WCA. A5»2> 18SI AMERICAN PUBLIC HEALTH ASSN. REPORT ON PREVENTION OF VENEREAL DISEASES WCA A512r 1881 0001567 nlm Dsi7ma a NATIONAL LIBRARY OF MEDICINE NLM051719988 LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF.MEDICINE do Aavaan ivnoiivn <»^ i ■*?£>( 4^ I 3NIDI03W dO AH>1 n IVNOIIVN 3NIDIC-3W dO AaVJIflll IVNOIIVN V S Xx-^^"' K&UY-./ S NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIOI 3NIDIC13W dO AMVoan IVNOIIVN 3NIDia3W dO AaVa9ll IVNOIIVN 3NI0K NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LI h. I ,..ck 3NIDIQ3W dO AaVaail IVNOIIVN 3NIDIQ3W dO AiiVa9n IVNOIIVN 3NIDIQ3W d i ^y Diasw do Aovaan ivnoiivn snidiosw do Aavaan ivnoiivn snidiqsw do Aavaan ivnoiivn lasw do Aavaan tvnoii' *j * my NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL L Diasw do Aavaan ivnoiivn SNiDiaaw do Aavaan ivnoiivn snidicisw do Aavaan ivnoiivn 3nidiq3w do Aavaan ivnoiivn snidiqsw do Aavaan ivnoiivn snioiqsvn REPORT OF THE COMMITTEE ON THE PREVENTION OF VENEREAL DISEASES, PRESENTED AT THE EIGHTH ANNUAL MEETING OK THE AMERICAN PUBLIC HEALTH ASSOCIATION, New Orleans, La., Nov. 7-10, BOSTON : FRANKLIN PRESS: RAND, AVERY, AND COMPANY. 1881. REPORT OF THE COMMITTEE ON THE PREVENTION OF VENEREAL DISEASES, PRESENTED AT THE EIGHTH ANNUAL MEETING AMERICAN PUBLIC HEALTH ASSOCIATION, New Orleans, La., Nov. 7-10, 1880. BOSTON: FRANKLIN PRESS: RAND, AVERY, AND COMPANY. 1881. A 5*1 "^ *- iBSi C. 1 NATIONAL LIBRARY OF MEDICINE BETHESDA 14, MD. VJU^&35*%MO'ty At the Eighth Annual Meeting of the American Public Health Associa- tion held at New Orleans, La., Dec. 7-10, 1880, the following resolution was adopted: — Resolved, That the Executive Committee be instructed to communicate with the State and Municipal Boards of Health throughout the country, and supply them with a copy of the Report of the Committee on Prevention of Venereal Diseases, and request their co-operation in the attainment of the object of the resolution submitted and adopted by the Association. The annexed copy of the Report of the Committee on Prevention of Venereal Diseases is herewith respectfully transmitted in compliance with this resolution. In behalf of the Executive Committee, Azel Ames, Jr., Secretary. American Public Health Association, Secretary's Office, Boston, Feb. 10, 1881. REPORT OF THE COMMITTEE ON THE PREVENTION OF VENEREAL DISEASES. By ALBERT L. GIHON, M.D., Medical Director U. S. N., Chairman. Your Committee, to whom was assigned the duty of suggesting some practicable plan for the prevention of the spread of venereal diseases, with especial reference to the protection of the innocent and helpless members of the community, beg to report: — That they have endeavored to consider the question without bias or prej- udice, uninfluenced on the one hand by the misrepresentations of certain pseudo-moralists, who have uncharitably denounced in advance their assumed intention to recommend the governmental license of prostitution; and on the other, by appeals from no less earnest, honest, and righteous persons, who, with equal insistence, have urged the propriety and necessity of just such action. Manifestly the first essential to the successful establishment and operation of any system of repression or prevention is the recognition by the commu- nity of the magnitude of the danger it is incurring without it. Diphtheria *") and typhoid continued to commit their ravages with a sad submission to what \ was supposed to be the will of an. inscrutable Providence, until the public ' learned that their homes were desolated through their own culpable careless-, ness. To-day syphilis lurks in the most exemplary household, denies the parent * and blights the offspring, its very name being unknown to them. Until the public are taught that mere personal rectitude is no .safeguard, it is idle to expect that any system will be cordially indorsed. So long as venereal dis- ease is popularly believed to be only the fruit of illicit sexual congress, its very consideration will be shunned. The public must, therefore, be enlight- ened — and your Committee beg to remind this Association that this task is eminently its duty — as to the existence in their midst of a disease, which is fraught with as much evil to humanity as any of the ills which afflict the human body. The other great scourges of mankind are occasional, like cholera, or limited by climatic bounds, like yellow fever, or outwardly hideous and terrifying, like small-pox; but syphilis spreads its venom invisibly, in- sidiously, daily throughout all seasons, in evciy land, and among all races and conditions of people. 