diseases, and if we leave freedom to the individual, we must inevitably
declare, with Duclaux, that every man or woman must be held responsible
for the diseases he or she communicates.

According to the Oldenburg Code of 1814 it was a punishable offence for a
venereally diseased person to have sexual intercourse with a healthy
person, whether or not infection resulted. In Germany to-day, however,
there is no law of this kind, although eminent German legal authorities,
notably Von Liszt, are of opinion that a paragraph should be added to the
Code declaring that sexual intercourse on the part of a person who knows
that he is diseased should be punishable by imprisonment for a period not
exceeding two years, the law not to be applied as between married couples
except on the application of one of the parties. At the present time in
Germany the transmission of venereal disease is only punishable as a
special case of the infliction of bodily injury.[246] In this matter
Germany is behind most of the Scandinavian countries where individual
responsibility for venereal infection is well recognized and actively
enforced.

In France, though the law is not definite and satisfactory, actions for
the transmission of syphilis are successfully brought before the courts.
Opinion seems to be more decisively in favor of punishment for this
offense than it is in Germany. In 1883 Després discussed the matter and
considered the objections. Few may avail themselves of the law, he
remarks, but all would be rendered more cautious by the fear of infringing
it; while the difficulties of tracing and proving infection are not
greater, he points out, than those of tracing and proving paternity in the
case of illegitimate children. Després would punish with imprisonment for
not more than two years any person, knowing himself to be diseased, who
transmitted a venereal disease, and would merely fine those who
communicated the contagion by imprudence, not realizing that they were
diseased.[247] The question has more recently been discussed by Aurientis
in a Paris thesis. He states that the present French law as regards the
transmission of sexual diseases is not clearly established and is
difficult to act upon, but it is certainly just that those who have been
contaminated and injured in this way should easily be able to obtain
reparation. Although it is admitted in principle that the communication of
syphilis is an offence even under common law he is in agreement with those
who would treat it as a special offence, making a new and more practical
law.[248] Heavy damages are even at the present time obtained in the
French courts from men who have infected young women in sexual
intercourse, and also from the doctors as well as the mothers of
syphilitic infants who have infected the foster-mothers they were
entrusted to. Although the French Penal Code forbids in general the
disclosure of professional secrets, it is the duty of the medical
practitioner to warn the foster-mother in such a case of the danger she is
incurring, but without naming the disease; if he neglects to give this
warning he may be held liable.

In England, as well as in the United States, the law is more
unsatisfactory and more helpless, in relation to this class of offences,
than it is in France. The mischievous and barbarous notion, already dealt
with, according to which venereal disease is the result of illicit
intercourse and should be tolerated as a just visitation of God, seems
still to flourish in these countries with fatal persistency. In England
the communication of venereal disease by illicit intercourse is not an
actionable wrong if the act of intercourse has been voluntary, even
although there has been wilful and intentional concealment of the disease.
_Ex turpi causâ non oritur actio_, it is sententiously said; for there is
much dormitative virtue in a Latin maxim. No legal offence has still been
committed if a husband contaminates his wife, or a wife her husband.[249]
The "freedom" enjoyed in this matter by England and the United States is
well illustrated by an American case quoted by Dr. Isidore Dyer, of New
Orleans, in his report to the Brussels Conference on the Prevention of
Venereal Diseases, in 1899: "A patient with primary syphilis refused even
charitable treatment and carried a book wherein she kept the number of men
she had inoculated. When I first saw her she declared the number had
reached two hundred and nineteen and that she would not be treated until
she had had revenge on five hundred men." In a community where the most
elementary rules of justice prevailed facilities would exist to enable
this woman to obtain damages from the man who had injured her or even to
secure his conviction to a term of imprisonment. In obtaining some
indemnity for the wrong done her, and securing the "revenge" she craved,
she would at the same time have conferred a benefit on society. She is
shut out from any action against the one person who injured her; but as a
sort of compensation she is allowed to become a radiating focus of
disease, to shorten many lives, to cause many deaths, to pile up
incalculable damages; and in so doing she is to-day perfectly within her
legal rights. A community which encourages this state of things is not
only immoral but stupid.

There seems, however, to be a growing body of influential opinion, both in
England and in the United States, in favor of making the transmission of
venereal disease an offence punishable by heavy fine or by
imprisonment.[250] In any enactment no stress should be put on the
infection being conveyed "knowingly." Any formal limitation of this kind
is unnecessary, as in such a case the Court always takes into account the
offender's ignorance or mere negligence, and it is mischievous because it
tends to render an enactment ineffective and to put a premium on
ignorance; the husbands who infect their wives with gonorrhoea
immediately after marriage have usually done so from ignorance, and it
should be at least necessary for them to prove that they have been
fortified in their ignorance by medical advice. It is sometimes said that
the existing law could be utilized for bringing actions of this kind, and
that no greater facilities should be offered for fear of increasing
attempts at blackmail. The inutility of the law at present for this
purpose is shown by the fact that it seldom or never happens that any
attempt is made to utilize it, while not only are there a number of
existing punishable offences which form the subject of attempts at
blackmail, but blackmail can still be demanded even in regard to
disreputable actions that are not legally punishable at all. Moreover, the
attempt to levy blackmail is itself an offence always sternly dealt with
in the courts.

