chapters to make it plain to any one who is open to conviction that syphilis is no affair for the patient himself to attempt to treat. The best judgment of the most skilled physicians is the least that the victim owes himself in his effort to get well.

+Patient and Physician.+--For the same reasons every person who has or has had syphilis, cured or not, or has been exposed to it, should make it an absolute rule to inform his physician of the fact. The recognition of many obscure conditions in medicine depends on this knowledge. For a patient to falsify the facts or to ignore or conceal them is simply to work against his own interests and to hinder his physician in his efforts to benefit him.

Chapter XIV

Mental Att.i.tudes in Their Relation to Syphilis

One's way of looking at a thing has an immense influence on what one does about it. Obvious as this principle is in the every-day affairs of life, it becomes still more obvious as one studies a disease and watches the way in which different individuals react to it. The state of mind of a few people infected with a rare condition may not seem a matter of more than pa.s.sing interest, but in a disease which is a wide-spread and disastrous influence in human life, the sum-total of our states of mind about it determines what we do against it and, to no small degree, what it does to us. Syphilis as a medical problem offers comparatively few difficulties at the present day. What blocks our progress now is largely an affair of mental att.i.tudes, of prejudices, of fears, or shame, of ignorance, stupidity, or indifference. Mental strain, a powerful influence in many diseases, is a factor in syphilis also, and the state of mind of the patient has often almost as much to do with the success of his treatment as has salvarsan or mercury. For that reason it is worth while to devote a chapter to picturing in a general way the mental side of syphilis.

+The Public Att.i.tude Toward Syphilis.+--First of all, in order to understand the mental state of the patient, consider once more the att.i.tude of the world at large toward the victim of syphilis. A few who are frankly ignorant of the existence of the disease to start with are unprejudiced when approached in the right way. But ninety-eight persons in a hundred who know that there is such a disease as syphilis are alive to the fact that it is considered a disgrace to have it, and to little else. Such a feeling naturally chokes all but secret discussion of it.

Most of us remember the day when newspaper copy containing reference to tuberculosis did not find ready publication. Syphilis is just crossing this same threshold into publicity. It is now possible to get the name of the disease into print outside of medical works and to have it referred to in other ways than as "blood poisoning" in quack advertis.e.m.e.nts. The mention of it in lectures on s.e.x hygiene is an affair of the last twenty years, and the earlier discussions of the disease on such occasions were only too often vague, prejudiced, and inaccurate. There are many who still believe, as did an old librarian whom I met in my effort to reach an important reference work on syphilis in a great public library. "We used to keep them on the shelves," he said, "until the high school boys began to get interested, and then we thought we would reserve the subject for the profession." Syphilis has been reserved for the profession for five hundred years and the disease has grown fat on it. The lean times will come when a reasonable curiosity about syphilis can be satisfied without either shame or secrecy by a reasonable presentation of the facts. We need the light on this subject and the light on reserved shelves is notoriously poor. The stigma attaching to syphilis as a disease is one of the most tragic examples of a great wrong done to do a little right. What if there are a few who deserve what they got? We may well ask ourselves how free we are to cast the first stone. And why single out syphilis as the badge of venery? The "itch" is transmitted by s.e.xual relations too. Why not make the itch a sign of shame? The power that has done the damage is not the intrinsic viciousness of syphilis, but the survival of the old idea of s.e.xual taboo, the feeling that s.e.x is a secret, shameful thing, essentially unclean. To this age-old myth some one added the idea of punishment, and brutalized our conception of syphilis for centuries. If there were a semblance of crude, stern justice in accepting syphilis as the divinely established punishment for s.e.xual wrong-doing, protest would lose half its meaning. Not only does syphilis fail to punish justly, but there is also something savage, akin almost to the mental att.i.tude that makes "frightfulness" possible in war, in the belief that it is necessary to make headway against a s.e.xual enemy by torturing, ruining, and dismembering men, women, and children, putting out the eyes of the boy who made a slip through bad companions.h.i.+p and mutilating the girl who loved "not wisely but too well." Only innocence pays the spiritual price of syphilis. The very ones whose punishment it should be are the most indifferent to it, and the least influenced by fear of it in their pursuit of s.e.xual gratification. I always recall with a shock the utterance of a university professor in the days when salvarsan was expected to cure syphilis at a single dose. He rated it as a catastrophe that any such drug should have been discovered, because he felt that it would remove a great barrier to promiscuous relations between men and women--the fear of venereal disease. This is the point of view that perpetuates the disease among us. It is this att.i.tude of mind that maintains an atmosphere of disgrace and secrecy and shame about a great problem in public health and muddles our every attempt to solve it.

