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Hygiene and Morality 
 
 A Manual for Nurses and Others, Giv- 
 ing an Outline of the Medical, 
 Social, and Legal Aspects of 
 the Venereal Diseases 
 
 By 
 
 Lavinia L. Dock, R.N. 
 
 Graduate of Bellevue Hospital Training School, Resident Member of the 
 
 Nurses' Settlement, New York, Secretary of the 
 
 International Council of Nurses 
 
 G. P. Putnam's Sons 
 
 New York and London 
 ^be ftnicfterbocftcc press 
 
Copyright, 19 io 
 
 BY 
 
 LAVINIA L. DOCK 
 
 Published, June, 1910 
 
 Reprinted, October, 1910 ; February, ign 
 
 January, 1912 
 
 "ISbc 'Knfcfserbocfier ^vc6e, l^ew l^ot^ 
 
PREFACE 
 
 TTHE plan of this manual has grown from the 
 ■■■ scope of a paper presented by the author 
 to the International Congress of Nurses in Lon- 
 don, in July, 1909, in which the chief purpose 
 aimed at was the same as has been here followed, 
 namely, to reiterate the social significance of the 
 venereal diseases and the crusade upon which 
 women should enter in regard to them. There- 
 fore, though the book is meant primarily for the 
 musing profession with its many thousands of 
 members, it has not been arranged simply as a 
 text -book on diseases, and the author hopes it 
 may be useful to many other women as well. 
 The author's thanks are to be cordially expressed 
 to Dr. Elizabeth Hurdon and Dr. Florence Sabin, 
 both of the Johns Hopkins Medical School, for 
 reading the text on the Venereal Diseases; to 
 Dr. Caroline Hedger, member of the Chicago 
 Society of Social Hygiene, who has read the whole 
 
 text; to Dr. Louis I. Dublin of Brooklyn for in- 
 
 iii 
 
iv Preface 
 
 formation relating to industrial insurance, and to 
 Miss Alice Henry of Hull House for notes on 
 maternal subsidies. 
 
 Lavinia L. Dock, R. N. 
 
 The Nurses* Settlement 
 
 265 Henry St., New York. 
 
By Lavinia L. Dock 
 
 AText-Book of Materia Medica for 
 Nurses. Fourth Edition, Revised 
 and Enlarged. Cr. 8vo. Net, $1.50 
 
 History of Nursing. The Evolution 
 of the Methods of Care for the Sick 
 from the Earliest Times to the Foun- 
 dation of the First English and Ameri- 
 can Training Schools for Nurses. By 
 Lavinia L. Dock, R.N., and M. 
 Adelaide Nutting, R.N. Two vol- 
 umes, 8vo. Fully illustrated. Net, 
 Iq.oo. 
 
CONTENTS 
 
 CHAPTER PAGB 
 
 Part I. — The Venereal Diseases i 
 
 I. Syphilis .3 
 
 IL GONORRHCEA AND CHANCROID . . 40 
 
 Part II. — Prostitution 57 
 
 I. Control and Regulation of Prostitu- 
 tion ...... 59 
 
 II . The White Slave Traffic . . .104 
 
 Part III. The Prevention of Venereal 
 
 Disease 127 
 
 I. Underlying Principles OF Prevention . 129 
 
 Appendices . . . . . .171 
 
 Index 195 
 
Part I. The Venereal Diseases 
 
CHAPTER I 
 
 SYPHILIS 
 
 THE venereal diseases are, in the commonly 
 accepted order of their gravity: Syphilis; 
 Gonorrhoea; Chancroid. The first mentioned is, 
 by many modem medical writers, classed by itself, 
 as will be explained later. For a long period in 
 medical history, these three were all believed to be 
 manifestations of one and the same disease. This 
 confusion of ideas continued until the identifica- 
 tion of the specific causative germs brought 
 definite imderstanding and gave a sound basis 
 to theory. 
 
 Historical Outline. Venereal diseases are of 
 
 great, probably of unknown antiquity. Some 
 
 writers say that gonorrhcea has always existed. 
 
 Syphilis appears to accompany certain stages of 
 
 civilisation, as at least some barbarous tribes are 
 
 and have been free from it. It is known that it 
 
 has been introduced into certain ones of such 
 
 tribes by white men. This has recently occurred 
 
 3 
 
4 Hygiene and Morality 
 
 with decimating results in the case of the tribe 
 of Baganzas in Central Africa. 
 
 Some medical historians affirm that syphilis 
 was unknown in Europe before the discovery of 
 America and that it was carried thence into 
 Europe, having presumably had its source in 
 the ancient civilisations of Central America. 
 Prominent authorities hold this view, while 
 others, also prominent, maintain that it has existed 
 for many more centuries in Europe but has been 
 confused with leprosy. The controversy is one 
 of no more than academic interest. What is 
 historically certain is, that an epidemic of syphilis 
 of frightful virulence raged in Europe at the end 
 of the fifteenth century, constituting a veritable 
 plague, and that it spread to all the countries and 
 corners of the continent. Since then, it has 
 been ever present in a less spectacular, sub-acute 
 form as an endemic disease. Though now less 
 noticeable, it is no less pestilential; perhaps 
 indeed it is even more dangerous by reason of its 
 concealment, as it is thus able to promote un- 
 discovered that racial degeneration which has 
 been pointed out as one of its chief activities. 
 
 Cause of Syphilis. Syphilis is caused by a 
 
Syphilis 5 
 
 micro-organism called the SpirochcEte pallida of 
 Schaudinn. This micro-organism, the specific and 
 invariable cause of syphilis, has not long been 
 known with certainty, though long before its 
 actual demonstration medical specialists had 
 suspected its existence. Metchnikoff records the 
 work of Donne, a French microscopist, who, in 
 1837, tried to learn from his microscope the exact 
 nature of the .s^enito-urinary discharge in both men 
 and women. But his efforts resulted in nothing 
 definite. In his day the germ theory was non- 
 existent. After the work of Pasteur had given a 
 new direction to medical and surgical study and 
 had caused the doctrine of the action of micro- 
 organisms as the cause of infectious disease to be 
 accepted, active search and research went on in 
 laboratories all over the world, to discover the 
 germs of this as well as of other diseases. But 
 for twenty years or more the definite attempts 
 made by Weigart, Lustgarten, Metchnikoff, and 
 many others to find the cause of syphilis ended 
 in failure. Finally a commission of experts was 
 formed under the lead of Schulze, Professor of 
 Zoology in the University of Berlin, and the in- 
 vestigation directed toward the discovery of the 
 syphilitic virus was by him entrusted to Schaudinn 
 
6 Hygiene and Morality 
 
 and Hoffman, who, finally, were successful in 
 their search, and in 1905 were able to demon- 
 strate the micro-organism which is now generally 
 accepted by the medical profession as the cause 
 of syphilis. 
 
 Schaudinn's Discovery. It was shown that 
 two varieties of Spirilla were to be found in normal 
 and in diseased states of the genital organs. The 
 first variety, called Spirilla refringens, may be 
 existent in either state, and may be demonstrated 
 in different pathological conditions, both non- 
 syphilitic and syphilitic in character. The second 
 variety, the Spirilla pallida, is only found in 
 syphilis, not even in other venereal diseases unless 
 syphilis is also present. 
 
 The Spirochete Pallida. The SpirochcBte 
 pallida is classed among the Spirilla. It is 
 not yet definitely settled whether it belongs 
 to the bacteria or the protozoa. This uncer- 
 tainty, which is practically unimportant, may 
 be ended any day, as active study of its nature 
 is constantly going on under such masters as 
 Metchnikoff, Roux, and others. Bloch, a high 
 authority, calls it a protozoon. 
 
Syphilis 7 
 
 Metchnikoff points out the fact that the female 
 genital organs are the home of other forms of 
 Spirilla, which may at times be mistaken for the 
 SpirochcBie pallida. Beside the Spirochcste re- 
 fringens there is still another, the Spirochcste 
 balanitis, and these, being sometimes found in 
 lesions of syphilis, have been called secondary 
 organisms. 
 
 The SpirochcBte pallida is a delicate organism. 
 It is smaller and slenderer than the other Spirilla 
 mentioned, and has more spirils. It has been 
 called ''pallida,'" the pale Spirochcete, because of 
 the technical difficulty of staining it for observa- 
 tion in laboratory work. Schaudinn, it is said, 
 first named it SpirochcBte pallida, later called it 
 SpirochcBte pallidum, and still later Treponema 
 pallidum. The first name remains the one in 
 general use. 
 
 It only survives for a few hours — six, Andrews 
 says — outside of the human body. After that its 
 infectious power is lost. It is destroyed by heating 
 for an hour to 51 degrees Centigrade (i2 4°Fahr. 
 approximately). It needs moisture, and if dried 
 dies quickly, but even with moisture present it 
 is very perishable when removed from its human 
 host. This readily perishable quality and early 
 
8 Hygiene and Morality 
 
 loss of pathogenic power is of the highest im- 
 portance in considering the subject of contagion 
 by direct mechanical contact with infected ob- 
 jects, as will be seen later, and has a definite 
 bearing on practical methods of disinfection and 
 on the avoidance of direct infection from inani- 
 mate objects and personal contact. 
 
 So far, efforts to cultivate the Spirochcste in 
 artificial media have not succeeded, but this, too, 
 may be accomplished any day, as all the famous 
 bacteriological laboratories of the world are ex- 
 perimenting on this line. 
 