It is possible to trace the beginning of a recognition that the
transmission of a venereal disease is a matter of which legal cognizance
may be taken in the English law courts. It is now well settled that the
infection of a wife by her husband may be held to constitute the legal
cruelty which, according to the present law, must be proved, in addition
to adultery, before a wife can obtain divorce from her husband. In 1777
Restif de la Bretonne proposed in his _Gynographes_ that the communication
of a venereal disease should itself be an adequate ground for divorce;
this, however, is not at present generally accepted.[251]

It is sometimes said that it is very well to make the individual legally
responsible for the venereal disease he communicates, but that the
difficulties of bringing that responsibility home would still remain. And
those who admit these difficulties frequently reply that at the worst we
should have in our hands a means of educating responsibility; the man who
deliberately ran the risk of transmitting such infection would be made to
feel that he was no longer fairly within his legal rights but had done a
bad action. We are thus led on finally to what is now becoming generally
recognized as the chief and central method of combating venereal disease,
if we are to accept the principle of individual responsibility as ruling
in this sphere of life. Organized sanitary and medical precautions, and
proper legal protection for those who have been injured, are inoperative
without the educative influence of elementary hygienic instruction placed
in the possession of every young man and woman. In a sphere that is
necessarily so intimate medical organization and legal resort can never be
all-sufficing; knowledge is needed at every step in every individual to
guide and even to awaken that sense of personal moral responsibility which
must here always rule. Wherever the importance of these questions is
becoming acutely realized--and notably at the Congresses of the German
Society for Combating Venereal Disease--the problem is resolving itself
mainly into one of education.[252] And although opinion and practice in
this matter are to-day more advanced in Germany than elsewhere the
conviction of this necessity is becoming scarcely less pronounced in all
other civilized countries, in England and America as much as in France and
the Scandinavian lands.

A knowledge of the risks of disease by sexual intercourse, both in and out
of marriage,--and indeed, apart from sexual intercourse altogether,--is a
further stage of that sexual education which, as we have already seen,
must begin, so far as the elements are concerned, at a very early age.
Youths and girls should be taught, as the distinguished Austrian
economist, Anton von Menger wrote, shortly before his death, in his
excellent little book, _Neue Sittenlehre_, that the production of children
is a crime when the parents are syphilitic or otherwise incompetent
through transmissible chronic diseases. Information about venereal disease
should not indeed be given until after puberty is well established. It is
unnecessary and undesirable to impart medical knowledge to young boys and
girls and to warn them against risks they are yet little liable to be
exposed to. It is when the age of strong sexual instinct, actual or
potential, begins that the risks, under some circumstances, of yielding to
it, need to be clearly present to the mind. No one who reflects on the
actual facts of life ought to doubt that it is in the highest degree
desirable that every adolescent youth and girl ought to receive some
elementary instruction in the general facts of venereal disease,
tuberculosis, and alcoholism. These three "plagues of civilization" are so
widespread, so subtle and manifold in their operation, that everyone comes
in contact with them during life, and that everyone is liable to suffer,
even before he is aware, perhaps hopelessly and forever, from the results
of that contact. Vague declamation about immorality and vaguer warnings
against it have no effect and possess no meaning, while rhetorical
exaggeration is unnecessary. A very simple and concise statement of the
actual facts concerning the evils that beset life is quite sufficient and
adequate, and quite essential. To ignore this need is only possible to
those who take a dangerously frivolous view of life.

It is the young woman as much as the youth who needs this enlightenment.
There are still some persons so ill-informed as to believe that though it
may be necessary to instruct the youth it is best to leave his sister
unsullied, as they consider it, by a knowledge of the facts of life. This
is the very reverse of the truth. It is desirable indeed that all should
be acquainted with facts so vital to humanity, even although not
themselves personally concerned. But the girl is even more concerned than
the youth. A man has the matter more within his own grasp, and if he so
chooses he may avoid all the grosser risks of contact with venereal
disease. But it is not so with the woman. Whatever her own purity, she
cannot be sure that she may not have to guard against the possibility of
disease in her future husband as well as in those to whom she may entrust
her child. It is a possibility which the educated woman, so far from
being dispensed from, is more liable to encounter than is the
working-class woman, for venereal disease is less prevalent among the poor
than the rich.[253] The careful physician, even when his patient is a
minister of religion, considers it his duty to inquire if he has had
syphilis, and the clergyman of most severely correct life recognizes the
need of such inquiry and may perhaps smile, but seldom feels himself
insulted. The relationship between husband and wife is even much more
intimate and important than that between doctor and patient, and a woman
is not dispensed from the necessity of such inquiry concerning her future
husband by the conviction that the reply must surely be satisfactory.
Moreover, it may well be in some cases that, if she is adequately
enlightened, she may be the means of saving him, before it is too late,
from the guilt of premature marriage and its fateful consequences, so
deserving to earn his everlasting gratitude. Even if she fails in winning
that, she still has her duty to herself and to the future race which her
children will help to form.

