Prevention Of Venereal Diseases
( Originally Published Early 1900's )
Cholera and the bubonic plague have been virtually eliminated from Western civilization. Yellow fever has been almost completely wiped out in Havana, in the Panama Canal Zone, and in other districts. The ravages of small-pox have been reduced, not through vaccination but through sanitation, until it is now exceedingly rare. And so with many other infections. It seems therefore, that it ought to be possible to control venereal disease, partly at least. Even if it cannot be stamped out, yet it would be a great achievement to so reduce the number of cases that there would be only five thousand syphilitics in the United States instead of five millions, though of course that would be five thousand too many.
But can such an improvement be brought about? So long as we have prostitution we shall also have venereal disease, and most of those who have studied the problem deeply are not very hopeful about the possibility of ever doing away with prostitution. This evil has existed ever since the beginning of civilization, and may possibly continue to exist in spite of all the best-laid plans of all types of reformers—and unfortunately most reformers make no attempt to go to the root of the evil. It is true that through an extensive campaign of education along the line of prophylaxis, the amount of infection incidental to prostitution might be greatly lessened, but it would be a practical impossibility to force all prostitutes to practice such prophylaxis, even granted that one could perfectly protect oneself in that way. Also, the clandestine prostitute could not be subjected to sanitary control, and so long as she exists she will always be the highly dangerous source of infection that she is to-day.
It is high time for our departments of health to show some activity in dealing with this form of disease. It is not sufficient to maintain dispensaries in which the victims may receive "treatment." Prevention is the important thing. Some day, after all the rest of the world has been aroused upon the subject, our departments of health may finally become interested. When that time comes every case of venereal disease will be quarantined just as other infectious and contagious diseases are quarantined. Of course, there are certain obstacles in the way of such a program, as for instance, the likelihood that many sufferers would conceal their ailment and even go without treatment rather than be reported and quarantined. But it must come some day, in spite of all difficulties. Meantime our chief means of prevention lies in reducing prostitution to a minimum.
Vice commissions in various great cities have recently given a great deal of study to the subject, as have social workers, physicians and sociologists generally. So far, they have not accomplished much. Questions of regulation, registration, examination and license have been much discussed, but the prevalent opinion among these investigators is that regulation and registration are not successful. There are many, how-ever, who still advocate these measures as tending to lessen the amount of infection. My own opinion is that we can accomplish very little by medical examination of the prostitutes at intervals, if we do not at the same time examine all of their male visitors as well. And this is never even considered. Furthermore, it is impossible to register those who ply their trade clandestinely.
There are some factors in this problem that are not usually taken into consideration by the vice commissions and most writers on the subject. The first of these undoubtedly is prudery, with the ignorance resulting therefrom. The second is bachelorhood, with its pretense of celibacy and actual promiscuity, in many cases. The third, and most important of all, is alcohol. Improperly conducted restaurants, theatres, dance-halls and other institutions of that nature are largely incidental.
Ignorance is always a source of danger, particularly in this matter, and it is entirely the result of prudery. If only the world would face this problem honestly and squarely, instead of shutting its eyes to it and keeping it in the dark, under cover, much of the danger would disappear and the harm done would be minimized. Think of the criminal folly of turning our young people loose in the world without knowledge of the most serious of all dangers that they will surely have to face. I know that there has been much objection to the teaching of sex hygiene to young people on the ground that knowledge is not always sufficient to restrain them from wrong-doing. This is undoubtedly true, but at the same time knowledge is safer than ignorance and if it did not save all of our young people, it would save most of them. A large percentage of venereal infections occurs among young men under the age of twenty-one.
It is true that there are many men who know that they are practically certain to contract what they familiarly call "the clap," but most of them are entirely ignorant of the terribly serious and dangerous character of this disease, for have they not been told with terrible untruth, that it is a trifling matter, "no worse than a cold"? Even here, where they possess a little knowledge it is really ignorance that makes them foolishly eager to take the life-damning risk. Some men, we must admit, would not be restrained by any consideration, even by the risk of life itself yet there is no question that a large number, probably the large majority, would not dare to take chances if they truly knew what they were exposing them-selves to. And up to the present time the prevailing policy has been to keep the young people in as nearly absolute ignorance upon the subject as possible. An extended campaign of public education along this line is the first requirement. And if we could entirely do away with prudery, so that the subject could be discussed honestly and freely, it would be possible very soon to develop other methods of fighting the evil of prostitution.