 General Results of Experiments. Experi- 
 mental work so far has been successful in 
 demonstrating the SpirochcBte pallida in the 
 primary, secondary, and tertiary lesions of syphi- 
 lis; in the lymphatic organs and the lymph; in the 
 saliva and urine; in arterial lesions; in the foetus, 
 and in the newborn congenitally syphilitic infant, 
 which, indeed, always shows enormous numbers 
 of the specific germ in its various organs.^ It 
 has also been occasionally demonstrated in the 
 blood. Further, experimental work, chiefly that 
 carried on in the Pasteur Institute under the 
 
 1 Metchnikoff. 
 
Syphilis 9 
 
 direction of Metchnikoff, and by Neisser in Java, 
 has been successful in transmitting the disease 
 syphilis to certain varieties of apes, and in thus 
 clearing up some important and formerly un- 
 known facts and principles that are of value for 
 early and correct diagnosis and treatment. 
 
 Thus it has been shown that the virus of syphilis 
 can be demonstrated in the internal organs within 
 sixteen days after infection, and long before 
 the usual time of appearance of the earliest outward 
 sign of the disease, namely, the ''primary sore."^ 
 Unremitting attempts made to obtain a prophy- 
 lactic serum or mitigated virus such as has been 
 successfully produced for diphtheria, tetanus, etc., 
 have so far been only partially successful, but, 
 though some scientists regard the production of 
 such a serum or vaccine as a doubtful possibility, 
 the efforts to produce it will no doubt go on until 
 it has been accomplished. 
 
 The proof of the early extinction of the life of 
 the germ after being removed from the body is one 
 of the important results of experiment, and, in 
 the work with apes, a number of data, valuable 
 for diagnosis and treatment, have been secured, 
 notably that of the "serum diagnosis" of Neisser, 
 
 i Xeisser. 
 
lo Hygiene and Morality 
 
 Wassermann, and Brink. This is based upon the 
 natural reaction that takes place in the blood after 
 the introduction of certain poisons, and the ap- 
 pearance in the blood of so-called ''antibodies," 
 or natural antagonists to the poison in question. 
 These "antibodies," normally not demonstrable 
 by ordinary methods of examination, may increase 
 and be found in large quantities under the stim- 
 ulus of the disease poison. Their presence in 
 syphilis is now regarded as an important passive 
 aid to diagnosis, though their absence would not 
 necessarily prove the non-existence of the disease. 
 The effects of the drugs u&ed in the clinical 
 treatment of syphilis, especially mercury, have 
 also been extensively and usefully studied in the 
 course of animal experimentation. 
 
 Symptoms and Course of Syphilis. Syphilis 
 has been defined as a specific disease of slow 
 evolution, propagated by inoculation (acquired 
 syphilis) , or by hereditary transmission (congenital 
 syphilis) . ^ 
 
 Acquired syphilis is invariably due to direct 
 contact with the discharges or secretions of a 
 patient already suffering from the disease. It is 
 
 » Osier, 
 
Syphilis ii 
 
 supposed that some minute break or abrasion 
 in the skin or mucous membrane exposed to the 
 virus is a condition of infection, though this break 
 may be too minute to be noticeable. The squamous 
 epithelium seems to be the primary channel of 
 infection. The germ of syphilis cannot be trans- 
 mitted through the atmosphere in dust particles, 
 as may happen in the case of the tubercle bacillus. 
 
 Syphilis is an infectious fever, nmning a slow or 
 chronic course, and, like other fevers, it has a 
 period of incubation followed by acute symptoms 
 including skin eruptions and general disturbances 
 of the health, and it has, later, sequels or remote 
 consequences of definite and varied, often of fright- 
 ful character. Unlike other fevers, which run 
 their course in a few weeks, this one lasts for 
 months and even for years, while its sequels, like 
 those of scarlet fever, are permanent and terrible 
 in their nature. 
 
 The course of syphilis is divided into three 
 stages : primary, secondary, and tertiary. 
 
 Primary Stage. The primary stage begins 
 with the close of the incubation period, while 
 incubation itself may take from ten days to 
 seven weeks after the time of exposure to 
 
12 Hygiene and Morality 
 
 infection. This variance in time is supposed to 
 be due to the varying number of SpirocluEte 
 pallida present in the infectious material or 
 discharges by which the disease is carried. The 
 average period of incubation is three or four 
 weeks. During this time there are no signs of 
 disturbance, and the abrasion through which the 
 poison has been received, heals. 
 
 Finally, at the end of the incubation period, 
 a small red papule appears at the point of inocu- 
 lation. It may or may not enlarge. A little later 
 it breaks down in the centre, forming an ulcer, 
 small or large as the case may be, but, as a rule, 
 single. This is known as the "hard chancre,'* 
 from the fact that the tissues about it are indurated 
 and dense, with a gristle-like feeling, and it is 
 known as the ''primary lesion" or "initial sore" 
 of syphilis. The discharge from this ulcer is 
 highly contagious, yet, if the ulcer is of small size, 
 it may be readily overlooked. In the primary 
 stage there may be no disturbance of the general 
 health, nor any symptoms that attract attention. 
 The primary stage continues for from one to three 
 months with no other signs of trouble than the 
 primary lesion itself. This quiescent period is 
 sometimes called the second incubation period. 
 
Syphilis 13 
 
 At its close, rarely later than the twelfth week, an 
 active set of constitutional symptoms come on. 
 
 Secondary Stage. The poison has now been 
 distributed by the lymphatic system, as evidenced 
 by enlargement of the glands in all parts of the 
 body. There may be fever, more or less marked 
 and of variable character, and skin eruptions, 
 also of very varied characteristics, the most usual 
 being a rash resembling measles which appears 
 first on the chest and abdomen, spreading thence to 
 other parts of the body. One form of the eruption 
 resembles smallpox ; others bear resemblance to skin 
 diseases of different origin and varying features. 
 There is severe nocturnal headache and pain in 
 the bones, with a general feeling of illness. The 
 inner surfaces of the mouth and all the structures 
 of the pharynx and throat may become sore, red, 
 and swollen, sometimes so acutely so that solid 
 food caimot be swallowed. The mucous patches 
 which are among the most significant and special 
 symptoms of syphilis may appear on all or any 
 parts of the inner surfaces of the mouth and gums, 
 tongue, tonsils, and phar3nix. They may also 
 appear at the comers of the lips, or in the nasal 
 lining, or in the folds of the axillae and the peri- 
 
14 Hygiene and Morality 
 
 neum, or even between the toes. The mucous 
 patch is a flat, greyish ulcer, which secretes a 
 copious, virulently infectious discharge. Other 
 symptoms of the secondary stage are syphilitic 
 iritis, inflammation of the periosteum and of the 
 joints, alopecia, syphilitic onychia, and condylo- 
 mata, or the "syphilitic warts" which are fre- 
 quently found in the vulvar region. The labyrinth 
 of the ear may be involved and deafness result. 
 
 Tertiary Stage. The oncoming of the tertiary 
 stage cannot always be separated from the second- 
 ary stage by a definite line, nor can the symptoms 
 of the secondary and tertiary periods always be 
 distinctly separated in classification, as, in some 
 cases, symptoms usually regarded as late ones 
 may appear early, or, again, the stages may not 
 run a perfectly typical course. Nor * does the 
 tertiary stage always develop. Tertiary symp- 
 toms, like sequels of other contagions, are not 
 wholly inevitable. They may be averted by 
 early, careful treatment carried on for a sufficient 
 length of time. 
 
 When the third stage of syphilis does occur, 
 its onset may not take place for months or even 
 years after the primary sore. During a long 
 
Syphilis 15 
 
 period the patient may have believed himself to be 
 entirely well and free from danger. This slowness 
 of development and insidious latency of the dis- 
 ease constitutes one of its most dread features. 
 Andrews says: "No other communicable disease 
 continues its manifestations after twenty and 
 even fifty years after the original infection." 
 
 It is beheved that the chief cause contributory 
 to the development of tertiary symptoms is 
 inadequate treatment in the very early stages. 
 As a result of this inadequacy of care it may 
 happen that cases which appeared mild and 
 insignificant at the outset, and which, in conse- 
 quence, may have received only brief or super- 
 ficial treatment, develop most malignant and 
 violent tertiary symptoms. There are, however, 
 some cases where the virulence of the poison 
 defies all, even early, treatment. 
 
 As a rule, the general condition of the patient 
 and of his surroundings have much bearing upon 
 the probable results of treatment. If the general 
 health is good, surroundings sanitary, and treat- 
 ment adequate and faithfully followed, the pa- 
 tient may generally feel hopefiil of cure. 
 
 Alcoholism makes the prognosis much worse, 
 and bad hygienic living conditions also add to 
 
1 6 Hygiene and Morality 
 
 a discouraging outlook. The parasites may not 
 be actually killed, but only rendered latent and 
 may, in consequence, produce tertiary symptoms 
 at a remote period. 
 
 The typical characteristics of the third period 
 of syphilis are **gummata" or soft tumors which 
 may develop in any set of tissues, from the hard 
 bony structure through the whole range of internal 
 organs to the brain and skin. These tumors or 
 gumma tend to ulceration and destruction of 
 tissues, and produce the deformities sometimes 
 seen, such as the destruction of the bridge of the 
 nose, etc. Skin eruptions of a more formidable 
 type than the earlier ones, and having a more 
 pronounced tendency to ulcerate, appear in this 
 stage. 
 