In most countries there is a growing feeling in favor of the
enlightenment of young women equally with young men as regards
venereal diseases. Thus in Germany Max Flesch, in his
_Prostitution und Frauenkrankheiten_, considers that at the end
of their school days all girls should receive instruction
concerning the grave physical and social dangers to which women
are exposed in life. In France Duclaux (in his _L'Hygiène
Sociale_) is emphatic that women must be taught. "Already," he
states, "doctors who by custom have been made, in spite of
themselves, the husband's accomplices, will tell you of the
ironical gaze they sometimes encounter when they seek to lead a
wife astray concerning the causes of her ills. The day is
approaching of a revolt against the social lie which has made so
many victims, and you will be obliged to teach women what they
need to know in order to guard themselves against you." It is the
same in America. Reform in this field, Isidore Dyer declares,
must emblazon on its flag the motto, "Knowledge is Health," as
well of mind as of body, for women as well as for men. In a
discussion introduced by Denslow Lewis at the annual meeting of
the American Medical Association in 1901 on the limitation of
venereal diseases (_Medico-Legal Journal_, June and September,
1903), there was a fairly general agreement among all the
speakers that almost or quite the chief method of prevention lay
in education, the education of women as much as of men.
"Education lies at the bottom of the whole thing," declared one
speaker (Seneca Egbert, of Philadelphia), "and we will never gain
much headway until every young man, and every young woman, even
before she falls in love and becomes engaged, knows what these
diseases are, and what it will mean if she marries a man who has
contracted them." "Educate father and mother, and they will
educate their sons and daughters," exclaims Egbert Grandin, more
especially in regard to gonorrhoea (_Medical Record_, May 26,
1906); "I lay stress on the daughter because she becomes the
chief sufferer from inoculation, and it is her right to know that
she should protect herself against the gonorrhoeic as well as
against the alcoholic."

We must fully face the fact that it is the woman herself who must be
accounted responsible, as much as a man, for securing the right conditions
of a marriage she proposes to enter into. In practice, at the outset, that
responsibility may no doubt be in part delegated to parents or guardians.
It is unreasonable that any false delicacy should be felt about this
matter on either side. Questions of money and of income are discussed
before marriage, and as public opinion grows sounder none will question
the necessity of discussing the still more serious question of health,
alike that of the prospective bridegroom and of the bride. An incalculable
amount of disease and marital unhappiness would be prevented if before an
engagement was finally concluded each party placed himself or herself in
the hands of a physician and authorized him to report to the other party.
Such a report would extend far beyond venereal disease. If its necessity
became generally recognized it would put an end to much fraud which now
takes place when entering the marriage bond. It constantly happens at
present that one party or the other conceals the existence of some serious
disease or disability which is speedily discovered after marriage,
sometimes with a painful and alarming shock--as when a man discovers his
wife in an epileptic fit on the wedding night--and always with the bitter
and abiding sense of having been duped. There can be no reasonable doubt
that such concealment is an adequate cause of divorce. Sir Thomas More
doubtless sought to guard against such frauds when he ordained in his
_Utopia_ that each party should before marriage be shown naked to the
other. The quaint ceremony he describes was based on a reasonable idea,
for it is ludicrous, if it were not often tragic in its results, that any
person should be asked to undertake to embrace for life a person whom he
or she has not so much as seen.

It may be necessary to point out that every movement in this direction
must be the spontaneous action of individuals directing their own lives
according to the rules of an enlightened conscience, and cannot be
initiated by the dictation of the community as a whole enforcing its
commands by law. In these matters law can only come in at the end, not at
the beginning. In the essential matters of marriage and procreation laws
are primarily made in the brains and consciences of individuals for their
own guidance. Unless such laws are already embodied in the actual practice
of the great majority of the community it is useless for parliaments to
enact them by statute. They will be ineffective or else they will be worse
than ineffective by producing undesigned mischiefs. We can only go to the
root of the matter by insisting on education in moral responsibility and
instruction, in matters of fact.