6 THE PREVENTION OF VENEREAL DISEASES. Certain individuals, few of them physicians, have disputed the statement that syphilis is either very common, or so dangerous that it is beyond speedy and permanent cure. In the absence of exact numerical statistics, your Committee believe it will be sufficient to refer to the experience of those medical practitioners who have had opportunities of judging, confident that they will, without exception, declare with Parent Duchatelet, that, "of all contagious diseases to which the human species is liable, and which cause the greatest evils to society, there are none more serious, more dangerous, or so much to be dreaded, as syphilis, its ravages far surpassing those of all the plagues which at different times have terrified society; " With Professor Gross and Dr. Marion Sims, that " a greater scourge than yellow fever and cholera and small-pox combined is quietly installed in our midst, sapping the foundations of society, poisoning the sources of life, rendering existence miserable, and deteriorating the whole human family; " With Sir Thomas Watson, that " it counts its victims, not only in the ranks of the vicious and self-indulgent, but among virtuous women and innocent children by hundreds and thousands ; " With Sir James Paget, that " it would be difficult to overstate the amount of damage that syphilis does to the population, children being born with diseases induced by it, which render them quite unfit for the work of life ; " With the other eminent medical men, quoted by Dr. Sims in his inaugural address as President of the American Medical Association at Philadelphia in 1876, — Sir William Jenner, Prescott Hewitt, and Mr. Simon, Chief Medical Officer of the Privy Council, — who have borne testimony of their experience of " its ravages among pure women and spotless children." Statements such as these do not need to be backed by numerical data of questionable value. These can often be distorted to prove any point desired, by selecting for comparison maxima and minima years, or special returns from certain localities, as illustrated by the array of figures jy which the oppo- nents of the British Contagious Diseases Acts have sought to prove that the sanitary surveillance of public women has actually augmented the amount of venereal disease in countries where it is exacted. The following extract from the Statistical Report of the Health of the Navy for the year i8yg, presented by the Director-General of the Medical Depart- ment, John W. Reid, M.D., and ordered 24th August, 1880, by the House of Commons, to be printed, is a sufficient refutation of this misstatement: — THE PREVENTION OF VENEREAL DISEASES. 7 Ratio of Syphilis in the Navy of Great Britain from i860 to i8yg inclusive, at Ports under the Contagious Diseases Acts, contrasted with that at Ports not under the Acts. Ratio of Cases per 1,000 of Force. PERIOD. At Ports under the Acts. At Ports not under the Acts. Primary. Secondary. Total. Primary. Secondary. Total. No Acts in force—1860-63 • • • Act of 1S64 in force — 1864-65 . . Acts of '66 and '69 in force —1866-70, — 1871-79, 34-72 28.79 12.47 II.10 75.02 79-12 47.19 39§9 59.14 72.27 25.6 21.8 70.05 100. 84.74 94.08 At best but a small proportion of venereal diseases ever appears on vital returns. The true statistics of their frequency are the professional secrets of the physician, whose aid is sought to relieve them, or whose eye recognizes them beneath the mask of other ailments. The most carefully prepared reports fail to exhibit the'rheumatisms, the cachexia?, the cutaneous affections, the defects of vision, the lesions of the spinal cord, the brain, the liver, which have had syphilis for their cause. Especially is this true of transmitted syphilis. Only a few days ago, a distinguished American ophthalmologist declared to one of your Committee, that the majority of his infant patients were characterized by the oldish features and notched incisors and badly shaped head which mark the syphilitic child; and he boldly asserted that interstitial keratitis was always a consequence of constitutional contamination. The greater proportion of venereal cases stalk about the streets in affected health, and never appear on any returns. How many others find expression in suicide, in insanity, in conjugal infidelity, and in actions for divorce ! As far as mere figures can be evidence, the statistics carefully collated by Dr. Frederic R. Sturgis of New York are worthy of consideration. A sum- mary of the poor treated in 1873 at the various hospitals and dispensaries of the city of New York, enabled him to estimate the total number of venereal and syphilitic poor patients; but this did not include those treated at their homes, often by themselves, at physicians' offices, by apothecaries, and by quacks. Notwithstanding these omissions, of 280,536 poor persons receiving aid at public institutions, 12,341 suffered from venereal diseases, 5,045 of these being syphilis; that is, forty-four in every thousand cases were venereal, eighteen per thousand being syphilitic. In Mr. Wagstaff's report of the amount and kind of venereal disease under treatment at certain charitable institutions in London during the year 1868, it is stated that sixty-nine in every thousand patients were venereal, thirty-five of these being syphilitic ; and he estimates, that, among the million and a half 8 THE PREVENTION OF VENEREAL DISEASES. of poor population of the metropolis, who receive medical relief for disease at hospitals, dispensaries, and at the hands of parochial medical officers, about one in fourteen is affected with venereal disease of some kind, — this not including midwifery cases, nor the classes excluded in Dr. Sturgis's report. During the same year, 9,796 venereal patients were treated at the hospitals in Paris ; and M. Lecour, Pre'fet of Police, estimating these as one-fifth of the total number of venereal