 Congenital Symptoms. Every feature of the 
 acquired disease except the primary sore, says 
 Dr. Osier, may be seen in the congenital form. 
 The baby born with syphilis is wasted and 
 withered, with the wrinkled ''old" looking little 
 face ; fissures at the corners of the mouth ; a dis- 
 charge from the nostrils, "snuffles"; ulcerated 
 lips; excoriated buttocks; dry and unhealthy 
 skin; eruptions, especially about the extremities: 
 
Syphilis 17 
 
 some or all of these symptoms may be present. 
 The baby with these marked evidences of disease 
 is not likely to live. Or, the baby may be born 
 healthy looking and well, but after a few weeks' 
 time may develop sniifQes, eruptions, fissures 
 about the mouth, loss of hair and eyebrows, 
 or other less markedly characteristic symptoms. 
 This process usually occurs between the third and 
 twelfth week. Children with congenital syphilis, 
 says Osier, rarely thrive. Certain ones may 
 improve or recover, but there is apt to be a return 
 of the disease at puberty. Even those who recover 
 from the early symptoms do not develop normally. 
 They often have a wizened, wasted look, their 
 growth is slower, and there is a frequent condition 
 known as ''infantilism" which gives, for instance, 
 to the youth of nineteen the appearance of a boy 
 of twelve. 
 
 About the time of puberty, the child with 
 inherited syphilis may develop persistent eye and 
 ear diseases. Of all the organs of special sense, 
 the eye is the one most frequently attacked. 
 Disease of bones may appear early or late, and 
 the late case of hereditary syphilis may display 
 the dread gummata and end in general paresis. 
 The lesions of the third stage are also infectious, 
 
1 8 Hygiene and Morality 
 
 though, as they are often situated in deep seated 
 tissues, there is less opportunity for the infection 
 to be conveyed to others. 
 
 The congenitally syphilitic infant is intensely 
 infectious. Fournier says: "Nothing is so dan- 
 gerous to its surroundings as a syphilitic infant." 
 
 Syphilis Hereditary in the Literal Sense. 
 Syphilis is hereditary, not in the sense of an 
 inherited predisposition only, as is the case with 
 tuberculosis (once believed to descend as an 
 actual entity from one generation to another), 
 but the disease vitself may be inherited. In other 
 words, the new-born baby may come into the 
 world with the Spirochcete pallida present in 
 enormous numbers in all or in any of its tissues. 
 Morrow says: "Syphilis is the only disease which 
 is transmitted in full virulence to the offspring." 
 
 Heredity to the Third Generation. It is 
 a matter of some difference of opinion and con- 
 troversy whether syphilis is transmissible to the 
 third generation. The French school, fairly 
 generally, some American writers, and Hutchin- 
 son, the English authority, take the negative, 
 while many others withhold a positive pronounce- 
 
Syphilis 19 
 
 ment. In the absence of a definite certainty, 
 however, one cannot but recall the words of the 
 Old Testament, ''The sins of the fathers are visited 
 upon the children, even unto the third and fourth 
 generations," and surmise that they may reflect 
 the accumulated wisdom of ages of experience. In 
 this connection it m^ay be remembered too that 
 the exact study of S3'phili5 is novr, according to 
 distinguished medical writers, only in its infancy. 
 
 It is supposed that, in a large number of cases, 
 the syphilitic taint is derived from the father only; 
 that the semen conveys the SpiroclicBte pallida 
 directly to the product of conception. It is also 
 authoritatively taught that, if the mother alone 
 has transmitted the disease to the offspring the 
 danger is graver — the fatahty to the children 
 more overwhelming than if the father alone has 
 transmitted it. Recent studies em^phasise the 
 predominant part of the mother in heredity. 
 
 A phenomenon first pointed out by a noted 
 surgeon of Dublin, Colles, and named after him, 
 is that of a mother who, herself apparently free 
 from the disease, gives birth to a child showing 
 congenital taint, and can herself nurse her baby 
 without becoming infected by it, whilst the most 
 healthy wet-nurse nursing the same baby becomes 
 
20 Hygiene and Morality 
 
 infected. But it seems to be a question whether 
 this mother, who appears to be immune, really 
 is so or not. Osier speaks of her as receiving 
 a ''protective inoculation." Hutchinson makes 
 the observation that it would be important to 
 know how many such mothers showed tertiary 
 symptoms in later life. This is at present not 
 known, but he believes there is proof that there 
 are many, and holds this to be corroborative of 
 the view that such mothers really do receive an 
 infection during pregnancy. The whole subject 
 is one of present incertitude, and with further 
 research is likely to be completely revised. An- 
 other phenomenon which has been called after 
 Profeta is that of a child apparently healthy 
 which nurses its syphilitic mother without be- 
 coming infected. This also must be taken with 
 reserve as needing further exact investigation. 
 
 Finally, it is supposed that the offspring may es- 
 cape infection altogether if the mother is not in- 
 fected until late in pregnancy, especially if not 
 until after the seventh month. 
 
 Immunity. A study of the most recent writings 
 gives the impression that it is regarded as, on the 
 whole, doubtful whether a true natural immunity 
 
Syphilis 21 
 
 against syphilis exists in the human individual. 
 D'Arcy Power says that, as far as is now known, 
 no healthy person is proof against syphilis, but 
 that any one who is directly exposed to it, in the 
 literal sense of having the Spirochcete pallida 
 introduced into the lymphatic system, will con- 
 tract the disease. Nor is there a certainty as to 
 acquired immunity. Neisser holds that, in the 
 case of syphilis, there is no such thing as the ac- 
 quired immunity which is familiar as following 
 upon some other contagious diseases — that is, 
 when an individual, having once had a contagious 
 disease and having been cured, is thereafter 
 insusceptible to it. He teaches, as the result 
 of his investigations with animals, that cases 
 which appear to display immunity and resistance 
 to fresh infection are really not cured, but have 
 the Spirochcete pallida still present in their 
 tissues, and that cases which had been really 
 cured by treatment, i. e., when the microscope 
 proved that the Spirochcete had actually been 
 killed, were susceptible to new infection. 
 
 While it is not always correct to make precise 
 deductions from animal experimentation for man 
 he believes that this is also true of htmian beings — 
 that cases of so-called ''immunity" are not such, 
 
22 Hygiene and Morality 
 
 but that these individuals still have the Spiro- 
 chcete pallida present in their tissues. In October, 
 1908, he stated that no method of procuring 
 active or passive immunity, nor mode of treat- 
 ment with immunising substances, had been 
 discovered. 
 
 On this point, Hutchinson says that he has 
 seen seven cases of true second attacks of syphilis 
 at intervals of from eighteen months to twelve 
 years after the first attack. The possibility of 
 a second attack, is therefore, he believes, only 
 the expression of the efficiency of the treatment 
 of the first. Lang of Vienna says that for a long 
 time there was a belief in the absolute immun- 
 ity conferred by a first attack of syphilis but that 
 this belief was disproved by Zeissl and others. 
 Reinfection, he holds, can only occur in individuals 
 who have been perfectly cured. Those in whom 
 the disease is still present are not susceptible to 
 new infection. 
 
 Reinfected cases usually run a mild course. 
 So, too, it is believed that races in which syphilis 
 has long been widely prevalent show a less obvious 
 type of symptom. 
 
 Relation of Syphilis to the Nervous Sys- 
 
Syphilis 23 
 
 TEM. The relation of syphilis to a number of the 
 disorders of the nervous system had only been 
 imperfectly understood up to the time of the 
 discovery of the SpirochcEte pallida. Careful 
 studies are now being pressed along this line, and 
 it cannot be doubted that the rapid progress of 
 modern medical science will continuously throw 
 new light upon these obscure problems, to the 
 incalculable benefit of the human race. 
 
 Some diseases of the nervous system are 
 directly due to syphilis, as hemiplegia from 
 syphilitic degeneration of the walls of arteries; 
 and " paralysis or convulsions due to syphilitic 
 tumors of the brain or those lying at the roots 
 of nerves. 
 
 Again, some of the most formidable nervous 
 diseases, classed as para-syphilitic, are regarded 
 not as in themselves syphilitic, but as resulting 
 in some way from the virus of syphilis or from 
 the changes it has brought about in the organs. 
 Prominent among these are locomotor ataxia and 
 the general paralysis of the insane. It was 
 formerly held that the first mentioned disease 
 might arise from other causes; that, though the 
 great majority of cases were of definitely syphilitic 
 origin, a certain percentage of the remainder must 
 
24 Hygiene and Morality 
 
 not be so regarded. But the more recent writers 
 tend to the assumption that the syphilitic taint 
 is invariably to be found in the previous history, 
 even though it may be many years, or a full 
 generation, earlier.^ 
 
 The Relation of Syphilis to Carcinoma. 
 
 Recent writers point out the great importance of 
 further investigation into the obscure relationship 
 between syphilis and carcinoma. D'Arcy Power 
 states that cancer is peculiarly liable to occur 
 in the tissue which has undergone a chronic 
 syphilitic inflammatory process, and speaks of the 
 virus of syphilis as "preparing the tissues" for 
 cancer, especially that form of it known as epithe- 
 lioma. While there is no reason for supposing that 
 syphilis is closely related to carcinoma yet its 
 importance as a predisposing or favourable 
 condition for the development of this terrible 
 affliction should give added weight to every argu- 
 ment for the extirpation of syphilis from human 
 society. 
 
 Syphilis and Tuberculosis. The author just 
 quoted points out the inter-relation between 
 syphilis and tuberculosis, and believes that 
 
 1 Mott in British Medical Journal, Feb. 27, 1909. 
 
Syphilis 25 
 
 syphilitic tissues are more liable to infection by 
 the bacillus of tuberculosis than other equally 
 ill-nourished tissues are, if syphilis-free. He 
 emphasises the interaction between the two dis- 
 eases, while, at a recent meeting of the American 
 Society of Sanitary and Moral Prophylaxis the 
 statement was made that, if syphilis could be 
 wiped out, a vast amount of the tuberculosis 
 now existent would also disappear. 
 
 Syphilis and other Diseases. In a general 
 way it may be stated that syphilis constitutes a 
 predisposition to bear all other constitutional 
 diseases badly. The intemperate, the tubercu- 
 lous, the rheumatic, the malarial patient all suffer 
 more, and find themselves in a less hopeful condi- 
 tion when syphilis or the syphilitic degeneration 
 is present as a complication. 
 