Those who feel syphilis to be an instrument adapted to warfare against s.e.xual mistakes, and are prepared to concede "frightfulness" to be honorable warfare, will, of course, fold their hands and smugly roll their eyes as they repeat the words of the secretary of a London Lock hospital, "I don't believe in making it safe."[14]

[14] Quoted by Flexner in "Prost.i.tution in Europe."

+Syphilis as a "Disgrace" and a "Moral Force."+--If syphilis really deterred, really acted as an efficient preventive of license, we might have to tolerate this att.i.tude of mind, even though we disagreed with it. I had occasion, during a period of two years, to live in the most intimate a.s.sociation with about 800 people who had syphilis--every kind of person from the top to the bottom of the social scale. It was not a simple matter of ordering pills for them from the pharmacy, or castor oil from the medicine room. I had to sit beside their beds when they heard the truth; I had to see the women crumple up and go limp; I had to tell the blind child's father that he did it, to bolster up the weak girl, to rebuild the wife's broken ideals, to suppress the rowdy and the roysterer, to hear the vows of the boy who was paying for his first mistake, and listen to the stories of the pimp and the seducer. What made syphilis terrible to the many really fine and upright spirits in the ma.s.s thus flung together in a common bondage? It was not the fear of paresis, or of any other consequence of the disease. It was the torture of disgrace, unearned shame, burnt into their backs by those who think syphilis a weapon against prost.i.tution and a punishment for sin. It wrecked some of them effectually--left them nothing to live for. It case-hardened others against the world in a way you and I can well pray we may never be case-hardened. It left scars on others, and others laughed it off. Hundreds of s.e.xual offenders pa.s.sed through my hands, and in the closest study of their points of view I was unable to find that in more than rare cases had the risk of syphilis any real power to control the expression of their desires. s.e.xual morality is a complex affair, in which the habit of self-control in many other activities of life plays an important part. The man or woman who best deserves to be called clean and honorable and s.e.xually blameless has not become so through a negative morality and an enlightened selfishness. The man who does not have bred into him from childhood the instinct to say the "everlasting no" to his pa.s.sions will never learn to say it from the fear of syphilis. s.e.xual self-control is a habit, not a reasoned-out affair, and its foundation must rest on the rock bottom of character and not in the muck of venereal disease.

+The Broader Outlook.+--If, then, it avails nothing in the uplifting of our morals to treat syphilis as a disgrace, if the disease is ineffective as a deterrent, and barbarously undiscriminating, inhuman, and unjust as a punishment, let us in all fairness lay aside the att.i.tude of mind which has so hindered and defeated our efforts to deal with it as an arch enemy to human health, happiness, and effectiveness.

In the face of all our harsh traditions it takes a good deal of breadth of view to look on the disease impersonally, rather than in the light of one or two contemptible examples of it whom we may happen to know. But, after all, to think in large terms and with a sympathy that can separate the sinner from his sin and the sick man from the folly that got the best of him, is no mean achievement, well worthy of the Samaritan in contrast with the Levite. To the remaking of the traditional att.i.tude of harsh, unkindly judgment upon those unfortunate enough to have a terrible disease, we must look for our soundest hope of progress.