The question arises as to the best person to impart this instruction. As
we have seen there can be little doubt that before puberty the parents,
and especially the mother, are the proper instructors of their children in
esoteric knowledge. But after puberty the case is altered. The boy and the
girl are becoming less amenable to parental influence, there is greater
shyness on both sides, and the parents rarely possess the more technical
knowledge that is now required. At this stage it seems that the assistance
of the physician, of the family doctor if he has the proper qualities for
the task, should be called in. The plan usually adopted, and now widely
carried out, is that of lectures setting forth the main facts concerning
venereal diseases, their dangers, and allied topics.[254] This method is
quite excellent. Such lectures should be delivered at intervals by medical
lecturers at all urban, educational, manufacturing, military, and naval
centres, wherever indeed a large number of young persons are gathered
together. It should be the business of the central educational authority
either to carry them out or to enforce on those controlling or employing
young persons the duty of providing such lectures. The lectures should be
free to all who have attained the age of sixteen.

In Germany the principle of instruction by lectures concerning
venereal diseases seems to have become established, at all events
so far as young men are concerned, and such lectures are
constantly becoming more usual. In 1907 the Minister of Education
established courses of lectures by doctors on sexual hygiene and
venereal diseases for higher schools and educational
institutions, though attendance was not made compulsory. The
courses now frequently given by medical men to the higher classes
in German secondary schools on the general principles of sexual
anatomy and physiology nearly always include sexual hygiene with
special reference to venereal diseases (see, e.g.,
_Sexualpädagogik_, pp. 131-153). In Austria, also, lectures on
personal hygiene and the dangers of venereal disease are
delivered to students about to leave the gymnasium for the
university; and the working men's clubs have instituted regular
courses of lectures on the same subjects delivered by physicians.
In France many distinguished men, both inside and outside the
medical profession, are working for the cause of the instruction
of the young in sexual hygiene, though they have to contend
against a more obstinate degree of prejudice and prudery on the
part of the middle class than is to be found in the Germanic
lands. The Commission Extraparlementaire du Régime des Moeurs,
with the conjunction of Augagneur, Alfred Fournier, Yves Guyot,
Gide, and other distinguished professors, teachers, etc., has
lately pronounced in favor of the official establishment of
instruction in sexual hygiene, to be given in the highest classes
at the lycées, or in the earliest class at higher educational
colleges; such instruction, it is argued, would not only furnish
needed enlightenment, but also educate the sense of moral
responsibility. There is in France, also, an active and
distinguished though unofficial Société Française de Prophylaxie
Sanitaire et Morale, which delivers public lectures on sexual
hygiene. Fournier, Pinard, Burlureaux and other eminent
physicians have written pamphlets on this subject for popular
distribution (see, e.g., _Le Progrès Médical_ of September,
1907). In England and the United States very little has yet been
done in this direction, but in the United States, at all events,
opinion in favor of action is rapidly growing (see, e.g., W.A.
Funk, "The Venereal Peril," _Medical Record_, April 13, 1907).
The American Society of Sanitary and Moral Prophylaxis (based on
the parent society founded in Paris in 1900 by Fournier) was
established in New York in 1905. There are similar societies in
Chicago and Philadelphia. The main object is to study venereal
diseases and to work toward their social control. Doctors,
laymen, and women are members. Lectures and short talks are now
given under the auspices of these societies to small groups of
young women in social settlements, and in other ways, with
encouraging success; it is found to be an excellent method of
reaching the young women of the working classes. Both men and
women physicians take part in the lectures (Clement Cleveland,
Presidential Address on "Prophylaxis of Venereal Diseases,"
_Transactions American Gynecological Society_, Philadelphia, vol.
xxxii, 1907).

An important auxiliary method of carrying out the task of sexual
hygiene, and at the same time of spreading useful enlightenment,
is furnished by the method of giving to every syphilitic patient
in clinics where such cases are treated a card of instruction for
his guidance in hygienic matters, together with a warning of the
risks of marriage within four or five years after infection, and
in no case without medical advice. Such printed instruction, in
clear, simple, and incisive language, should be put into the
hands of every syphilitic patient as a matter of routine, and it
might be as well to have a corresponding card for gonorrhoeal
patients. This plan has already been introduced at some
hospitals, and it is so simple and unobjectionable a precaution
that it will, no doubt, be generally adopted. In some countries
this measure is carried out on a wider scale. Thus in Austria, as
the result of a movement in which several university professors
have taken an active part, leaflets and circulars, explaining
briefly the chief symptoms of venereal diseases and warning
against quacks and secret remedies, are circulated among young
laborers and factory hands, matriculating students, and scholars
who are leaving trade schools.