 Syphilis and Alcoholism. A relationship or 
 affinity appears to exist between syphilis, alcohol, 
 and prostitution which unites them in a trio of 
 great and evil menace to health. Dr. Morrow 
 says: 
 
 Instruction would be incomplete without a warning 
 as to the influence of alcohol in the instigation of im- 
 
2 6 Hygiene and Morality 
 
 moral relations and as one of the most powerful 
 auxiliaries of sexual contamination. The r61e of 
 alcohol in the propagation of venereal diseases has not 
 been sufficiently appreciated, and the consideration 
 that every repressive measure against alcohol will 
 be an important prophylactic measure against the 
 spread of venereal diseases has not received the 
 attention it deserves. Perhaps more than any other 
 agency, alcohol relaxes the moral sense while it 
 stimulates the sexual impulse. 
 
 Neisser speaks of "the fatal r6le of alcoholism 
 which drives innumerable young men to exagger- 
 ated exercise of the sexual functions"; and Pon- 
 toppidan says: 
 
 Alcohol is an inducing and even a downright cause 
 of the rise and propagation of venereal diseases. 
 Alcohol paralyses the will and understanding, and 
 stimulates sexual and sentimental emotion. Ab- 
 stinence and temperance movements must be taken 
 as important allies in the prevention of venereal 
 diseases. 
 
 Medical statistics show that an excessive pro- 
 portion of venereal disease has been contracted 
 while under the influence of alcohol. Dr. Forel's 
 investigations suggest an affinity between syphilis 
 and tissues that are habituated to alcohol. He 
 finds that alcohol is oftener the exciting cause of 
 infection in men than in women, while it oftener 
 
Syphilis 27 
 
 induces women to commit the first irregular act. 
 Dr. Morrow states also that chronic alcoholism is 
 a powerful factor in bringing on the development 
 of severe and extensive lesions of the skin and 
 mucous membranes; that it promotes the cere- 
 bral disorders of syphilis, and causes the disease 
 to run into the third stage. 
 
 Loxton emphasises the necessity of cutting off 
 alcohol entirely in the treatment of all venereal 
 diseases, and cites cases of gonorrhoea where 
 abrupt relapses with acute symptoms followed 
 immediatel}^ after alcoholic drinks had been 
 taken. ^ 
 
 Ravogli says: 
 
 Alcoholism when associated with syphilis is also 
 a most important factor in crime. We know the 
 deleterious influence of alcohol in individuals affected 
 with syphilis, — so much so that the French speak of a 
 special kind of syphilis, la syphilis alcoholisee. Some 
 writers indeed go so far as to claim that the general 
 paralyses of tertiary syphilis only occur in those 
 who have been addicted to drink. 
 
 Syphilis and Crime. A suggestive article by 
 Ravogli on syphilis in relation to crime gives the 
 scientific reasons of the author for believing 
 
 1 British Medical Journal, Feb. 27, 1909. 
 
2S Hygiene and Morality 
 
 that the injurious action of the syphiHtic virus 
 upon the vascular system and the structures of 
 nerves is an explanation of much of the degeneracy 
 that is evidenced by crime, and especially by 
 cruel and persecutory kinds of crime where the 
 perpetrator enjoys the sufferings of others. He 
 quotes Barthelemy, who says that **the great 
 class of heredo-syphilitics forms the ranks of the 
 degenerate, unbalanced, obnubilated mattoids," 
 and that this heredity, with alcoholism, is the 
 most effective cause of human degradation. 
 Ravogli says: "The existence of moral insanity 
 admits of no doubt, and that it is often the result 
 of syphilitic alterations of blood-vessels is easy 
 to demonstrate." 
 
 While he does not mean to be understood as 
 saying that syphilis is the determining cause of 
 crime, he does believe that it is one of the pre- 
 disposing factors of crime, and he then goes on 
 to say: 
 
 A strange relation exists between syphilis, crime, 
 and prostitution — cases of prostitution which cannot 
 be explained by poverty or by special accident have 
 to be attributed to hereditary syphilis. Prostitution 
 and crime go hand in hand, and in the families 
 where the brothers are criminals the sisters are pros- 
 
Syphilis 29 
 
 titutes. Syphilis is the tie between crime and 
 prostitution when it causes the affections of the 
 nervous system resulting in moral degeneration. 
 
 Statistical Estimates of Syphilis. No com- 
 prehensive or general system of counting the cases 
 of syphilis or the other venereal disorders is yet 
 officially established in any country. The avail- 
 able statistics, therefore, being those collected by 
 medical specialists in their own practice and in 
 hospital records, though authoritative, and suf- 
 ficiently startling, have not the extent of those 
 collected by public bureaus or health departments. 
 Nevertheless there are data enough to enable 
 medical experts to make very definite assertions 
 as to the prevalence of venereal diseases and 
 their share in morbidity and mortality. 
 
 The general prevalence of syphilis is estimated 
 at from five to eighteen per cent, of popula- 
 tions, some countries having a worse record than 
 others. It is stated in medical writings that from 
 ten to fifteen per cent, of the male population of 
 Europe have syphilis. 
 
 Destruction of the foetus and a heavy infant 
 mortality are prominent results of syphilis. 
 Morrow says: "No disease has such a murderous 
 
30 Hygiene and Morality 
 
 influence upon the offspring." It is known that 
 syphiHs is responsible for a large percentage of all 
 miscarriages, while the death-rate of congeni- 
 tally syphilitic infants is described by the ex- 
 pression ''Poly-Mortality." 
 
 Figures taken from European hospital records 
 and from physicians' note-books, all classes of the 
 community being considered as one, show a double 
 fatality when both parents are infected, or an 
 infant death-rate of sixty-eight per cent. In pri- 
 vate practice only, the social status here being 
 rather superior, the infant mortality is sixty or 
 sixty-one per cent. Free pubhc hospitals, where 
 the most indigent cases find refuge, show the worst 
 figures, from eighty-four to eighty-six deaths in 
 every hundred infants. One in every four or five 
 lives long enough to pass the heritage on. Phy- 
 sicians record instances of the extinction of entire 
 families from syphilis. Fournier cites one such 
 case, where, to 157 births, there were 157 deaths 
 from this cause. In the Transactions of the 
 American Society of Sanitary and Moral Prophy- 
 laxis the statement is made that in France alone 
 syphilis kills twenty thousand children annually. 
 The ages at which syphilis is, in a large proportion 
 of cases, contracted, give melancholy testimony 
 
Syphilis 31 
 
 to the prevalent neglect of the young. There are 
 authentic medical figures showing that from 
 thirty to forty per cent, of the cases of this disease 
 are infected between the ages of fourteen and 
 twenty years. 
 
 Besides the hereditary infection of children by 
 their parents the infection of wives by their hus- 
 bands is common. Morrow's records show that, 
 of all the women suffering from syphiHs who at- 
 tended the clinics of a large hospital, seventy 
 per cent, were respectable married women who 
 had been infected by their husbands. He says 
 further that "possibly ten per cent, of men who 
 marry infect their wives with venereal disease," 
 and his estimation of the total number of syphil- 
 itics in the United States is two million. 
 
 It is beheved that, generally speaking, about 
 ten per cent, of all cases of syphilis are transmitted 
 accidentally in various ways like ordinary con- 
 tagions, that is to say, not by sexual contact. 
 Thus, of 887 cases of syphilis in women, recorded 
 by Foumier, 842 had been acquired in sexual 
 contact, while the others had been accidentally 
 conveyed by ordinary contact, through instru- 
 ments, tubes, utensils, etc., or by caring for or 
 suckling diseased infants, etc. 
 
32 Hygiene and Morality 
 
 The Source and Spread of Syphilis. A 
 distinction must be made between (a) cause; (b) 
 source or breeding-place ; (c) mode of spread of any 
 infectious disease. 
 
 The cause of every such disease is a special 
 micro-organism. The sources or breeding-places 
 where these organisms flourish and congregate 
 vary, as we know, while the means by which they 
 are disseminated broadcast also vary, almost to 
 infinity. 
 
 Those contagions that are called, familiarly, 
 filth diseases, do not cease being filth diseases 
 when they are conveyed into clean homes to 
 strike down cleanly living individuals. In the 
 study of every infectious disease knowledge of the 
 breeding-place or native haunt of its germ is of 
 the utmost importance for practical hygiene. 
 Thus the world has rung with the announcements 
 of the mosquito carriers of yellow fever and 
 malaria and with the exploits of those medical 
 heroes who sacrificed their lives in the search for 
 this knowledge; — again, in the case of tuberculosis, 
 information as to the breeding-places and modes 
 of dissemination of the tubercle bacillus is pub- 
 lished in public places, told in public lectures, and, 
 indeed, almost cried in the streets. 
 
Syphilis 33 
 
 In the case of typhoid fever, it is accepted by- 
 all intelligent people as a civic crime to neglect 
 water supplies. So in the case of every infectious 
 germ; as its habitat and ways of spreading are 
 learned, the knowledge is given freely and fully 
 to the world. In the case of syphilis, and of other 
 venereal diseases as well, though their specific 
 micro-organisms have not long been identified, 
 their breeding-places and most prominent mode 
 of transmission have been well known for many 
 years by the medical and legal professions and 
 by sophisticated members of the laity, but, be- 
 cause of the perplexing, complicated, and diffi- 
 cult social web in which they were woven, these 
 facts have been concealed and an absolutely 
 opposite policy has prevailed from that followed, 
 for instance, with tuberculosis. With the latter, 
 full publicity : with the former, until most recently, 
 almost unbroken secrecy. Every one talks of 
 tuberculosis; almost no one of venereal disease. 
 It is true that tuberculosis also was not made 
 a matter of public, national importance until its 
 ciirable, preventable, and non-inheritable nature 
 was discovered. This gives hope for believing 
 that venereal diseases also may be brought 
 into the open, since it can be shown that they 
 
34 Hygiene and Morality 
 
 are not only curable, but, more than any others, 
 preventable, since their prevention may be a 
 matter of choice and of the individual will. To 
 these hopeful facts the certainty of the relentless 
 hereditary transmission of syphilis should act 
 as a powerful spur. 
 