+The Mental States of Syphilitics.+--The mental outlook of the person with syphilis is in its turn as important a factor in our campaign against the disease as is that of the person without it. In order to give some idea of the ways in which this can influence the situation it may be well to sketch what might be called the four types of mind with which one has to deal--the conscientious, the average, the irresponsible, and the morbid. Under the morbid type are included those persons who, without having syphilis, are in morbid fear of the disease, or have the fixed belief that they are infected with it, even when they are not.

+The Conscientious Type.+--Conscientious patients, speaking from the physician's standpoint, are the product of intelligence and character combined. Though distinctly in the minority, and usually met in the better grades of private practice, one is often surprised how many there are, considering the treacherous and deceptive features of the disease, which leave so much excuse for laxity and misunderstanding on the part of the laymen. A conscientious patient is one who is not content with any ideal short of that of radical cure. It takes unselfishness and self-control to go without those things which make the patient in the infectious stage dangerous to others. For a time life seems pretty well stripped of its pleasures for the man who may not smoke, must always think beforehand whether any contact which he makes with persons or things about him may subject others to risk of infection, and perhaps must meet the misunderstanding and condemnation of others whom he has to take into his confidence for the same purpose. An element of moral courage and a keen sense of personal responsibility help to make the ideal patient in this disease. To meet a treatment appointment promptly at the same day and hour week after week, to go through the drudgery of rubbing mercurial ointment, for example, to say nothing of the unpleasantness of the method to a cleanly person, night after night for weeks, takes unmistakable grit and a well-developed sense of moral obligation. The man who has been cured of syphilis has pa.s.sed through a discipline which calls for the best in him, and repays him in terms of better manhood as well as better health.

The physician's cooperation in the development of the necessary sense of responsibility and the requisite character basis for a successful treatment is invaluable. To the large majority of the victims of the disease it is a severe shock to find out what ails them. Many of them, without saying much about it, give up all hope for a worth-while life from the moment they learn of their condition. Just as in the old days the belief that consumption was incurable cost nearly as many lives as the disease itself, by leading victims to give up the fight when a little persistence would have won it, so among many who acquire syphilis, especially when it is contracted under distressing circ.u.mstances, there is a lowering of the victims' fighting strength, a sapping of their courage which makes them an easy prey to the indifference to cure that is so fatal in this disease. The person with syphilis should have the benefit of all the friendly counsel, rea.s.surance, and moral support that his physician can give, and such time and labor on the latter's part are richly repaid.

+The Average State of Mind.+--The average mental att.i.tude stops tantalizingly short of the best type of conscientiousness. Average patients are good cooperators in the beginning of a course of treatment or while the symptoms are alarming or obvious, but their energy leaves them once they are outwardly cured. The average patient only too often overrules his physician's good judgment on trivial grounds, slight inconveniences, and temporary considerations, forgetting that cure is what he needs more than anything else in the world. The deprivations go hard with this type of patients, and it is difficult, almost impossible, to persuade them to stop smoking or to abstain from s.e.xual relations or other contacts that are apt to subject others to risk. Average patients will almost never remain under the care of a physician until cured. A year, or at the most two years, is all that can be expected, and a second or third negative blood test is usually the signal for their disappearance. They are, of course, lost in the great unknown of syphilis, and swell the total of deaths from internal causes of syphilitic origin, such as diseases of the arteries and of the nervous system. A good many have to be treated for relapses, but the amount of infection spread by them, while of course unknown, is probably small considering how many of them there are.

+Effect of the High Cost of Treatment.+--A factor which is extremely influential in forcing average treatment and ideals on those who, if opportunity were more abundant, would be conscientious about the disease, has already been mentioned as the cost of treatment, which is such that persons with small incomes, who are too proud or sensitive to seek charitable aid, can scarcely be expected to meet. The cost of salvarsan under present conditions is a burden that few can hope to a.s.sume to the extent that modern treatment tends to require, and the slower methods of treatment are more of a tax on the patient's courage and determination, and less effective in preventing the danger of infectiousness, although quite as reliable for cure. There is no more serious problem in the public health movement against syphilis than to get for the average man who can pay a moderate but not a large fee the benefits of expensive and elaborate methods of recognizing and treating a disease such as syphilis. Some practical methods of doing this will be taken up in the next chapter.