I have mentioned bachelorhood as a factor in this problem. What can we expect to do with the social evil so long as nearly one-third of the men of marriageable age in the country are unmarried? This means millions of men who are pretending to live celibate lives, but who are actually living immoral lives. It is foolish for us to, continue to shut our eyes to this fact. It does not solve the problem to say merely that these men ought to remain continent if they are not married. A few of them do so. But the fact—the hard, cold, relentless fact is that the majority of them find a substitute for marriage, either prostitution, or in the degradation of young women who serve first as mistresses only to join the ranks of the prostitutes later.
It is often said that prostitution is maintained in large part by married men. Unfortunately there is a certain amount of truth in this statement. I believe, however, that the percentage of married men among the patrons of the houses of ill-fame has been greatly exaggerated. The majority of married men live a decent life. When they do visit the brothel, I am convinced that it is usually because they have formed the habit of so doing before marriage. If they had married earlier they might never have fallen into the habit. The man who has not been accustomed to such a life will not be likely to commence it after marriage. The more general practice of fairly early marriage, therefore, would go a long way toward reducing the social evil.
The alcohol question in its relation to venereal disease is important whether we consider it as a public one, relating to legal prohibition or restriction, or as a private matter, relating to the habits of the individual. The fact is that the saloon and the brothel are never very far apart. Alcohol and sexual debauchery commonly go together. I have already referred to this relationship of the two evils in a previous chapter, on "Sowing Wild Oats," showing that most girls "go wrong" in the first instance when under the influence of liquor, and that most young men also "go wrong" in the same way. No man who has any respect for himself can afford to drink, if only for this reason. He should understand what drinking so often leads to. Not only is an intoxicated man more nearly certain to contract a venereal disease, when exposed to it, than a man who is sober, for various self-evident reasons, but in many cases it is only because his senses have been taken away by the alcohol that he exposes himself to the infection. I cannot too strongly emphasize this point. Until the liquor problem has been solved, if it ever is, it will be impossible to accomplish very much in the direction of minimizing either the social evil or the diseases that go with it.
We may assume, therefore, that there will always be some danger of infection, even of innocent infection, for prostitution we will always have with us. But if we cannot deal with these evils adequately in a public way, at least the individual may do what he can to safeguard himself.
Ordinary cleanliness and hygiene are usually sufficient to protect one against accidental infection. One should be careful to avoid the use of public towels, public drinking-cups, unwashed fruit, unsterilized dental or surgical tools, borrowed lead pencils moistened with possibly syphilitic saliva, public hairbrushes and combs, and various other objects that may, carry infection. The public toilet seat may be a medium of infection. It is best to shave oneself; otherwise make sure that the barber follows sanitary methods. Always avoid placing the fingers in the mouth after having the hands on public stair rails, car straps, or other places where the hands of others have been.
Kissing is the most frequent of all causes of infection, aside from intercourse itself. The saliva of a syphilitic person is literally alive with the germs. A strange woman, for instance, has been known to infect a child by licking a piece of sticking-plaster to apply to a scratch on the latter's knee. No matter how attractive the lips may look, there may be ulcerous patches just behind them of the most dangerous kind. It is never safe to kiss a strange person. Parlor games which call for promiscuous kissing are extremely dangerous.
Leaving accidental infection out of the question, the only satisfactory or perfect method of avoiding venereal disease is to live a clean and continent life. This is absolutely safe, and it is truly the only course open to a self-respecting unmarried man. There are many physicians, how-ever, who ,believe in the teaching of prophylactic measures by means of which one who has been exposed to infection may protect himself. It is pointed out that, as the experience of the world proves, there are some men who will not be deterred by fear of disease from exposing them-selves to the danger, and that under such circumstances it is better for them to be able to protect themselves than to contract these diseases and then transmit them to innocent wives and children. The great trouble with this plan is that none of the suggested prophylactics are entirely dependable, and that because of the false sense of security they give many men will be inclined to take chances, whereas under other conditions they might restrain themselves.
Various governments have at times put into practice the use of such prophylactic measures in the army and navy, and usually with remarkable results in diminishing, if not eradicating, venereal disease. In some army posts the exposed men are ordered to report at the hospital for preventive treatment immediately on return from absence. In others the men are supplied with what is called a prophylactic packet, containing a calomel ointment in one end of a collapsible tube, and a two per cent. protargol solution in the other. It is reported that in one army post where a hospital-corps attendant was on duty day and night, and where consultation and treatment were given in strict privacy, only fifteen cases of disease followed one thousand six hundred and seventy-five prophylactic treatments, which is less than one per vent. of those exposed. So far as conditions in the army are concerned, such results are certainly worth while.