 Breeding-place of Syphilis and the Vener- 
 eal Diseases. The breeding-place of all venereal 
 diseases without exception is in the social insti- 
 tution called prostitution, or sexual promiscuity: 
 in the debasement and degradation of what should 
 be the highest and most revered of physical 
 powers, those involved in the act of generation. 
 Bred and cultivated in prostitution, venereal 
 diseases spread thence through the community, 
 attacking the innocent as well as the guilty, the 
 pure as well as the impure, just as typhoid fever 
 is no respecter of persons, no matter how strict 
 their own personal sanitary standards may be. 
 
 How, or why, the parasitic powers of the 
 SpirochcBte pallida first declared themselves in 
 unlawful, not in lawful sexual intercourse, is a 
 mystery. But it is certain that this organism 
 is never met with in the relation of mar- 
 riage unless it has been brought from with- 
 
Syphilis 35 
 
 out. Excesses in the marriage relation, though 
 productive of other evils, do not bring on 
 venereal diseases. If, as some writers state, 
 even polygamy does not promote them, then 
 it would seem as if the original exciting cause 
 favourable to the parasitic vigour of the Spiro- 
 clicBte pallida must have been in some way related 
 to the numbers and variety of male beings who 
 practised a heterogeneous promiscuity. How- 
 soever their derivation might be traced, prostitu- 
 tion is now as certainly the abiding-place and 
 inexhaustible source of this as of other germs of 
 venereal disease, as the marshy swamp is the 
 abode of the malaria-carrying mosquito, or the 
 polluted water supply of the typhoid bacillus. 
 Pontoppidan of Copenhagen says: ''Even if 
 contagion is carried in different ways, its origin can 
 nearly always be traced back to prostitution." 
 And Bulkley says: ''Prostitution undoubtedly 
 stands foremost as a cause of syphilis and far 
 outweighs all other causes together." Again, 
 he says: "In the enormous majority of cases 
 syphilis is acquired in illicit intercourse." Osier 
 says, "Inextricably blended with it [the social 
 evil] is the prevention of syphilis." Morrow 
 speaks of "The original source of these infections 
 
36 Hygiene and Morality 
 
 in that irregular commerce between the sexes 
 known as prostitution.'* 
 
 Since the discovery of the germ of syphilis there 
 appears some tendency on the part of some medical 
 writers to remove syphilis from the list of venereal 
 diseases. As has been mentioned, it is frequently 
 classified separately, thus: "Syphilis and the 
 Venereal Diseases." The argument is that, with 
 the fuller knowledge of its many modes of trans- 
 mission, its constitutional features, and heredita- 
 bility, its venereal stigma should be removed. 
 Yet, as, although a germ disease, its germ does 
 not appear to be distributed generally, like the 
 pus-producing germs ; as the disease syphilis never 
 breaks out afresh under normal conditions, nor 
 develops from the germ in the course of moral liv- 
 ing, but is cultivated in morally unclean sexual 
 relations, then it does not seem incorrect to call 
 it a venereal disease, even though it may be com- 
 municated to moral and innocent individuals in 
 non-venereal ways arising in the ordinary contact 
 of daily life. The important things to know are: 
 That it is cultivated in prostitution and thence 
 spread through the community in ways which 
 are to be mentioned in detail. These ways are 
 classified by Bulkley as follows : 
 
Syphilis 37 
 
 I. Inherited. II. Marital. III. Extra- genital. 
 
 I. The hereditary communicability of syphilis 
 has been discussed. 
 
 II. The marital mode of transmission is the 
 infection of one partner (usually the wife) by the 
 other during the performance of the act of genera- 
 tion. As this act offers the most favourable 
 possible opportunity for infection of such a nature 
 to be carried, it results that by far the greatest 
 proportion of cases that are innocently or acci- 
 dentally received — a proportion that is variably 
 estimated — have been conveyed in the marriage 
 relation. 
 
 III. With the knowledge of the micro-organism 
 and its presence in all syphilitic lesions and in the 
 discharges from primary sores, ulcers, mucous 
 patches, secretions of the mouth and nose, etc., 
 it may be readily understood that the opportu- 
 nities for infection to be conveyed in the ordinary 
 processes of daily life, especially when people live 
 under crowded or uncleanly conditions, are very 
 numerous. 
 
 That syphilis is not more frequently conveyed 
 by incidental contact than is actually the case is 
 due to the, fortunately, very short life of the 
 germ outside the human body. 
 
38 Hygiene and Morality 
 
 All of the common acts of daily life may serve 
 as means of infection during the brief period 
 of the parasite's existence, viz., eating and drink- 
 ing from cups and saucers, knives, forks, and 
 spoons that may have been in contact with the 
 lips of a syphilitic; putting pencils, pins, money, 
 whistles, or any other article in the mouth after 
 it may possibly have been in that of an infected 
 person. 
 
 Towels, handkerchiefs, pillow-cases, or any 
 article of bedding as well as water-closet seats 
 and bath-tubs may serve as carriers. Surgical 
 and dental instruments, shaving apparatus, med- 
 ical appliances in familiar use, as bulbs, sprays, 
 douche bags, spatulas, and syringes, may convey 
 the poison. Cases have been recorded where it 
 has been inoculated during the process of vaccina- 
 tion, and occasional known instances of this kind 
 have had much to do with strengthening the 
 objections of anti-vaccinationists and intensifying 
 the popular prejudice against vaccination that is 
 found in some communities. Syphilis has also 
 been conveyed in circumcision and other slight 
 operations. 
 
 Laundresses and rag-pickers have not infre- 
 quently been infected by soiled or cast-off clothing; 
 
Syphilis 39 
 
 physicians and surgeons are always liable to this 
 danger in the course of their professional work; 
 midwives are exposed during the delivery and 
 care of patients; nurses have been infected while 
 caring for patients, the nature of whose illness 
 had not been made known to them, and with whom 
 they were therefore not as vigilantly on guard 
 as they should have been. 
 
 Most dangerous of all the avenues of accidental 
 infection is contact with the person of the syphili- 
 tic, on account of the probability of then receiving 
 germs that are living and virulent. Any such 
 contact with the lips, teeth, or tongue is es- 
 pecially dangerous, such as kissing (an act which 
 is known to have been the cause of many innocent 
 cases), pla^rful biting or mouthing (such as is 
 often carried on playfully between children and 
 adults), sucking wounds, licking with the tongue, 
 etc. 
 
 The syphilitic baby is an especially infectious 
 object because of the many necessities of the 
 baby for close personal care and handling in feeding 
 and bathing it. 
 
CHAPTER II 
 
 gonorrhcea and chancroid 
 
 /"^onorrhcea; its Specific Micro-organism. 
 ^^ Gonorrhoea is caused by an organism called 
 Gonococcus gonorrhcece which was discovered by 
 Neisser in 1879 and has been especially studied 
 and described by Bumm. As it is usually seen 
 in pairs, it is also called the Diplococcus gon- 
 orrhxcB or the Micrococcus of Neisser. It is 
 cultivable with difficulty, and does not survive 
 many transplantations, yet transplanting does 
 not lessen its virulence. It is always found in 
 gonorrhoeal pus, but is never found in other 
 inflammatory conditions unless these are of 
 gonorrhoeal origin. It is said to perish quickly 
 in sunlight and to be killed in a few hours by 
 drying. Experimentation with it in the inocu- 
 lation of animals has been attended with special 
 and unusual difficulties. 
 
 The Gonococcus gonorrhcece can live for years, 
 
 or indefinitely, in the human tissues in a dormant 
 
 40 
 
Gonorrhoea and Chancroid 41 
 
 or latent state, latent gonorrhoea being frequent 
 in both men and women. This characteristic, 
 imknown until the day of bacteriological study 
 with the microscope, and not immediately dis- 
 covered even then, gives the disease a specially 
 uncertain character and makes it quite as treacher- 
 ous as syphilis, if not even more so. 
 
 After remaining latent for a long time, perhaps 
 for years, the organism of gonorrhoea, if conveyed 
 to the sound and healthy tissues of another indi- 
 vidual (such tissues being spoken of, in regard 
 to the organism, as ''virgin," or "sterile" tissues), 
 finds its most favourable conditions for growth 
 and then excites an actively acute inflammation 
 and displays its utmost virulence. 
 