+The Irresponsible.+--The irresponsible att.i.tude of mind about syphilis forms the background of the darkest and most repellent chapter in the story of the disease. Yet we ought to confront it if we wish to master the situation. The irresponsible person has either no regard for, or no conception of, the rights of others where a dangerous contagious disease is concerned, and often little conception of, and less interest in, what is to his own ultimate advantage. Irresponsible syphilitics lack character first and sense next. Many of them, through the G.o.ds-defying combination of stupidity and ignorance, cannot be approached through any channel of reason or persuasion. The only argument capable of influencing such minds is compulsion. Others are, of course, mental defectives with criminal and perverted tendencies. Yet it is both amazing and discouraging to find how many irresponsibles there are in the ordinary and even in the better walks of life. To the wilful type of irresponsible person the transmission of a syphilitic infection is nothing, and cannot weigh a straw against the gratification of his desire or the pursuit of his own interest. The disease cannot teach such people anything, and if it cannot, how can the physician? Such people pursue their personal and s.e.xual pleasure, marry, spread disaster around them, and outlive it all, perhaps brazenly to acknowledge the fact.

Others, suave, attractive, agreeable, seductive, often masquerade as respectability, or const.i.tute the perfumed, the romantic, the elegant carriers of disease. The proportion of ignorant to wilful irresponsibility can scarcely be estimated. But there is little choice between the two except on the score of the hopefulness of the latter. As examples of the mixture of types with which a large hospital is constantly dealing, I might offer the following at random, from my own recollections: A milkman came to a clinic one morning with an eruption all over his body and his mouth full of the most dangerously contagious patches. Two of us cornered him and explained to him in full why he should come in if only for twenty-four hours. He promised to be back next morning and disappeared. Another, a butcher in the same condition, put his wife, whom he had already infected, into the hospital, and in spite of every argument by all the members of the staff, went home to attend to his business--the selling of meat over the counter. A lunch-room helper, literally oozing germs, was after several days induced to come up for an examination and promised to begin treatment, whereupon he disappeared. A college student reported with an early primary sore. "X----," I said, "If you will pledge me your honor as a gentleman never to take another chance and not to marry until I say you are cured I will use salvarsan on you, which is just about as scarce as gold now, and give you a chance for abortive cure." He pledged himself, and six months later there was every sign that we were going to secure a perfect result. Suddenly he failed to appear for a treatment appointment, and I never saw him again. But I did see a letter written to him by the clinic which showed that he had come up for the examination with a newly acquired sore while he knew I was away--in all probability a reinfection. He was not even man enough to face me with his broken word. Three or four men with chancres may report in an afternoon and leave, the clinic powerless to detain them or to protect others against the damage they may do. One such, a Greek boy, had exposed four different women to infection before we saw him, and only the most strenuous efforts of the entire staff got him into the hospital, because he had neither money nor sense. Half-witted tramps, gang laborers, and foreigners who cannot understand a word of any other language than Lithuanian or some other of the European dialects for which no interpreter can be secured, pa.s.s in a steady stream through the free clinics of large cities. The impossibility of securing even the simplest cooperation from such patients is scarcely realized by any one who is not called upon to deal with them face to face. Even with an interpreter, they display the wilfulness of irresponsibility. One Italian woman wiped her chancre, which was on her lip, with her fingers at every other shake of the head. She was cooking for two boarders and had two children. She did not like hospitals and was homesick and pettish. Would she go over to the dispensary in the next block and find out how to take care of herself? Not a bit of it. She was going home, and she went. I saw the children later in the children's ward, both infected with syphilis--a poor start in life. Criminal intent in the transmission of syphilis is common enough, and the writer can think off-hand of four or five cases in which men or women "got" their estranged partners later in their careers.