patients treated at their homes by physicians, or who seek relief at the hands of apothecaries and charlatans, gives a sum total of 48,980 cases, about one in forty of the entire population. " A for- midable array, and one probably much below the real amount." The same estimate of the proportion of private to public cases of five to one, arrived at by Dr. Sturgis from wholly different data*, would give for New York, out of a much smaller population, 61,705 venereal patients, or nearly one in every fifteen of its men, women, and children, — a number only dwarfed by comparison with London, where one hundred thousand poor alone are annually affected with syphilis. Military and naval reports, while not free from the same objections of defective registration and classification, are, however, very much more exact, . especially in the matter of enthetic diseases, there being less reluctance to apply for treatment, and less dread of exposure on the part of the patient in a community composed wholly of men, and no alternative but to consult the medical officer, who is required to include them in his reports. Your Committee are indebted to the Surgeons-General of the Navy, Army, and Marine Hospital Service, for the following official returns of the amount of venereal disease treated by medical officers in the naval and military services and mercantile marine of the United States during the last five years. VENEREAL DISEASE IN THE UNITED STATES NAVY. ! Peri OOO OF Per 1,000 1 Total Force Afloat. Total Sick from all Causes on board Men-of-War. No. of Cases of Venereal Disease. No. of Cases of Syphilis. Force. of Sick. Per Cent Year. 1 -a I 4) a .a 0. V c M of Syphi-lis to Venereal. > >> to > 1873 . . . 12,723 8,837 1,029 595 81 46 116 67 57-82 1874 • • • 13.870 9.995 963 562 69 40 96 56 58-36 1875 . . . 10,141 7,^ 956 500 94 49 122 04 52-30 1876 . . . II,I38 7.797 889 437 79 39 114 56 49.15 1877 • • • 7,461 6,748 703 342 94 4S IO4 Si 40.65 1878 . . . 7,806 6,873 751 34i 96 54 109 50 4540 1879 • • • 8,869 10,488 1,101 490 124 45 IO5 47 44.50 Average . . 10,287 8,367 913 467 88 45 IO9 56 51-15 THE PREVENTION OF VENEREAL DISEASES. VENEREAL DISEASE IN UNITED STATES ARMY. Total Sick from all Causes. No. of Cases of Venereal Disease. No. of Cases of Syphilis. Per 1,000 of Force. Per 1,000 of Sick. Per Cent Years. Total Force. "<3 s a > 3 ft m c > p. >. in of Syphi-lis to Venereal. 1875-/6, White . Colored, 21,718 2,014 32,523 2,971 2,262 364 1,147 198 104 l8l 53 98 69 126 35 67 50.70 54-40 Total . 23,732 35.494 2,626 1,345 no 57 74 38 51.22 1876-77, White . Colored, 23,383 2,083 34,683 3,779 2,463 35i 1,283 170 169 55 82 7i 93 37 45 52.09 48-43 Total . 25,466 38,462 2,814 M53 no 57 73 38 51.64 1877-78, White . Colored, 20,812 1,895 26,398 3>°48 1,840 321 954 146 88 169 46 77 69 105 48 51.84 45-84 Total . 22,707 29,446 2,161 1,100 95 48 73 58 81 V 50.90 1878-79, White . Colored, 21,847 1,964 32,8l4 3,455 1,902 281 885 J55 87 143 4i 79 27 45 46-53 55-15 Total . 23,811 36,269 2,183 1,040 92 44 60 29 47.64 1879-80, White . Colored, 22,087 2,387 33,645 3.669 1,957 3°9 960 *52 89 129 43 64 58 84 29 4i 49-05 49.09 Total . 24,474 37,3*4 2,266 1,112 92 45 60 29 49.08 Mean . White . Colored, 21,969 2,069 32,013 3,384 2,085 325 1,046 164 95 lS7 103 48 79 50 65 96 33 48 50-17 50. Total . 24,038 35.397 2,410 1,210 68 34 50- VENEREAL DISEASE IN MERCANTILE MARINE. (As shown by United States Marine Hospital Service Reports.) Total Sick from all Causes. No. of Cases of Venereal Disease. No. of Cases of Syphilis. Per i;ooo of Sick. Per Cent of Syphi- Years. Venereal. Syphilis. lis to Venereal. 1875-76. • • 1876-77. . . 1877-78. • • l878-79- • • 1879-80. . . 10,975 10,914 ",334 ",449 24,860 2,698 2,o6l 2,162 2,362 6,384 2,IIO 1,627 1,825 I,8l8 4,492 246 189 190 206 257 192 149 l6l 180 78.20 78.94 84.41 76-93 7O.36 Mean . . . 13,906 3>x33 2,374 225 171 75-71 10 THE PREVENTION OF VENEREAL DISEASES. The table of Venereal Disease in the United States Navy, presented on p. 8, comprises not only those classed as enthetic diseases, but also the large number of venereal affections reported by medical officers under the class of local diseases affecting the urino-genital system. No such distinction having been made in the tables furnished by the Army and Marine Hospital Service, those local lesions have been here included, the propriety of this being evident from the following exhibit of them in detail: — Enthetic Diseases. Diseases of Urino-Genital System. Year. 'a 0. 1 0 X .2 j3 >p ■505 .2 >» °£ s • '£ .2 E^ G rt rt rt E rethrae strictura and Vesicoe Fis-ula. 13 Total Venereal Diseases. C/3 O H u Q W (S p--- H 1 1873 • • 595 228 823 18 8 123 II 46 206 1,029 1874 • • 562 157 719 16 12 '59 16 41 244 963 1875 • • 500 237 737 14 10 147 !3 35 219 j 956 1876 . . 437 267 699 J3 9 118 IO 40 190 889 1877 . . 342 i8S 527 12 10 120 7 27 176 703 1878 . . 