 History of Gonorrhoea. Gonorrhoea is pri- 
 marily a genito-urinary disease, and was for- 
 merly believed to be a purely local affection. It 
 is supposed to be as old as the human race, and, 
 like syphilis, its main line of propagation has 
 always been in the promiscuous intercourse of 
 prostitution, whence it has been disseminated 
 in every direction. Ancient writings specify its 
 symptoms with enough exactitude to make its 
 identity plain. This identity was lost in the 
 
42 Hygiene and Morality 
 
 epidemic of syphilis in the 15th century, to which 
 allusion has been made. During the i8th century 
 the difference between syphilis and gonorrhoea 
 might have been rediscovered, had not an inexact 
 experiment of the celebrated John Hunter caused 
 the medical profession to regard all venereal dis- 
 eases as one up to the time of the work of Ricord. 
 If syphilis has only been fairly well understood 
 for the last half -century, gonorrhoea, at least in 
 so far as women are concerned, has only been 
 estimated according to its real gravity in the 
 last decade, though Neisser made his discovery 
 in 1879. In 1857 two medical writers, Bernitz 
 and Goupil, had made studies of gonorrhoeal in- 
 fection of the Fallopian tubes, but had found no 
 followers. In 1 878 Noeggerath sounded a warning, 
 declaring that individuals with gonorrhoea could 
 remain infectious during a lifetime, but he was 
 regarded as an alarmist and his statistics of the 
 frequency of gonorrhoea in married men as ex- 
 aggerations. Gonorrhoea had been regarded as 
 an ordinary *' catarrhal" inflammation of the 
 mucous membrane, locating itself usually in the 
 urethra, and as, in men, the disease was well 
 known to be acquired in promiscuous sex relations, 
 it was commonly regarded with indifference, or 
 
Gonorrhoea and Chancroid 43 
 
 even with levity, as a proof of rakishness, the 
 purulent discharge being colloquially described 
 in military countries as the "goutte militaire." 
 
 In the light of modem knowledge of the dis- 
 astrous part taken by the gonococcus of gonorrhoea 
 in that sad array of obscure and unnecessary ail- 
 ments which have been erroneously called "Dis- 
 eases of Women," the traces of this levity make 
 painful reading, found, as they are, even in 
 medical writings of a generation ago or less. 
 To-day, instead of being regarded as a local 
 disease, gonorrhoea also, like syphilis, is known 
 to develop constitutional disturbances of a serious 
 and chronic nature, and suggestions are not 
 wanting that the former point of view will soon be 
 antiquated. 
 
 Course and Symptoms of Gonorrhoea. Osier 
 
 divides the course of gonorrhoea into three 
 stages : 
 
 1. Primary infection. 
 
 2. Extension through the entire genito-urinary 
 tract. 
 
 3. Systemic infection. 
 
 Primary Infection. The period of infection 
 is from twelve hours to a week or more, the average 
 
44 Hygiene and Morality 
 
 being one or two days. In adults the urethra 
 is usually the point of infection, or, in women, it 
 may be also the cervix uteri, for the reason that the 
 delicate linings of these parts are only weakly 
 resistant and are easily penetrated by the bacillus. 
 The uninjured squamous epithelium of the adult 
 is not easily infected. With little girls, infection 
 usually attacks the vulva and vagina, by reason 
 of their delicate structure in childhood. 
 
 The symptoms of the primary stage are those 
 of an ordinary acute local infection, with itching 
 and burning of the parts, redness and swelling, 
 pains, often intense, on urination, and a discharge, 
 first mucous and finally purulent, with oedema 
 of the surrounding tissues, excoriations, multiple 
 abscesses, and perhaps hemorrhage from swollen 
 papillae. To the eye there is nothing to distin- 
 guish the symptoms from those of an ordinary- 
 inflammation, and only the microscope makes the 
 diagnosis positive. Formerly, it was believed that 
 cure had taken place when the discharge ceased. 
 It is now known that this is far from being the 
 case. 
 
 Second Stage. The inflammation now goes 
 on and involves the organs of generation and 
 the urinary tract, ascending the ureters and. 
 
Gonorrhoea and Chancroid 45 
 
 spreading, it may be, to the kidneys, where it may 
 produce a fatal pyelitis. In women a large 
 proportion of all cases of cystitis, salpingitis, 
 metritis, ovaritis, and pelvic peritonitis, as well 
 as many cases of infection after childbirth are 
 caused by the gonococcus. 
 
 The most serious, because irreparable, action of 
 gonorrhoea upon the organs of generation is to 
 cause sterility in both men and women. The 
 frequency with which this sequel occurs will be 
 referred to under ''Statistics." In women this 
 sterility is sometimes brought about by occlusion 
 or blocking of the Fallopian tubes. Again, there 
 is what is called ''one-child sterility." When 
 this happens, the gonococcus, at first restricted in 
 its location to the cervix uteri, is enabled owing 
 to the relaxation of the parts after childbirth, to 
 extend to the tubes and ovaries. Or, again, the 
 necessity of complete operative removal of all 
 the female organs of generation effectually puts an 
 end to all expectations of maternity. 
 
 The Destruction of Eyesight. Calamitous 
 as are the sequels of gonorrhoea to the adult, 
 especially to the married woman, no other single 
 effect wrought by it can compare with the tragedy 
 
46 Hygiene and Morality 
 
 of infants, blinded at birth by virulent gonorrhoeal 
 poison, which enters the eyes during the infant's 
 passage through the vaginal canal. This, too, 
 will be referred to under "Statistics." Gonor- 
 rhoea! poison is most actively destructive of the 
 cornea, and the danger of incurring blindness 
 from having the eyes infected with pus or dis- 
 charge containing this virus is equally as great 
 for adults as for infants. The opportunity for 
 infection is less, yet blindness of older children 
 and adults from the gonococcus received from 
 towels, sheets and pillow-cases, fingers, hand- 
 kerchiefs, etc., is frequent, and cases have occurred 
 where nurses have lost one or both eyes through 
 lack of sufficient precautions. 
 
 Third Stage. The constitutional forms of 
 gonorrhoea include, besides disease of the kidneys 
 already mentioned, gonorrhoeal arthritis, an 
 intractable and obstinate form of rheumatism, 
 prone to relapses, and gonorrhoeal endocarditis. 
 These are regarded as its two most serious consti- 
 tutional sequels. There is also a gonorrhoeal 
 septicaemia. Authorities mention a urogenital tu- 
 berculosis, to which chronic urethritis has the re- 
 lation of a predisposing cause. Morrow speaks of 
 
Gonorrhoea and Chancroid 47 
 
 this as a recent acquisition of knowledge, and 
 adds that modern investigations are showing 
 that it is possible for the gonococcus to be taken 
 up by the blood and lymph and carried to all 
 organs of the body, and that it may affect them 
 all injuriously. It has been found in the brain 
 and cord, the pleura, the liver, spleen, and kidneys, 
 the endocardiimi, the sheaths of tendons and of 
 joints, and in the periosteum. Finally, it may 
 not be amiss to place imder the constitutional 
 effects of the gonococcus that innumerable army 
 of chronically semi-invalided married women of 
 all ages, who, without having clearly defined loss 
 of health, "have never been well since married," 
 whose whole existence is a drag and who have often 
 failed to find the commiseration due them, this 
 having indeed been oftener given to the husbands, 
 whose lot in having ailing wives was all unknow- 
 ingly due, in many cases, to their own transmission 
 to these imsuspecting and imf ortunate women of 
 the deadly gonococcus of Neisser. 
 
 Modes of Transmission. Though in the 
 majority of cases the germ is conveyed during 
 the act of coitus, it is also possible for it to be 
 carried in the contact of daily life, and it is only 
 
48 Hygiene and Morality 
 
 the brevity of its existence after being dried that 
 saves many cases from infection. Infection from 
 unclean water-closet seats is frequent, instances 
 having been known where a whole series of 
 cases of vulvo-vaginitis have arisen from this 
 cause. It is pointed out by medical writers that 
 it is not necessary to conclude that little girls 
 with a gonorrhoeal discharge have been violated 
 or addicted to bad practices (though such may 
 have been the case) as it is quite possible for them 
 to have contracted the disease from badly kept 
 school closets, or from sleeping in the same 
 bed and being contaminated by the sheets or 
 clothing of diseased persons. Family towels 
 under such circumstances are sources of danger, 
 and public baths and tubs are also known to 
 have been media of contagion. 
 
 Immunity and Anti-Serum Treatment. It 
 is not believed that there is immunity against 
 the gonococcus. Serum treatment has been tried 
 in certain forms of constitutional disease, and 
 beneficial results have been claimed in the case of 
 rheimiatism. The Lister Institute prepares an 
 "Anti-gonococcus Vaccine," which is a preparation 
 of dead gonococci that is said to be poisonous 
 
Gonorrhoea and Chancroid 49 
 
 to the living germ.* It is probably too early 
 to find anything quite authoritative upon this 
 line of study. 
 
 The statistics of gonorrhoea are so startling as 
 to seem almost incredible. Like those of syphilis, 
 they are drawn from the records of hospitals and 
 medical practitioners, as health boards ignore the 
 existence of venereal diseases. 
 
 Prevalence of Gonorrhcea. Morrow quotes 
 Neisser to the effect that gonorrhcea is the most 
 widespread and universal of diseases in the 
 adult male. European records indicate that 
 about seventy-five per cent, of all men have 
 gonorrhoea. 
 
 Assuming that a somewhat better moral stand- 
 ard prevails in the United States, it is given as 
 a conservative estimate that the prevalence of 
 both gonorrhoea and syphilis among men is at 
 least sixty per cent. Morrow says that it is im- 
 possible to estimate accurately the extent to which 
 gonorrhoea is conveyed to wives in marriage, but 
 that it is generally agreed that this is greater than 
 is generally suspected. Statistics gathered in New 
 York City by the Committee of Seven indicated 
 
 » British Medical Journal, Feb. 27, 1909. 
 4 
 
50 Hygiene and Morality 
 
 that nearly thirty per cent, of all venereal diseases 
 of women in that city had been transmitted in 
 marriage by the husbands. The remainder (leav- 
 ing out hereditary transmission and accidental 
 infection) would probably be found among pros- 
 titutes. As to these unfortunate centres of 
 infection, J. Taber Johnson estimates, conserva- 
 tively, that at least thirty per cent, of their whole 
 mortality is due to gonorrhoea. 
 