+The Necessity for Legal Control.+--All these repulsive details have a place in driving home a conception of the cost to society of the immoral and irresponsible syphilitic. Syphilis is an infectious disease, dangerous to the individual and to society. If it is rational to quarantine a mouth and throat full of diphtheria germs, it is rational to quarantine a mouth and throat full of syphilitic germs at least until the germs are killed off for the time being. There can be no more excuse for placing society at the mercy of the one than of the other.

+The Morbid Att.i.tude of Mind: Syphilophobia.+--The morbid att.i.tude of mind, whether in persons who have the disease or in those who fear they may have it, is one of the hardest the physician has to deal with. Any one who knows anything of the disease naturally has a healthy desire to avoid it, and if he is a victim of it, a considerable belief in its seriousness. But certain types of persons, who are usually predisposed to it by a nervous makeup, or who have a tendency to brood over things, or who perhaps have heard some needlessly dreadful presentation of the facts, become the victims of an actual mental disorder, a temporary unbalancing of their point of view. To the victims of syphilophobia, as this condition is called, syphilis fills the whole horizon. If they have not been too seriously disturbed by the idea, a simple statement of the facts does wonders toward relieving their minds. A few of them cling with the greatest tenacity to the most absurd notions. For those victims of the disease who are the prey of morbid anxiety the a.s.surance that it is one of the most curable of all the serious diseases, and that if they are persistent and determined to get well, they can scarcely help doing so, usually sets their minds at rest. The idea that there is a cloud of disgrace over the whole subject, and the old-fas.h.i.+oned belief that syphilis is incurable and hopeless, inflict needless torture and may do serious damage to the highly organized sensitive spirits which it is to society's best interest to conserve. The overconscientious syphilitic hardly realizes that the real horrors of the disease are usually the rewards of indifference rather than overanxiety. Persons who subject themselves to the ordinary risks of infection which have been described in the preceding chapters do well to be on their guard and to maintain even a somewhat exaggerated caution. Those who do not expose themselves need not look upon the disease with morbid anxiety or alarm. In the relations of life in which syphilis is likely to be a factor it should, of course, be ferreted out. But there is no occasion for panic. We need a sane consciousness of the disease, a knowledge of its ways and of the means of prevention and cure for the world at large. We do not need hysteria, whether personal or general, and there is nothing in the facts of the situation to warrant the development of such a mental att.i.tude either on the part of the syphilitic or of those by whom he is surrounded. Insofar as morbid fear in otherwise normal persons is the product of ignorance it can be dispelled by convincing them of this fact.

Chapter XV

Moral and Personal Prophylaxis

Prophylaxis, of course, means prevention, and it has been a large part of the purpose of the present study to deal with syphilis from the standpoint of prevention and cure. The material of this chapter is, therefore, only a special aspect of the larger problem.

+Repression of Prost.i.tution.+--By the moral prophylaxis of syphilis is meant the cultivation of such moral ideals as will contribute to the control of a disease which is so closely a.s.sociated with s.e.xual irregularities. Since public and secret prost.i.tution serve as the princ.i.p.al agencies for the dissemination of the disease, it follows that anything tending to decrease the amount of disease in prost.i.tutes, on the one hand, or to diminish the amount of promiscuous s.e.xual activity, on the other, will r.e.t.a.r.d the spread of syphilis. Systems based on the first ideas, aiming rather to control the disease in public women by inspection of their health and activities than by suppressing prost.i.tution, have failed because the methods of control ordinarily practised are worthless for the detection of infectiousness. So-called regulation has, therefore, given way very largely in progressive communities to the second ideal of repressing or abolis.h.i.+ng the outward evidences of vice as far as possible. In behalf of sanitary control of prost.i.tution, leaving out of the question its moral aspect, it must be admitted that Neisser, probably the greatest authority on the s.e.xual diseases, believed that, as far as syphilis is concerned, the use of salvarsan as a means of preventing infection from prost.i.tutes has never had a satisfactory trial. In behalf of abolition it would seem that systematic stamping-out of the outward evidences of vice, the making of immorality less attractive and conspicuous, is, in theory at least, a valuable means of diminis.h.i.+ng the extent and availability of an important source of infection.