341 208 W9 22 7 I25 x3 35 202 751 1879 • • 490 363 853 24 3 150 18 53 248 1,101 The special character of the disease is, however, of minor interest to non- professional men, who, if indifferent to the moral and sanitary considerations involved, cannot avoid looking at the practical aspect of the question, and paying heed to the facts, that the effective force of a navy of ten thousand men is actually diminished nearly one thousand by men on the sick-list with pre- ventable diseases of their genital organs, and that one-ninth of the sums appropriated for the care and treatment of the sick is expended upon a class of vile disorders which ought not to exist. The last year of the Marine Hospital Service reports includes patients treated at the dispensaries and surgeons' offices outside of hospitals. Neither these nor the naval and military returns include the large number of cases not regis- tered, and treated surreptitiously by apothecaries, nurses, and hospital-stewards. Officers generally avoid the necessary exposure ; and their cases, consequently, seldom appear on the returns. Enough has been shown to establish this fact, that at least one man in every thirteen in the naval service of the United States (last year, one in ten), one in every nine in the army, of the negro troops one in six, one in every seven in the British army, and one in every four of the merchant sailors, presenting themselves for treatment at marine hospitals and dispensaries, are affected with some form of venereal disease. The amount of venereal disease in the British navy is no less formidable. The tables following, extracted from the last report of the Director-General, show that, during the past ten years, among every thousand men in the service, there has been a daily average of forty-five or forty-six unfit for duty by reason of sickness; and that, of these, ten or eleven — about one-fourth of all the sick — were disabled by this class of diseases. THE PREVENTION OF VENEREAL DISEASES. II VENEREAL DISEASE IN THE BRITISH NAVY. Year. Avera ee Total Sick from all Causes. No. of No. of Cases of Syphilis. Per 1,000 of Force. Force. Venereal Disease. All Causes. Venereal. Syphilis. 1879 ■ ■ 1869-78 . 44,745 49,976 6,274 2,585 1,116.90 1,188.76 I4O.I9 I26.56 57-76 55-75 Average Number of Men Sick Daily. Ratio per 1,000 of Daily Sick. Year. e . 0 •" Total Venereal and Genito-urinary Dis-ease. X 0. >> Ul 8 AS u 0 C O O OJ g S u X. O "a 6 . 0 jj 3 c/5 Total Venereal and Genito-urinary Dis-eases. X a. >-. rx> a 8 A O C O p 1 0 1879 . . 1869-78 . 2,012.8 492-57 • .. .. 250.47 211.77 30-33 44.98 46.52 IO.99 10. 5-59 5.62 4-73 4-38 .67 Your Committee are able, by the courtesy of the Surgeon-General of the Navy, to supplement these alarming figures by the significant fact, that, of the boys who were applicants for enlistment as apprentices in the United States Navy during the year 1879, twenty per thousand—one in every fifty lads under seventeen years of age — were rejected on account of venereal disease, twelve of these being syphilitics. Furthermore, of the young men examined at a cer- tain institution, which they had left two years before in good health, not one in five escaped venereal disease of some sort. There is no reason to believe that the proportion among other young men is less appalling. The family physician, and the specialist for private diseases, advertised without disguise in the family newspaper, will never tell the tale of the tens of thousands who seek relief at their hands. But, even were it possible to obtain accurate information of the number of cases of venereal disease contracted in coitu, it would give no indication of the actual injury to the human race by these diseases. It would take no account of the myriads of the happily stillborn and of the feeble offspring, who bring their taint into the world with them, after having diseased their mothers dur- ing their intra-uterine existence; nor of those other myriads contaminated by mere contact with the infected, who mingle in every crowd. Every one instinctively shrinks from the touch of the sufferer with small-pox ; but how few realize that the syphilitic is a leper, also to be shunned ! how few mothers are aware of the danger to themselves and their children from nurses and house- maids, drawn from a population in which every fifteenth person is diseased ! how few parents suspect the peril to their daughter from her accepted lover's kiss, who may be that one in every five young men among the better classes, who has a venereal disease, which, there is one chance in two, is syphilis ! 12 THE PREVENTION OF VENEREAL DISEASES. These are not speculations. Gross has seen many cases communicated by kissing; and he tells of fifteen women, nine children, and ten men diseased by a midwife, who had a chancre on her finger, contracted in the exercise of her profession, and who had thus carried the disease from house to house. Marion Sims says, " I have seen a cook and chambermaid with syphilitic ulcers on the fingers, and nurses, infected by the children who had been born of syphilitic parents, in turn infecting sucking babes, born of healthy parents ; and I have known a drunken vagabond husband to contract syphilis in a low brothel, and communicate it to his wife, who unwittingly gave it to her four children simply by using the same towels and washbowl; " and one of your Committee can add the case of an estimable and venerable lady who lost her eyesight this very year, from using a towel in her son's room, carelessly left by him upon the rack ; and another, of the wife of a clergyman, who, this summer, sought relief at a