 Sterility. Neisser regards gonorrhoea as re- 
 sponsible for more than forty -five per cent, of sterile 
 marriages, while Morrow points out that these 
 figures refer to primary, not to secondary sterility, 
 which is additional. Gonorrhoea is the foremost 
 cause of male sterility. One specialist found 
 thirty cases of male sterility in ninety-six sterile 
 marriages, while the statement is made by Morrow 
 that men are ultimately responsible for from fifty 
 to seventy-five per cent, of all sterility in married 
 life. In from twenty to twenty-five per cent, of 
 such cases, the husband is sterile. In the others, 
 he has infected the wife, making her sterile. 
 
 The extent of secondary sterility is not known. 
 A major share, then, of all sterility is to be laid 
 at the door of the gonococcus. 
 
Gonorrhoea and Chancroid 51 
 
 Diseases of Women. The responsibility of 
 the gonococcus in causing these diseases is vari- 
 ably estimated by different surgeons, ranging 
 from forty to eighty per cent. All cases of 
 pus in the Fallopian tubes are gonorrhceal, while 
 at least fifty per cent, of all gynaecological opera- 
 tions are necessita ed by the gonococcus. This is a 
 conservative estimate, some gynsecologists giving 
 figures from their own practice that are much 
 higher. 
 
 Blindness. Eighty per cent, of all the puru- 
 lent ophthalmia of infants is gonorrhceal, and from 
 fifteen to twenty-five per cent, of all the blindness 
 in America is due to the same cause. Neisser 
 says that Germany alone has 30,000 blind persons 
 whose affliction was caused by gonorrhceal pus, 
 while in Paris the institutions for the blind show 
 that forty-five per cent, of the cases have been 
 due to this infection. 
 
 Summary of Syphilis and Gonorrhcea. The 
 
 consensus of expert medical opinion is, that, as 
 a depopulating factor, gonorrhoea is more formid- 
 able than syphilis, and that it is also more perilous 
 
52 Hygiene and Morality 
 
 to the wife. Syphilis is more destructive to the 
 life of offspring; gonorrhoea more destructive 
 to the female organs of generation and to the 
 general health. The hereditary quality and slow 
 development of syphilis constitute its chief terrors, 
 but the treacherous nature and persistent vitality 
 of the gonococcus make gonorrhoea almost, if not 
 quite, as terrible. Syphilis is, as a rule, more 
 curable. The prognosis of gonorrhoea is always 
 most uncertain. Both show certain types which 
 are believed to be incurable. 
 
 Taking them together, they seem to exhibit the 
 true race suicide, and both, says Taber Johnson, 
 are intimately connected with the degeneration 
 of races and the downfall of nations. Grandin 
 says: *'Man, largely through ignorance of the 
 calamities following the misuse of this [the re- 
 productive] instinct, has converted it into one 
 for the extermination of the species." 
 
 Chancroid (Venereal Sore; Soft Chancre J. 
 The identity of the specific micro-organism of this 
 last of the venereal diseases is still uncertain. A 
 strepto-bacillus called the bacillus of Ducrey has 
 been demonstrated in the soft chancre but it 
 has not been proved to be its sole or specific cause. 
 
Gonorrhoea and Chancroid 53 
 
 Clinically, Bassereau, in 1856, determined that 
 chancroid and syphilis were not the same. Never- 
 theless mistakes in confusing the two were fre- 
 quently made until the organism of syphilis was 
 discovered. 
 
 Venereal sore is by far the simplest and least 
 dangerous of the three diseases under considera- 
 tion. If treated promptly it is readily curable, 
 though, if neglected, serious complications may 
 ensue and cure be a more difficult matter. The 
 incubation period is short; from several hours to 
 several days. The first manifestation is a small 
 nodule which proceeds rapidly toward suppuration, 
 forming a painful ulcer with an intensely infectious 
 discharge. The ulcer is deep and irregular, and 
 its tendency is to spread and become multiple. 
 Herein lies the danger of complications. Neg- 
 lected ulcers may involve the glands and other 
 parts in their vicinity with much consequent 
 destruction of tissues locally, but the disease 
 has no constitutional complications, nor has it/ 
 sequels or belated manifestations. If properly 
 treated from the outset, from four to six weeks 
 suffice for cure. It only runs a prolonged course 
 
 when neglected. 
 
 Venereal sore is always located on the genitalia. 
 
SOURCES OF MATERIAL USED IN THE PRE- 
 PARATION OF PART I 
 
 Bloch, Ivan, Der Ursprung der Syphilis. Jena, 1901. 
 Bolduan, Charles Frederick, M.D., Immune Sera (Appendix 
 
 A: Serum Diagnosis of Syphilis). New York, 1908. 
 Bulkley, L. D., M.D., Syphilis in the Innocent. New York, 
 
 1894. 
 Bull, Ophthalmia Neonatorum and its Prophylaxis. In New 
 
 York Medical Journal, May 15, 1909. 
 Findlay, Palmer, M.D., Gonorrhoea in Women. 1908. 
 Forel, August, M.D., Alcohol and Questions of Sex. In Re- 
 port of the International Congress against Alcohol. 1905. 
 Forel, August, M.D., Alkohol und venerische Krankheiten. 
 
 In Report of the International Congress against Alcohol, 
 
 1901. 
 Fournier, Alfred, Syphilis et Mariage. Paris, 1890/ 
 Fournier, Alfred, Traite de la Syphilis. 1903. 
 Francke, Hermann, M.D., Beitrag zur Entwickelung bosarti- 
 
 ger Geschwulste auf dem Boden alter Syphilitischer Nar- 
 
 ben. Wiirzburg, 1894. 
 Horaud, Ren6 Denis, M.D., Syphilis et Cancer. Lyon, 1907. 
 Johnson, J. Taber, M.D., The Influence of Gonorrhoea as a 
 
 Factor in Depopulation. In Journal of the American 
 
 Medical Association, August 10, 1907. 
 Metchnikoff, Elie, The Microbiology of Syphilis. In A 
 
 System of Syphilis. Edited by D'Arcy Power and J. 
 
 Keogh Murphy. London, 1908. 
 Morrow, Prince A., M.D., Gonorrhoeae Insontium, especially 
 
 in Relation to Marriage. In New York Medical Journal, 
 
 June 27 and July 4, 1903. 
 Morrow, Prince A., M.D., Prognosis and Relation of Syphilis 
 
 54 
 
Sources of Material Used 55 
 
 to Marriage and Heredity. In Medical News, Sept. 2, 
 
 1907. 
 Morrow, Prince A., M.D., Social Diseases and Marriage. 
 
 New York, 1905. 
 Mott, Syphilis. In British Medical Journal, Feb. 27, 1909. 
 Noeggerath, Emil, AI.D., Die latenteGonorrhoe im weiblichen 
 
 Geschlecht. Tr. Amer. Gyn. Soc. I. 1876. 
 Osier, William, M.D., Practice of Medicine. [Syphilis and 
 
 Gonorrhoea.] London and New York, 1909. 
 Pontoppidan, Erik, M.D., What Venereal Diseases Mean 
 
 and How to Prevent Them. Translated by W. Jessen. 
 Ravogli, Syphilis in Relation to Crime. In Ohio State 
 
 Medical Journal, August, 1906. 
 Rogers and Torrey, The Treatment of Gonorrhoeal Infection 
 
 by a Specific Antitoxin. In Journal of the American 
 
 Medical Association, Sept. 14, 1907. 
 System of Medicine, A. [Syphilis, etc.] Edited by Allbutt. 
 
 London, 1906. 
 System of Syphilis, A. [Several Authors.] Edited by D'Arcy 
 
 Power and J. Keogh Murphy. London, 1906. 
 Taylor, Prognosis in Syphilis. In Medical News, Sept. 2, 
 
 1907. 
 Torrey, An Antigonococcus Serum. In Journal of the Ameri- 
 can Medical Association, Jan. 2"]^ 1906. 
 
Part IL Prostitution 
 
 57 
 
CHAPTER I 
 
 CONTROL AND REGULATION OF PROSTITUTION 
 
 T^HERE is a long and revolting history of the 
 ■■• spasmodic attempts made from time to time 
 during the past ages to control or punish prostitu- 
 tion. These attempts usualty took the form 
 of grotesque and brutal punishments for women, 
 rarely for men. As a rule, the vicious male 
 seems to have been overlooked or regarded as an 
 insignificant factor in the problem. Punishments 
 meted out to the woman were chiefly hypocritical 
 or vindictive, not in the least preventive. Some- 
 times she was put into an iron cage and dipped 
 into the river, — almost but not quite drowned; 
 sometimes her nose was cut off ; or she was whipped 
 or compelled to w^ear a distinguishing dress. 
 She has always been the victim of blackmail, 
 and the methods by which this has been levied 
 show a remarkable similarity right down through 
 the ages to modem times: they were usually 
 
 59 
 
6o Hygiene and Morality 
 
 the enactment of non-preventive legislation, of 
 a petty and harassing character, with the im- 
 position of heavy fines for breach of observance. 
 As such legislation simply made it more difficult 
 for her to earn her bread in the only way open to 
 her, it of course had to be violated, and the fines 
 collected were divided between the accuser and 
 the city government. Perhaps this mode of profit- 
 sharing is not yet obsolete. It is needless to give 
 much time to the painful details of centuries 
 that are gone, and it will suffice to state simply 
 that all such legislation rested, as it still does, 
 on the acceptance (once unquestioned, but to- 
 day no longer so) of the double standard of 
 morals. 
 
 The Double Moral Standard. The essential 
 feature of the double code or standard of morals 
 is the entire absence of logical sequence. There- 
 from results the injustice which is so strik- 
 ing, both from the standpoint of reason and of 
 humanity. 
 
 The double standard tacitly permits men to in- 
 dulge freely and unchecked in sexual irregularity 
 without consequent loss of social standing, but it 
 dooms the women who are necessarily involved 
 
Control of Prostitution 6i 
 
 in these irregularities to social ostracism and 
 even to complete degradation. 
 