+Educational Influences.+--To do something positive against an evil is certainly a more promising mode of attack than to use only the negative force of repression of temptation. Education of public opinion offers us just such a positive mode of attack. Men and women and boys and girls should first be taught s.e.xual self-control even before being made aware of the risk they run in throwing aside the conventional moral code.

Teach honor first and prudence next. The slogan of education in s.e.xual self-restraint is the easiest to utter and the most difficult to put into practice of all the schemes for the control of s.e.xual diseases. A large part of the difficulty of making education effective arises from one or two situations which are worth thinking over.

+Economic Forces Opposing s.e.xual Self-control.+--In the first place, while continence, or abstinence from s.e.xual relations, is a valuable ideal in its place, it cannot be indefinitely extended with benefit either to the individual or to the race. The instinct to reproduce is as fundamental as the instinct of self-preservation and the desire for food. A social order which disregards it or defies it will meet defeat.

To an alarming extent the tendency of the present economic system is to create unsocial impulses by making the normal gratification of s.e.xual instinct in marriage and the a.s.sumption of the responsibility of a family more and more difficult. The cost of living is steadily rising without a corresponding certainty on the part of a large proportion of young men that they can meet it for themselves, to say nothing of meeting it for wife and children. The uncertainties of a 'job' are often serious enough to discourage the rashest of men from depending on a variable earning power to help him do his share for the advancement of the race. It will be an impossible task to convince even naturally clean-minded, healthy young men and women that they should live a life of hopeless virtue because it is part of the divine order that they should be so held down by hard times and small earnings as to make marrying and having children an unattainable luxury. Continence and clean living as preparations for decent and reasonably early marriage and the raising of a healthy family are the highest of ideals, and ought to be preached from every housetop. Continence as a life-long punishment for the impossible demands of an oppressive social and economic order gets as little attention as it deserves. First, let us make a clean s.e.xual life lead with greater certainty to some of the rewards that make life worth living and we shall then have a more substantial basis for making continence before marriage other than empty words. If every father, for example, could say to his sons and daughters that if they showed themselves clean men and women he would back them in an early marriage, there would be an appreciable decrease in the amount of young manhood which is now squandered on indecency. If every employer, or the state itself, would give a clean marriage a preferred position in the social and economic scale, and, by helping to meet the cost of it, recognize in a substantial way the value to the race of a family of vigorous children, an important factor in youthful s.e.xual laxity would be robbed of its power. No one will a.s.sert that such remedial proposals are of themselves cure-alls for present evils, but they must have at least an emphatic place in the future of moral prophylaxis.

+The Teaching of s.e.xual Self-control.+--First then, make the social order such that s.e.xual self-control yields a reward and not a punishment. Second, teach s.e.xual control itself, since it is one of the fundamental means of attack on the problem of syphilis. How can such control be taught? Information about the physical dangers of illicit s.e.xual indulgence is of course of value, and should be spread broadcast.