It is sometimes necessary for a husband and wife to be able to protect themselves against each other. The infection of the husband by the wife is, of course, comparatively rare. The reverse is, unfortunately, not so uncommon. There are said to be a million innocent wives suffering from gonorrhea in this country—a sort of wedding gift from their husbands.
It is on this account, and because of the possibility of syphilitic infection, that thorough examination of all men before marriage is desirable, as a part of any public program to limit the spread of these diseases. Some States have already passed laws calling for a certificate of health as a' requirement for securing a marriage license, and this is certainly a step in the right direction. It is also true that no physician can absolutely guarantee that a man who has had either gonorrhea or syphilis is entirely free from it. At the same time marriage with this precaution is much safer than marriage without it, and in a million marriages such a measure would undoubtedly save thousands of wives from the frightful consequences of these diseases. When the law does not require such a certificate of health as the condition of obtaining a marriage license every father should protect his daughter by demanding it. Or she may demand it for herself, but any young man who is a gentleman in the highest sense will not wait for the demand. He will voluntarily present his bride-to-be with such a certificate of health. The examination should properly be made and the certificate of good health is-sued not by the young man's physician, but by the physician of the young woman, who may be presumed to have her interests at heart.
There is a time coming when no one will think of marrying without such a certificate of health for both parties to the contract. Under existing conditions, however, it will be a sufficient achievement to establish the practice of demanding such assurance of health from men only. There is seldom danger of serious infection from the wife. At the same time, there are cases, as when a man marries a widow, or even under ordinary circumstances, in which he may suffer at the hands of his wife. And the fact that it is impossible to absolutely guarantee a cure, even by the most thorough tests and examinations, makes it essential that both men and women should be able to protect themselves under these unusual circumstances.
As a rule, any infection which a man may contract from his wife is of a less serious character than those which she contracts from him. There is a rather widespread opinion that "a man may contract gonorrhea from his own wife," particularly during menstruation, even though she has not been infected with this disease. This notion, however, is absolutely unfounded. A husband does not contract this particular disease from his wife when she is free from it, though he may con-tract some other inflammatory infection that resembles it. He may be unable to tell the difference, but the difference is very marked, nevertheless. There is only one way in which a man can be infected through contact with a woman who is free from disease, and that is when she has just previously consorted with another who is so tainted, and who has left upon her person the virus of the disease. This oftens happens in houses of prostitution, but the possibility is practically out of the question in marriage.
It is important to know these facts, for ignorance of them may lead to false and unjust accusations in marriage and possibly to domestic tragedies. Infections that are not specific or gonorrheal in nature, and which are entirely innocent, so far as the wife is concerned, occasionally take place, but even they would not be possible if a woman were absolutely healthy. When any such thing takes place, it is because of some diseased condition, involving catarrhal discharges that are more or less purulent in nature, and inflammation of the womb or related parts. If the condition of these organs is absolutely wholesome and healthy, a man could not even contract an infection of this kind during the menstrual period. Of course there are other reasons for avoiding any relationships at this time, if only those of fastidiousness, but unless the discharges are purulent with disease secretions, there is no possibility of infection resulting from such intercourse. However, when the wife suffers from any inflammatory disorder, however mild, the husband should take certain precautions, which, while very simple, are usually effective.
There is another condition that often demands care of a similar nature,. and that is the possibility of re-infecting oneself after it is thought that a previous attack of gonorrhea has been cured. As already said, in some cases the active symptoms may have disappeared, although the disease lies dormant, the germs quietly sleeping, so to speak, in the recesses of the prostate gland. Unusual excitement or activity, such as the first experiences of marriage, may force them out of their hiding place, into the urethra, and cause reinfection. The ignorant husband in such a case
is likely to accuse his wife when he is himself to blame. The man who has previously suffered should be on the lookout for any such recurring symptoms, and immediately take measures to prevent the development of the disease, and to avoid infecting his wife. The prophylactic treatment would be the same as that used to protect against non-specific infections.
Lead a clean decent life, one that will command the respect of others and also entitle you to your own self respect.
Avoid alcohol, above all things. "Go in" for athletic pastimes and outdoor activities. Fairly early in your twenties, if possible, marry a good, pure girl, and give her as good as you get in the way of clean blood and a pure life.