In France, where great social questions are sometimes faced with
a more chivalrous daring than elsewhere, the dangers of syphilis,
and the social position of the prostitute, have alike been dealt
with by distinguished novelists and dramatists. Huysmans
inaugurated this movement with his first novel, _Marthe_, which
was immediately suppressed by the police. Shortly afterwards
Edmond de Goncourt published _La Fille Elisa_, the first notable
novel of the kind by a distinguished author. It was written with
much reticence, and was not indeed a work of high artistic
value, but it boldly faced a great social problem and clearly set
forth the evils of the common attitude towards prostitution. It
was dramatized and played by Antoine at the Théâtre Libre, but
when, in 1891, Antoine wished to produce it at the
Porte-Saint-Martin Theatre, the censor interfered and prohibited
the play on account of its "contexture générale." The Minister of
Education defended this decision on the ground that there was
much in the play that might arouse repugnance and disgust.
"Repugnance here is more moral than attraction," exclaimed M.
Paul Déroulède, and the newspapers criticized a censure which
permitted on the stage all the trivial indecencies which favor
prostitution, but cannot tolerate any attack on prostitution. In
more recent years the brothers Margueritte, both in novels and in
journalism, have largely devoted their distinguished abilities
and high literary skill to the courageous and enlightened
advocacy of many social reforms. Victor Margueritte, in his
_Prostituée_ (1907)--a novel which has attracted wide attention
and been translated into various languages--has sought to
represent the condition of women in our actual society, and more
especially the condition of the prostitute under what he regards
as the odious and iniquitous system still prevailing. The book is
a faithful picture of the real facts, thanks to the assistance
the author received from the Paris Préfecture of Police, and
largely for that reason is not altogether a satisfactory work of
art, but it vividly and poignantly represents the cruelty,
indifference, and hypocrisy so often shown by men towards women,
and is a book which, on that account, cannot be too widely read.
One of the most notable of modern plays is Brieux's _Les Avariés_
(1902). This distinguished dramatist, himself a medical man,
dedicates his play to Fournier, the greatest of syphilographers.
"I think with you," he writes here, "that syphilis will lose much
of its danger when it is possible to speak openly of an evil
which is neither a shame nor a punishment, and when those who
suffer from it, knowing what evils they may propagate, will
better understand their duties towards others and towards
themselves." The story developed in the drama is the old and
typical story of the young man who has spent his bachelor days in
what he considers a discrete and regular manner, having only had
two mistresses, neither of them prostitutes, but at the end of
this period, at a gay supper at which he bids farewell to his
bachelor life, he commits a fatal indiscretion and becomes
infected by syphilis; his marriage is approaching and he goes to
a distinguished specialist who warns him that treatment takes
time, and that marriage is impossible for several years; he finds
a quack, however, who undertakes to cure him in six months; at
the end of the time he marries; a syphilitic child is born; the
wife discovers the state of things and forsakes her home to
return to her parents; her indignant father, a deputy in
Parliament, arrives in Paris; the last word is with the great
specialist who brings finally some degree of peace and hope into
the family. The chief morals Brieux points out are that it is the
duty of the bride's parents before marriage to ascertain the
bridegroom's health; that the bridegroom should have a doctor's
certificate; that at every marriage the part of the doctors is at
least as important as that of the lawyers. Even if it were a less
accomplished work of art than it is, _Les Avariés_ is a play
which, from the social and educative point of view alone, all who
have reached the age of adolescence should be compelled to see.

Another aspect of the same problem has been presented in _Plus
Fort que le Mal_, a book written in dramatic form (though not as
a properly constituted play intended for the stage) by a
distinguished French medical author who here adopts the name of
Espy de Metz. The author (who is not, however, pleading _pro
domo_) calls for a more sympathetic attitude towards those who
suffer from syphilis, and though he writes with much less
dramatic skill than Brieux, and scarcely presents his moral in so
unequivocal a form, his work is a notable contribution to the
dramatic literature of syphilis.

It will probably be some time before these questions, poignant as
they are from the dramatic point of view, and vitally important
from the social point of view, are introduced on the English or
the American stage. It is a remarkable fact that, notwithstanding
the Puritanic elements which still exist in Anglo-Saxon thought
and feeling generally, the Puritanic aspect of life has never
received embodiment in the English or American drama. On the
English stage it is never permitted to hint at the tragic side of
wantonness; vice must always be made seductive, even though a
_deus ex machina_ causes it to collapse at the end of the
performance. As Mr. Bernard Shaw has said, the English theatrical
method by no means banishes vice; it merely consents that it
shall be made attractive; its charms are advertised and its
penalties suppressed. "Now, it is futile to plead that the stage
is not the proper place for the representation and discussion of
illegal operations, incest, and venereal disease. If the stage is
the proper place for the exhibition and discussion of seduction,
adultery, promiscuity, and prostitution, it must be thrown open
to all the consequences of these things, or it will demoralize
the nation."