Virginia spring for a horrible affection contracted in domestic contact with her servant. The present Surgeon-General of the Navy, Dr. Wales, saw a number of cases of chancre of the lips among the smokers of one set of cheipots, of which the wrappers had been moistened by the saliva of a Manila cigar-girl; and, at Beyrout, he learned that it was not unusual for syphilis to be contracted by using an arghileh that had been pressed by the lips of a diseased smoker. Who would venture to eat the Smyrna fig, if he had seen the top layer of the choicest box pressed flat by the saliva-wetted thumb of a packer, who, there was one chance in ten, was a syphilitic? A member of your Committee astounded an otherwise well-informed gentle- man by explaining the risk he ran, after he had been capsized in a river, in accepting the proffer of a flannel undershirt from a young man, whose body was accidentally discovered to be spotted with a suspicious eruption. A lady was equally alarmed when told by her husband, a physician, that she had invited to her table a young man, who, in the course of a physical examination that morning, had been found to have his mouth and tongue covered with mucous patches ; and that her daughter was dancing in a public ball-room with another whose body was repulsive from syphilitic ekzema. A tried invalid at a fashionable hotel had just settled himself in bed, when the odor of tobacco on the pillow prompted an inspection, which revealed sheets that had not been changed, and which, being a medical man, he quickly deserted, conscious that they might have shrouded a syphilitic predecessor. An editorial in "The College and Clinical Record" of Philadelphia of October 15, states, ''It happened to the writer to be recently called to see a man of most respectable surroundings, who bore an unmistakable venereal sore upon his lip, and subsequently manifested all the features of secondary syphilis. It was said that this had followed a trifling surgical operation upon the part affected for the removal of a slight deformity; the instruments or hands of the surgeon communicating the specific virus, in the same manner, it will be remembered, that a New York dentist, not long ago, communicated syphilis by his forceps, and a well-known laryngologist inoculated a number of patients with pharyngeal chancre." THE PREVENTION OF VENEREAL DISEASES. 13 When the public know by how many thousand channels this disease may assail them, your Committee have no doubt that they will demand protection at any cost; and they urge upon this Association the promulgation of the fact, that, so long as syphilitics are allowed to go unrestrained, the spotless woman and the innocent child share the danger of contamination with the libertine and prostitute. Let it be known that this fearful pest may be communicated, — By the blankets of the sleeping-car, the sheets, towels, and napkins of the steamship, hotel, and restaurant; By the hired bathing-dresses at the seaside resort, and the costumes rented for the fancy ball; By the chipped edges of a coffee-cup, as seen at any hotel or eating-house, and their half-cleansed knives, forks, and spoons; By the public drinking-vessel in the railway car or station, as well as the public urinal or closet; By the barber's utensils, the comb and brush in the guest-chamber, the hatter's measure, or the borrowed hat; By the surgeon's and dentist's instruments, or the vaccinator's lancet; By the broom or dustbrush handled by a parlor-maid, or by the spoon touched by the mouth of the cook or nurse ; By the toys sold to children in the streets by vendors with poisoned lips or fingers; By playing and visiting cards, which have been used, and especially by car-tickets and paper money circulating in a city where fifty thousand syphilitics are at large; By the loaned pipe or cane or glove; By the grasp of a friend's hand, or the kiss of a betrothed lover; by the son to his mother and sister, the husband to his wife and unborn child, and by the latter to its mother. Were venereal disease restricted to those who seek illicit sexual gratifica- tion, it might be well to let the guilty suffer and die; but, when their sin is sure to leave upon them an ineradicable taint, and to be transmitted to their helpless offspring; when, worse than all, the syphilitic leaves his stain upon whatever he touches, to foul the chance passer, man, woman, or child, as fear- fully as if they had visited the vilest lupanar, it becomes the duty of this Association — the most important of all its duties — to devise some plan for their protection. Your Committee have been charged with the suggestion of such a practica- ble plan. Of the numerous propositions submitted to them, that most zeal- ously advocated provides for the registration and compulsory examination of prostitutes, and the seclusion of those diseased ; but this alone your Committee does not hesitate to admit to be inadequate. It has undeniably accomplished a wonderful amount of good in continental cities, in the military towns of England, in insular garrisons like Malta, and recently and remarkably in Japan. On this point the universal testimony of naval and military officers cannot be impeached. Fournier, one of the ablest 14 THE PREVENTION OF. VENEREAL