But taken by itself, the fear of disease, especially if it enters the individual's life after the age when he has already experienced the force of his s.e.xual instincts, is a feeble influence. The person who has nothing but the knowledge that he is taking great risks between him and the gratification of his s.e.xual desires will take the risks and take them once too often. One cannot begin to teach the boy or girl of high school age that s.e.xual offenses mean physical disaster, and expect to control syphilis. The time to control the future of the s.e.xual diseases is in the toddler at the knee, the child whose daily lesson in self-control will culminate when he says the final 'No' to his pa.s.sions as a man. The child who does not learn to respect his body in the act of brus.h.i.+ng his teeth and taking his bath and exercise, and whose thought and speech and temper are unbridled by any self-restraint, will give little heed when told not to abuse his manhood by exposing himself to filth. The prevention of syphilis by s.e.xual self-control goes down to the foundations of character, and has practical value only in those whose self-control is the expression of a lifelong habit of self-discipline bred in the bone from childhood, not merely painted on the surface at p.u.b.erty. Those who want their sons and daughters never to know by personal experience the meaning of syphilis must first build a foundation in character for them which will make self-control in them instinctive, almost automatic. Knowledge of s.e.xual matters has power only in proportion to the strength of the character that wields it, and on well-rounded character education, rather than mere knowledge of the facts, the soundest results will be based.

[Ill.u.s.tration: E. ROUX

eLIE METCHNIKOFF [1845-1916]

(From McIntosh and Fildes, "Syphilis from the Modern Standpoint,"

New York, Longmans Green & Co., 1911.)]

The moral prophylaxis of syphilis is then briefly summed up in the repression of as many of the recognized agencies for the spread of the disease as possible; the making of continence a preparation for a normal s.e.x life rather than an end in itself; the control and remedying of those influences which are making normal marriage harder of attainment; and the development of an instinctive self-control and self-discipline in every field of life from childhood up as the character basis necessary to make knowledge about s.e.xual life and s.e.xual disease effective.

+Personal Preventive Methods.--Continence.+[15]--There remains to be considered what is often called the personal prophylaxis of syphilis, meaning thereby the methods by which the individual himself can diminish or escape the risk of infection. The first and most effective method of avoiding syphilis is abstinence from s.e.xual relations and intimacies except in normal marriage with a healthy person. Although it has been alluded to under the moral prophylaxis of syphilis, it deserves to be reemphasized. No consideration as to the justice or desirability of continence and self-restraint can add anything to the simple fact that it is _the_ way to avoid disease, and can be unhesitatingly recommended as the standard for personal prophylaxis. In the experience of physicians it is an axiom that disillusionment sooner or later overtakes those who think they are exempt from this rule. Persons who discard continence in favor of what they believe to be some absolutely safe indulgence are so almost invariably deceived that the exceptions are not worth considering. Although infection with syphilis is no necessary evidence of unclean living, clean living will always remain the best method of avoiding syphilis.

[15] The American Social Hygiene a.s.sociation, 105 W. 40th Street, New York City, can supply pamphlets and lists of authoritative publications bearing on this and related subjects.

+The Metchnikoff Prophylaxis.+--The second method of personal prophylaxis of syphilis was developed as a result of the discovery of Metchnikoff and Roux in 1906, that a specially prepared ointment containing a mercurial salt, if rubbed into the place on which the germs were deposited within a few hours (not exceeding eighteen hours, and the sooner the better) after exposure to the risk of syphilis, would prevent the disease by killing the germs before they could gain a foothold. This method of protection against syphilis has been subjected to rigid tests, with fairly satisfactory results. It has been adopted by the army and navy of practically every country in the world, and, as carried out under the direction of physicians and with military control of the patient, has apparently reduced the amount of syphilitic infection acquired in the armies and navies using it to a remarkable degree. The method, of course, cannot a.s.sume to be infallible, but if intelligently applied, it is one of the important weapons for the extinction of syphilis in our hands at the present day. It fails to meet expectations precisely in those circ.u.mstances and among those persons in whom intelligent employment of it cannot be expected. This of course covers a considerable number of those who acquire syphilis. What disposal an awakened opinion will make of this knowledge remains to be seen. At the present time it may well be doubted whether the indiscriminate placing of it in the hands of anybody and everybody would not work as much harm as good through ignorant and unintelligent use. This opinion is shared by European as well as American authorities. Administered under the direction of a physician, the Metchnikoff prophylaxis of syphilis would undoubtedly be at its best in the prevention of the disease. For these reasons, as well as to prevent the spread of the knowledge to those who would be damaged by it, those interested are referred to their physicians for a description of the method. Any one having the benefit of it should be able to convince his medical advisor that there is good reason why this kind of professional knowledge should be brought to bear on his case. The ordinary methods of preventing infection by washes and similar applications used by the "knowing ones" are most of them worthless or greatly inferior to the Metchnikoff prophylaxis. They are, moreover, a positive source of danger because of the false sense of security which they create. If every person who has run the risk of contracting syphilis should visit his physician _at once_ to receive prophylactic treatment, the effect on syphilis at large would probably be as good as in the army and navy. There would still be opportunity on such occasions to bring moral forces and influence to bear on those who would respond to them. There can be no object in withholding such knowledge from those who are confirmed in their irregular s.e.xual habits.