The impulse to insist that vice shall always be made attractive
is not really, notwithstanding appearances, a vicious impulse. It
arises from a mental confusion, a common psychic tendency, which
is by no means confined to Anglo-Saxon lands, and is even more
well marked among the better educated in the merely literary
sense, than among the worse educated people. The æsthetic is
confused with the moral, and what arouses disgust is thus
regarded as immoral. In France the novels of Zola, the most
pedestrianally moralistic of writers, were for a long time
supposed to be immoral because they were often disgusting. The
same feeling is still more widespread in England. If a
prostitute is brought on the stage, and she is pretty,
well-dressed, seductive, she may gaily sail through the play and
every one is satisfied. But if she were not particularly pretty,
well-dressed, or seductive, if it were made plain that she was
diseased and was reckless in infecting others with that disease,
if it were hinted that she could on occasion be foul-mouthed, if,
in short, a picture were shown from life--then we should hear
that the unfortunate dramatist had committed something that was
"disgusting" and "immoral." Disgusting it might be, but, on that
very account, it would be moral. There is a distinction here that
the psychologist cannot too often point out or the moralist too
often emphasize.

It is not for the physician to complicate and confuse his own task as
teacher by mixing it up with considerations which belong to the spiritual
sphere. But in carrying out impartially his own special work of
enlightenment he will always do well to remember that there is in the
adolescent mind, as it has been necessary to point out in a previous
chapter, a spontaneous force working on the side of sexual hygiene. Those
who believe that the adolescent mind is merely bent on sensual indulgence
are not less false and mischievous in their influence than are those who
think it possible and desirable for adolescents to be preserved in sheer
sexual ignorance. However concealed, suppressed, or deformed--usually by
the misplaced and premature zeal of foolish parents and teachers--there
arise at puberty ideal impulses which, even though they may be rooted in
sex, yet in their scope transcend sex. These are capable of becoming far
more potent guides of the physical sex impulse than are merely material or
even hygienic considerations.

It is time to summarize and conclude this discussion of the prevention of
venereal disease, which, though it may seem to the superficial observer to
be merely a medical and sanitary question outside the psychologist's
sphere, is yet seen on closer view to be intimately related even to the
most spiritual conception of the sexual relationships. Not only are
venereal diseases the foes to the finer development of the race, but we
cannot attain to any wholesome and beautiful vision of the relationships
of sex so long as such relationships are liable at every moment to be
corrupted and undermined at their source. We cannot yet precisely measure
the interval which must elapse before, so far as Europe at least is
concerned, syphilis and gonorrhoea are sent to that limbo of monstrous old
dead diseases to which plague and leprosy have gone and smallpox is
already drawing near. But society is beginning to realize that into this
field also must be brought the weapons of light and air, the sword and the
breastplate with which all diseases can alone be attacked. As we have
seen, there are four methods by which in the more enlightened countries
venereal disease is now beginning to be combated.[255] (1) By proclaiming
openly that the venereal diseases are diseases like any other disease,
although more subtle and terrible than most, which may attack anyone from
the unborn baby to its grandmother, and that they are not, more than other
diseases, the shameful penalties of sin, from which relief is only to be
sought, if at all, by stealth, but human calamities; (2) by adopting
methods of securing official information concerning the extent,
distribution, and variation of venereal disease, through the already
recognized plan of notification and otherwise, and by providing such
facilities for treatment, especially for free treatment, as may be found
necessary; (3) by training the individual sense of moral responsibility,
so that every member of the community may realize that to inflict a
serious disease on another person, even only as a result of reckless
negligence, is a more serious offence than if he or she had used the knife
or the gun or poison as the method of attack, and that it is necessary to
introduce special legal provision in every country to assist the recovery
of damages for such injuries and to inflict penalties by loss of liberty
or otherwise; (4) by the spread of hygienic knowledge, so that all
adolescents, youths and girls alike, may be furnished at the outset of
adult life with an equipment of information which will assist them to
avoid the grosser risks of contamination and enable them to recognize and
avoid danger at the earliest stages.

A few years ago, when no method of combating venereal disease was known
except that system of police regulation which is now in its decadence, it
would have been impossible to bring forward such considerations as these;
they would have seemed Utopian. To-day they are not only recognizable as
practical, but they are being actually put into practice, although, it is
true, with very varying energy and insight in different countries. Yet it
is certain that in the competition of nationalities, as Max von Niessen
has well said, "that country will best take a leading place in the march
of civilization which has the foresight and courage to introduce and carry
through those practical movements of sexual hygiene which have so wide and
significant a bearing on its own future, and that of the human race
generally."[256]


FOOTNOTES:

[220] It is probable that Schopenhauer felt a more than merely speculative
interest in this matter. Bloch has shown good reason for believing that
Schopenhauer himself contracted syphilis in 1813, and that this was a
factor in constituting his conception of the world and in confirming his
constitutional pessimism (_Medizinische Klinik_, Nos. 25 and 26, 1906).