DISEASES. of living syphilographers, declared to Medical Director Coues that syphilis had been virtually stamped out of Paris, when the advent of the German army re-introduced it; but he expressed his confidence that it would again be stamped out as before. Col. Fletcher of the Surgeon-General's Office of the United States Army writes to your Committee : — "In 1863, while I was on duty in Nashville, the question of the periodical examination of prostitutes, as a protection to the troops stationed at or passing through that city, was referred to another medical officer and myself. We drew up regulations for the purpose; and for nearly three years the women were examined, at first every two weeks, but subsequently every ten days. " I believe this was the first occasion of any systematic inspection of prosti- tutes attempted in the United States. Its result^ may be briefly stated thus : — " 1. The amount of venereal disease was markedly lessened; so much so that its occurrence came to be looked upon (absurdly, of course) as an imputation on the care of the examining surgeon. I have more than once known a company officer complain that a man was off duty for disease caught of such a girl at such a time, and demand that she be sent to the hospital. " 2. The women, who were at first rebellious, became quite reconciled to the system. I have known them come to the hospital voluntarily, desiring to be examined for suspected disease. "3. It was self-supporting, the fees paying the expenses of the hospital." To-day the Nashville prostitute advertises herself in big gilt letters over her front door, before a blazing light, more conspicuously by far than were she enrolled on a police register; while purblind virtue and false morality stalk by, and leave no other guaranty to society than the poor creature's own good sense, that her house shall not become a focus of disease as disastrous as small- pox or diphtheria. In ten years, the Surgeon-General of the Navy is authority for stating, the amount of venereal disease on the Asiatic station has fallen from 425.8 per thousand to 112.1, — a difference of 313.7 per thousand, due to the exami- nation of prostitutes practised at Hong-Kong and in Japan, and the seclusion of infected women in lock-hospitals. The scandalous scenes which disgrace the chief thoroughfares of Liverpool and London and New York are no longer possible in cities like Paris and Lisbon and Hamburg, where public women are under police surveillance ; nor is it true that clandestine prostitution attains such enormous proportions in places where the Gan Keiro or Yoshiwara con- fines the whore, as in Japan, or where, as in Marseilles, the temples of Venus Meretrix have their own secluded quarter, to be shunned by the virtuous, that it does in Philadelphia and Brooklyn and Boston, where the respectable woman is jostled in every street by unsuspected courtesans, and unfledged boys are lured to disease by young girls in the garb of decent poverty. If the Contagious Diseases Acts of England have not accomplished all the good contemplated, it is because those Acts have not been stringent enough. If syphilis re-entered Paris after having been once stamped out, it was because every avenue for its approach was not carefully guarded. " Doubtless," says THE PREVENTION OF VENEREAL DISEASES. 15 Diday, " a sensible progress has marked the beginning of this century. With the establishment of a better regulated surveillance, we have seen the coinci- dence of the diminution of the number of venereal affections; but the perr sistence of the scourge is an evidence of the insufficiency of these measures." "How is it, then," asks Fournier, "that syphilis is especially derived from inspected women? It is, on the one hand, because the relations with this class of women are more numerous ; and, on the other, because the surveillance which is exercised over them is completely insufficient." The idle charge, endeavored to be substantiated by figures, that the inspection of public women has only induced a greater amount of disease, is not worth refuting; but the insufficiency of these inspections is evident, — Because, while discovering women who are diseased at the weekly or semi- weekly visit, it leaves them unprotected against the intermediate approaches of infected men, and the unconscious contamination of their subsequent visitors; Because minute abrasions, hidden deep in the vagina or among its rugce, may escape detection; Because a woman may undoubtedly be the vehicle of communicating disease from one man to others, without herself becoming infected; Because women who are not avowed and registered prostitutes — shop-girls, domestic servants, saloon-attendants, ballet-girls, choristers, kept women, and the like — are exempt from examination; and chiefly, Because it ignores the men, who are the original contaminators of the prostitute. Furthermore, in this country at least, it is a fact that prostitutes, except those of the lowest class, have learned that it is their own interest to keep well. There are few public houses which do not now have their regular medical attendants, who examine the inmates, and treat them when diseased; and the first lesson taught the young harlot is, to carefully inspect