At the same time there could be few better influences thrown across the path of one just starting on a wrong track than that exerted by a physician of skill and character, to whom the individual had appealed to avert the possible disastrous result of an indiscretion.

Chapter XVI

Public Effort Against Syphilis

+The World-wide Movement Against Venereal Disease.+--This chapter is intended to give some account of the great movements now begun to control syphilis and its fellow-diseases throughout the world. A campaign of publicity was the starting-point of the organized attempt to control tuberculosis, and in the same way a similar campaign has been at the bottom of movements which now, under the pressure of the tremendous necessities of war, are making headway at a pace that generations of talking and thinking in peaceful times could not have brought about.

Although this country at the present writing is probably farther in the rear than any other great nation of the world in its efforts to control the venereal diseases as a national problem, it is fortunate in having had the way paved for it by epoch-making movements such as those of the Scandinavian countries, and by the studies of the Sydenham Royal Commission on whose findings the British Government is now undertaking the greatest single movement against syphilis and gonorrhea that has ever been launched. For many years Germany has had a society whose roll includes some of the greatest names in modern science, directing all its energy toward the solution of the problem of s.e.xual disease, and German sentiment on these matters is developing so fast that it is difficult, even for those in touch with such matters, to keep pace with it. In this country progress has been much slower, hampered by peculiarities of mental outlook and tradition very different from those which have controlled the thought of Europe. The a.s.sociation of syphilis with prost.i.tution has been largely instrumental in putting much valuable statistical and general knowledge of the disease into semi-private reports and sources not available to the large ma.s.s of the thinking public. The effect of finding the problem of syphilis invariably bound up with discussions of the social evil has been to perpetuate in popular thought an a.s.sociation which simply blocks the way to any solution of the public health problem. While the control of prost.i.tution will influence syphilis, ignoring syphilis, or treating it as incidental, will never contribute anything to the conquest of either. It is one of the most significant features of the great movements now on foot all over the world that they have finally adopted the direct route, and are attacking syphilis and gonorrhea as diseases and not by way of their a.s.sociation with prost.i.tution.

The agencies in this country which are making notable efforts to push the campaign against syphilis and gonorrhea deserve every possible support from the thinking public. The American Social Hygiene a.s.sociation is a clearing-house for trustworthy information in regard to the problems of s.e.xual disease, and publishes a quarterly journal.[16]

The National Committee for Mental Hygiene and its branch societies are also engaged in spreading knowledge of the relation of syphilis to mental disease and degeneration. State and City Boards of Health are active in their efforts to further the campaign, and notable work is being done by New York City, Buffalo, Cleveland, and Rochester, New York, both on publicity and in the provision of facilities for recognizing and treating the diseases in question. Certain states, such as Ohio, Michigan, and Vermont, have made steps toward an intelligent legislative attack on different aspects of the problem. Influential newspapers and magazines have made the idea of a campaign against these diseases familiar enough to the public, for example, to bring a young girl to me to ask outright without affectation that she be told about syphilis, because she had seen the word in the paper and did not fully understand it. The aggregate of these forces is large, and an awakening is inevitable.

[16] Social Hygiene, New York.