[221] Havelburg, in Senator and Kaminer, _Health and Disease in Relation
to Marriage_, vol. i, pp. 186-189.

[222] This is the very definite opinion of Lowndes after an experience of
fifty-four years in the treatment of venereal diseases in Liverpool
(_British Medical Journal_, Feb. 9, 1907, p. 334). It is further indicated
by the fact (if it is a real fact) that since 1876 there has been a
decline of both the infantile and general mortality from syphilis in
England.

[223] "There is no doubt whatever that syphilis is on the increase in
London, judging from hospital work alone," says Pernet (_British Medical
Journal_, March 30, 1907). Syphilis was evidently very prevalent, however,
a century or two ago, and there is no ground for asserting positively that
it is more prevalent to-day.

[224] See, e.g., A. Neisser, _Die experimentelle Syphilisforschung_, 1906,
and E. Hoffmann (who was associated with Schaudinn's discovery), _Die
Aetiologie der Syphilis_, 1906; D'Arcy Power, _A System of Syphilis_,
1908, etc.; F.W. Mott, "Pathology of Syphilis in the Light of Modern
Research," _British Medical Journal_, February 20, 1909; also, _Archives
of Neurology and Psychiatry_, vol. iv, 1909.

[225] There is some difference of opinion on this point, and though it
seems probable that early and thorough treatment usually cures the disease
in a few years and renders further complications highly improbable, it is
not possible, even under the most favorable circumstances, to speak with
absolute certainty as to the future.

[226] "That syphilis has been, and is, one of the chief causes of physical
degeneration in England cannot be denied, and it is a fact that is
acknowledged on all sides," writes Lieutenant-Colonel Lambkin, the medical
officer in command of the London Military Hospital for Venereal Diseases.
"To grapple with the treatment of syphilis among the civil population of
England ought to be the chief object of those interested in that most
burning question, the physical degeneration of our race" (_British Medical
Journal_, August 19, 1905).

[227] F.W. Mott, "Syphilis as a Cause of Insanity," _British Medical
Journal_, October 18, 1902.

[228] It can seldom be proved in more than eighty per cent. of cases, but
in twenty per cent. of old syphilitic cases it is commonly impossible to
find traces of the disease or to obtain a history of it. Crocker found
that it was only in eighty per cent. of cases of absolutely certain
syphilitic skin diseases that he could obtain a history of syphilitic
infection, and Mott found exactly the same percentage in absolutely
certain syphilitic lesions of the brain; Mott believes (e.g., "Syphilis in
Relation to the Nervous System," _British Medical Journal_, January 4,
1908) that syphilis is the essential cause of general paralysis and tabes.

[229] Audry. _La Semaine Médicale_, June 26, 1907. When Europeans carry
syphilis to lands inhabited by people of lower race, the results are often
very much worse than this. Thus Lambkin, as a result of a special mission
to investigate syphilis in Uganda, found that in some districts as many as
ninety per cent, of the people suffer from syphilis, and fifty to sixty
per cent, of the infant mortality is due to this cause. These people are
Baganda, a highly intelligent, powerful, and well-organized tribe before
they received, in the gift of syphilis, the full benefit of civilization
and Christianity, which (Lambkin points out) has been largely the cause of
the spread of the disease by breaking down social customs and emancipating
the women. Christianity is powerful enough to break down the old morality,
but not powerful enough to build up a new morality (_British Medical
Journal_, October 3, 1908, p. 1037).

[230] Even within the limits of the English army it is found In India
(H.C. French, _Syphilis in the Army_, 1907) that venereal disease is ten
times more frequent among British troops than among Native troops. Outside
of national armies it is found, by admission to hospital and death rates,
that the United States stands far away at the head for frequency of
venereal disease, being followed by Great Britain, then France and
Austria-Hungary, Russia, and Germany.

[231] There is no dispute concerning the antiquity of gonorrhoea in the
Old World as there is regarding syphilis. The disease was certainly known
at a very remote period. Even Esarhaddon, the famous King of Assyria,
referred to in the Old Testament, was treated by the priests for a
disorder which, as described in the cuneiform documents of the time, could
only have been gonorrhoea. The disease was also well known to the ancient
Egyptians, and evidently common, for they recorded many prescriptions for
its treatment (Oefele, "Gonorrhoe 1350 vor Christi Geburt," _Monatshefte
für Praktische Dermatologie_, 1899, p. 260).

[232] Cf. Memorandum by Sydney Stephenson, Report of Ophthalmia Neonatorum
Committee, _British Medical Journal_, May 8, 1909.