her male visitor, however gentlemanly his exterior. As the erring country girl brings forth the fruit of her illicit amour as promptly as if wedded, because ignorant of her sinning city sisters' devices to avoid such a calamity, so the poor shop-girl, unaware of the sanitary value of syringes and astringent lotions, is diseased by the well-dressed admirer who has turned her head, when the professional whore would have driven him from her room. The young libertine of this day, can, consequently, visit brothels with little risk. The sentimental objec- tion that their location is thereby published and their nefarious trade adver- tised, is of little weight beside the fact that the young man, bent upon sinning, might be saved from irretrievable ruin, who, with no less moral turpitude, consorts with the shop-girl whose favors are bought with cheap jewelry, or the housemaid whose chamber is conveniently near his own, and who gratifies him without charge. While believing that the police registration of brothels and their restriction to designated quarters under sanitary surveillance are in the interest of humanity and morality, and that this no more implies the recognition and 16 THE PREVENTION OF VENEREAL DISEASES. countenance of the sin of immorality than the license of rum-shops and the taxation of whiskey-stills presuppose the encouragement of intoxication ; Believing that the toleration and connivance, through pretended ignorance of their existence, of bawdy-houses, bed-houses, cheap lodging-houses, spurious dressmaker's rooms and cigar-shops, dentist's offices, and other notorious places of resort, and the freedom of exposure permitted in public places to the most abandoned and unmistakable strumpets, are the most monstrous blots upon the civilization of this century, and infinitely more reprehensible than their repression and sanitary and disciplinary control by their authorities, your Committee, nevertheless, consider this to be rather a question of public morals than of public health; and they therefore now only recommend, as, in their opinion, the most effectual, practicable means of preventing the spread of venereal diseases, the enactment by the legislatures of the several States of a law constituting it a criminal offence or misdemeanor to communicate, or to aid or abet in any way the communication of, a contagious disease, such as small-pox or syphilis, and empowering and requiring health officials to estab- lish such regulations as may be necessary for the prevention, discovery, treat- ment, and suppression of such diseases. Deterred by the fear of public accusation and its consequences, no diseased man would, thereafter, venture to cohabit with any woman, whether public harlot, clandestine strumpet, or his own wife. Satisfied that the law would punish the unscrupulous wretches who have hitherto so cruelly wronged them with impunity, no woman would care to evade its application to herself; and not only the poor panderer to man's lust would have a greater incentive to preserve her personal cleanliness, but the proprietors of the bawdy-house would be equally responsible for and equally interested in the physical welfare of its inmates. Inspections would be cheerfully submitted to or voluntarily solicited; and only those perversely negligent of sanitary observances, and the degraded habituees of the lowest slums, would become subjects of sanitary constraint, and, with the professional burglar and black-leg, be treated as forever objects of suspicion. It might open the way to false accusations by abandoned women, but they who object to any semblance of protection of vice can hardly find fault with this additional impediment to sensual indulgence. Under the operations of such a law, it would become the duty of every phy- sician to exact from his syphilitic patient that voluntary isolation or seclusion which may be necessary to prevent contamination, under penalty of punish- ment of the former for his neglect to advise, or of the latter for his refusal to conform to the advice. While it is manifestly impracticable to require a physician to confine his syphilitic patient in a pest-house, it is nevertheless his legitimate office to instruct him to shun such contact with his fellow-beings as may expose them to the risk of contamination. Military and naval medical officers already have, and the surgeons of the Marine Hospital Service and those of emigrant and passenger ships ought to have, the righc to ascertain the THE PREVENTION OF VENEREAL DISEASES. 