[233] The extent of these evils is set forth, e.g., in a comprehensive
essay by Taylor, _American Journal Obstetrics_, January, 1908.

[234] Neisser brings together figures bearing on the prevalence of
gonorrhoea in Germany, Senator and Kaminer, _Health and Disease in
Relation to Marriage_, vol. ii, pp. 486-492.

[235] _Lancet_, September 23, 1882. As regards women, Dr. Frances Ivens
(_British Medical Journal_, June 19, 1909) has found at Liverpool that 14
per cent. of gynæcological cases revealed the presence of gonorrhoea. They
were mostly poor respectable married women. This is probably a high
proportion, as Liverpool is a busy seaport, but it is less than Sänger's
estimate of 18 per cent.

[236] E.H. Grandin, _Medical Record_, May 26, 1906.

[237] E.W. Cushing, "Sociological Aspects of Gonorrhoea," _Transactions
American Gynecological Society_, vol. xxii, 1897.

[238] It is only in very small communities ruled by an autocratic power
with absolute authority to control conditions and to examine persons of
both sexes that reglementation becomes in any degree effectual. This is
well shown by Dr. W.E. Harwood, who describes the system he organized in
the mines of the Minnesota Iron Company (_Journal American Medical
Association_, December 22, 1906). The women in the brothels on the
company's estate were of the lowest class, and disease was very prevalent.
Careful examination of the women was established, and control of the men,
who, immediately on becoming diseased, were bound to declare by what woman
they had been infected. The woman was responsible for the medical bill of
the man she infected, and even for his board, if incapacitated, and the
women were compelled to maintain a fund for their own hospital expenses
when required. In this way venereal disease, though not entirely uprooted,
was very greatly diminished.

[239] A clear and comprehensive statement of the present position of the
question is given by Iwan Bloch, _Das Sexualleben Unserer Zeit_, Chs.
XIII-XV. How ineffectual the system of police regulation is, even in
Germany, where police interference is tolerated to so marked a degree, may
be illustrated by the case of Mannheim. Here the regulation of
prostitution is very severe and thorough, yet a careful inquiry in 1905
among the doctors of Mannheim (ninety-two of whom sent in detailed
returns) showed that of six hundred cases of venereal disease in men,
nearly half had been contracted from prostitutes. About half the remaining
cases (nearly a quarter of the whole) were due to waitresses and
bar-maids; then followed servant-girls (Lion and Loeb, in
_Sexualpädagogik_, the Proceedings of the Third German Congress for
Combating Venereal Diseases, 1907, p. 295).

[240] A sixth less numerous class might be added of the young girls, often
no more than children, who have been practically raped by men who believe
that intercourse with a virgin is a cure for obstinate venereal disease.
In America this belief is frequently held by Italians, Chinese, negroes,
etc. W. Travis Gibb, Examining Physician of the New York Society for the
Prevention of Cruelty to Children, has examined over 900 raped children
(only a small proportion, he states, of the cases actually occurring), and
finds that thirteen per cent have venereal diseases. A fairly large
proportion of these cases, among girls from twelve to sixteen, are, he
states, willing victims. Dr. Flora Pollack, also, of the Johns Hopkins
Hospital Dispensary, estimates that in Baltimore alone from 800 to 1,000
children between the ages of one and fifteen are venereally infected every
year. The largest number, she finds, is at the age of six, and the chief
cause appears to be, not lust, but superstition.

[241] For a discussion of inherited syphilis, see, e.g., Clement Lucas,
_Lancet_, February 1, 1908.

[242] Much harm has been done in some countries by the foolish and
mischievous practice of friendly societies and sick clubs of ignoring
venereal diseases, and not according free medical aid or sick pay to those
members who suffer from them. This practice prevailed, for instance, in
Vienna until 1907, when a more humane and enlightened policy was
inaugurated, venereal diseases being placed on the same level as other
diseases.

[243] Active measures against venereal disease were introduced in Sweden
early in the last century, and compulsory and gratuitous treatment
established. Compulsory notification was introduced many years ago in
Norway, and by 1907 there was a great diminution in the prevalence of
venereal diseases; there is compulsory treatment.

[244] See, e.g., Morrow, _Social Diseases and Marriage_, Ch. XXXVII.

[245] A committee of the Medical Society of New York, appointed in 1902 to
consider this question, reported in favor of notification without giving
names and addresses, and Dr. C.R. Drysdale, who took an active part in the
Brussels International Conference of 1899, advocated a similar plan in
England, _British Medical Journal_, February 3, 1900.

[246] Thus in Munich, in 1908, a man who had given gonorrhoea to a
servant-girl was sent to prison for ten months on this ground. The state
of German opinion to-day on this subject is summarized by Bloch,