17 condition, and the power to restrain the liberty, of diseased men and others under their charge. For the syphilitic who marries and contaminates an innocent woman, and begets a diseased child, the law can scarcely frame an adequate punishment, while no code of ethics should permit a medical practitioner to screen his infamy. The plan proposed by your Committee implies the appointment of sanitary officers in every hamlet, village, town, and city of the country, subordinated to and controlled by county, municipal, or State Boards of Health, and empowered to investigate and discover every preventable cause or form of disease, syphilis included. They further recommend the establishment of special or.lock hospitals for the gratuitous treatment of all venereal affections, and, in the absence of such hospitals, provision for their treatment without charge and without unnecessary exposure of their victims by health officials under whose cognizance they have come, since, as Dr. Beardsley has well stated, " the cost of treatment for venereal lesions has become so heavy, the prices so exorbitant, that thousands are deterred from consulting a physician through fear of being fleeced." Professor Andrews quotes the case of a private-diseases doctor, one of a dozen in Chicago, whose receipts in a single month amounted to two thousand dollars. The special hospitals suggested would naturally supplement and not wholly supplant the private charities, dispensaries, and special wards in general hospitals for the treatment of such as might be reluctant to enter the former, which, however, it is believed, might, by thoroughness and care in treatment, not only attract a large proportion of unfortunate sufferers, but ulti- mately become the means of accomplishing the reformation of many whose doings had led them thither to seek relief. The plan proposed by the Committee of the American Medical Association, consisting of Doctors Gross of Philadelphia, Marion Sims of New York, N. S. Davis of Chicago, John Morris of Baltimore, and J. M. Toner of Washington, at Louisville, Kentucky, in 1877, though in the same direction, is less compre- hensive than that of your Committee. They reported, "That, in their judg- ment, there is no possibility of stamping out syphilis until all the nations of the world are protected by proper legislative measures. Great difficulties, unfortu- nately, surround the execution of laws having for their end the prevention of syphilis; and it is impracticable, at the present time, in view of the ignorance and prejudices of men, to secure more than partial legislation looking to this purpose. We can, therefore, only hope to obtain the passage, at first, of enact- ments having in view the regulation of persons engaged in the military and naval service of the government, and also those ordinarily subject to the con- trol and supervision of the police and municipal authorities of cities and large towns, though in the end we are convinced that the extension of this control and supervision to the whole civil population will be the inevitable legislation of all countries." Your Committee have contemplated this wider application of the law in the plan they have unanimously concluded to submit, and which it only remains for them to formulate in the following resolution ; —■ i8 THE PREVENTION OF VENEREAL DISEASES. Resolved, That the American Public Health Association earnestly recommends the municipal and State Boards of Health to urge upon the legislative bodies of this country the enactment of a law constituting it a criminal offence to knowingly communicate, or to be instrumental in communicating, by any direct or indirect means, a contagious disease, such as small-pox, scarlet fever, or venereal disease, and giving to said Boards of Health, and to the State and municipal health officials under their control, the same power in the prevention, detection, suppression, and gratuitous treatment of venereal affections, which they now possess in the case of small-pox and other contagious diseases. Respectfully submitted. Albert L. Gihon, M.D., Medical Director U. S. Navy, Chairman. J. M. Keller, M.D., Hot Springs, Ark. George M. Sternberg, M.D., Surgeon U. S. Army. D. C. Holliday, M.D., New Orleans, La. Preston H. Bailhache, M.D., Surgeon U. S. Marine Hospital Service. William E. Griffiths, M.D., Brooklyn, N.Y. The Association on the ioth inst., on motion of Dr. McCormack of Ken- tucky, adopted the following resolution : — Resolved, That for the purpose of securing uniformity in legislation in the States of this Union for the prevention of venereal diseases, the Committee on Prevention of Venereal Diseases be reconstituted, and instructed to prepare draughts of a State law and of a municipal ordinance calculated to secure the desired results, and report at the next Annual Meeting of this Association. The Committee was accordingly reconstituted; and suggestions of draughts of laws, municipal ordinances, or other propositions, may be forwarded to any of the members, whose names and addresses are as follows: — Albert L. Gihon, M.D., Medical Director U. S. Navy, Washington, D.C., Chairman. J. M. Keller, M.D., Hot Springs, Arkansas. George N. Sternberg, M.D., Surgeon U. S. Army, 132 West Madison Street, Baltimore, Md. D. C. Holliday, M.D., P.O. Box 2157, New Orleans, La. Preston H. Bailhache, M.D., Surgeon U. S. Marine Hospital Service, National Board of Health, Washington, D.C. ' John Morris, M.D., 5 Franklin Street, Baltimore, Md. Committee on Prevention of Venereal Diseases. r- § 'uo(4D5npg 'u,4|Dan 40 |uaw4JDd3(] Sfl 5 Health Service < Bethesda, Md. / z Xx pyv 'opsaqiag aoiAjae u,(|03|-) 3i|qnj'ajDj|a^\puo 'uonosnpg 'u,4|oaH ..\ I /5& i rJIN 5 \#Afc = <&%./ 5 \ >% >- > >- US. 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Department of < Health, Education, ^ and Welfare, Public < Health Service ° ' i< - * 2 •*%a~wrr S V^4f*\ WCA A512r 1881 0001567 NLfl 0S17mfl fl NATIONAL LIBRARY OF MEDICINE i H'J'%' NLM051719988