 In order to justify immoral practices among 
 themselves and to have a plausible explanation 
 ready if criticism offered, the doctrine of "physical 
 necessity" has been invented for men by them- 
 selves, and has even been fortified by the positive 
 teachings of prominent medical men. This doc- 
 trine, however, has never been extended to women, 
 but, instead, the cowardly and cruel theory of in- 
 nate depravity has been industriously dissemi- 
 nated as applying to "fallen women," thus 
 skilfully ensuring an isolated position for these 
 unfortunates, and effectually checking the out- 
 growth of pity for them among women of the 
 protected classes. The practical resiilts of this 
 psychological jugglery have been, that, of two 
 partners in one and the same act, neither one of 
 whom could execute this act alone, and with 
 whom, if the element of compulsion entered as a 
 complication, it could not possibly be present 
 in the case of the stronger partner, — men, the 
 stronger, have remained free from blame ; women, 
 the weaker, have lived under a curse. 
 
 The fact that this way of regarding the woman 
 concerned disproves the argument of "physical 
 
62 Hygiene and Morality- 
 
 necessity" is only a part of the illogicality of the 
 whole. It is evident that, if unregulated sexual 
 practice were really necessary for men, there 
 could be no element of shame or wrong in it, and 
 there could therefore, obviously, be none for the 
 women, for no act that is physically necessary is 
 wrong, no matter how primal it may be. 
 
 In order to give strength to the social structure 
 of prostitution, certain catch phrases have been 
 passed current to act as mental hypnotics. For 
 instance: " Prostitution must always exist, because 
 it always has existed. Because it always has 
 existed, therefore it always must exist." But it 
 will be seen that, in company with this dictum, 
 there have always gone very definite social and 
 legal contrivances for ensuring its existence. 
 
 Modern Systems of Regulation. In spite of 
 the hitherto generally accepted belief in the neces- 
 sity and right of men to practise sexual irregularity, 
 the presence of prostitution in the community, 
 though the inevitable result of such practice, has 
 been regarded as a "social evil," partly because of 
 its accompaniment of disease. In order to minimise 
 the danger of disease while maintaining prostitu- 
 tion, associations of men have, in the past, set 
 
Control of Prostitution 63 
 
 themselves to the task of making vice safe, by 
 establishing systems of " Regulation" with medical 
 inspection of female prostitutes. This device 
 originated, it is said, with Napoleon Bonaparte, 
 who thought it proper that women should be 
 sacrificed to his soldiers, but did not wish the 
 soldiers to be invalided. Since his day, regulatory 
 systems have been established in most European 
 countries. They vary somewhat in detail, and 
 have been roughly divided into three types: 
 the Scandinavian, the simplest and the most free 
 from obnoxious features, combining a certain 
 amount of police supervision with the compulsory 
 reporting of venereal diseases and ample free 
 medical service without a stigma attached to it; 
 the German, sometimes called Neisser's system, 
 highly complicated, with some slight attempt 
 at more logic than is foimd in the third, called 
 the unilateral system, and which has been adopted 
 in many foreign countries, having reached its most 
 notorious development in France, where, in the 
 main, it is still in force, though it is probable that 
 its downfall is near. 
 
 Opposed alike to all systems of state or 
 police regulation of prostitution are the principles 
 of the abolitionists, to be discussed later, and 
 
64 Hygiene and Morality 
 
 of the most modem and wisest socio-medical 
 teachers. 
 
 The organisation of the unilateral system was 
 as follows: A special department of poHce, 
 called Morals Police {Police des Mceurs), was 
 authorised to regulate and control prostitution 
 as, in general, the head of the department saw 
 fit ; that is, ordinarily no public legislation defined 
 their powers, but these were defined in police 
 codes and in municipal ordinances. At the 
 very outset, therefore, the women thus dealt 
 with were excluded from the realm of the common 
 law. The police had full power to arrest any 
 women whom they might "believe" or ''suspect," 
 or "have reason to think" were immoral. This 
 part of their powers rested chiefly upon a spy 
 system of plain-clothes men, and anonymous 
 letters were regarded as valuable sources of 
 information. Arrest was followed by forcible 
 medical examination, and the woman's name and 
 address were inscribed on the lists in the police de- 
 partment. Every two weeks, or at other spec- 
 ified times, she was compelled to appear for 
 examination, and, if found diseased, was confined 
 in what was essentially a hospital prison. 
 < The one-time head of the Morals Police of 
 
Control of Prostitution 65 
 
 Paris, when asked wherein lay the chief strength 
 of his system, repHed: "Arrests; always arrests; 
 more and more arrests; that is our only hope." 
 
 That innocent women were often subjected to 
 arrest and even imprisonment under this system 
 was regarded as an unavoidable incident. 
 
 The unfortunates under police surveillance 
 could never hope to escape from their life. 
 Hounded by the police wherever they went, their 
 outlook was described by Dr. Mireur, a defender 
 of the system, in these words : 
 
 Cut off, not only from society hut from heaven; from 
 hope, and from the power to repent; nevertheless 
 [he added] inscription and licensing are essential, 
 indispensable, even as prostitution itself. 
 
 All systems of regulation alike brought into 
 existence the licensed or "tolerated" houses of 
 ill-fame, and such houses were protected by the 
 police. Their keepers possessed a certain status 
 by reason of this connection, and the appearance 
 of recognition and support by the government 
 confused the moral sense of the people. The 
 keepers of such places have alw^ays been active 
 supporters of regulative acts, because the women 
 are then more completely helpless. A German 
 
66 Hygiene and Morality 
 
 chief of police admitted in his reports that the 
 inscription of prostitutes by the pohce aggravated 
 their abject condition in a horrible manner, while 
 a member of the Reichstag once said: "It is well 
 known that these are marked women and can 
 never reform." 
 
 Such is the system, which, with varying modi- 
 fications and with some differences of detail 
 as to the harshness with which it has been or is 
 enforced, still prevails widely under the general 
 term, *' The Continental System of the Regulation 
 of Vice." It has recently been discarded in Italy, 
 and has been strongly condemned by public 
 commissions in France. Switzerland has given 
 it up, except in Geneva, where it is in force in 
 full ignominy. 
 
 It seems almost incredible that there are many 
 who would willingly see this system implanted in 
 the United States. More than one attempt has 
 been made to introduce it into this country, and 
 arguments in its favour are not infrequently 
 heard. It is for this reason, among others, that 
 women should be informed and alert upon a sub- 
 ject which would otherwise seem too horrible to 
 contemplate. 
 
 The continental system of licensed houses of 
 
Control of Prostitution 67 
 
 ill-fame, as will be seen in a later chapter, has 
 been the breeder for the white slave traffic, and 
 these houses have been the main market of the 
 traders and have afforded the trade its security. 
 The unfortunate women hate the hcensed houses 
 because of their tyrannous features, and it has 
 never been easy to fill the vacancies caused by 
 disease and death. An organised system of 
 supply and demand has therefore grown up, 
 having developed early in the 19th century, not 
 very long after the establishment of the regulation 
 system. It must be explained that no govern- 
 ment has ever consciously encouraged a white 
 slave trade, but this has been the logical though 
 unforeseen result of giving the tolerated houses a 
 recognised status. 
 
 The Introduction of State Regulation into 
 Great Britain. The strongest bulwark of regu- 
 lated vice in all countries has been the military 
 element. It has been a generally accepted under- 
 standing that armies of men must have free 
 access to abandoned women, and it has always 
 been a subject of serious concern with authorities 
 to make this vice as safe as possible, in order that 
 the fighting strength of regiments might be 
 
68 Hygiene and Morality 
 
 maintained in its efficiency. The necessary sac- 
 rifice of women involved in this point of view 
 brought forth no protests, even from women, until 
 the women of England were aroused to it by an 
 attempt made to force the continental system upon 
 that country. 
 
 The Contagious Diseases Acts. Early in 
 the 19th century the military hierarchy had 
 been desirous of establishing a regulated system 
 in England, but the time did not seem propitious 
 until well along in the mid-century, when the 
 purpose crystallised. 
 
 A woman sounded the first warning. Harriet 
 Martineau, with her finger always on the political 
 pulse, foresaw the coming danger, and wrote 
 several powerful letters of protest to the Daily 
 News in 1859. I^ i860 a Committee of the House 
 of Lords sat to consider the advisability of intro- 
 ducing compulsory acts into India. Miss Martin- 
 eau, in her autobiography, says that Florence 
 Nightingale was called to give her opinion, and 
 spoke strongly, with positive testimony against it. 
 Nevertheless, between 1864 and 1869, the sys- 
 tem was established in Great Britain by a series of 
 Acts of Parliament passed with such haste and 
 
Control of Prostitution 69 
 
 secrecy that, as is authoritatively stated in many 
 published sources of reference, only about one 
 tenth of the members knew of them. Introduced 
 in late night sessions and rushed through with sur- 
 reptitious haste, the first and second were only 
 entering wedges, but the third established the full 
 programme of regulation for all garrison towns and 
 within a radius of fifteen miles around each one. 
 
 The first to give publicity to the new legislation, 
 which was enforced with great secrecy, was the 
 head of a Home for Girls, Daniel Cooper, who 
 first suspected the onset of something new and 
 menacing, and finally succeeded in obtaining a 
 copy of the Acts. He exposed their iniquity, 
 and was supported by two physicians, Dr. Charles 
 Bell Taylor and Dr. Worth, who denounced 
 them vigorously. But no headway was made 
 in opposing them until all the moral forces of 
 England were finally united under the leadership 
 of Mrs. Josephine E. Butler, — one of the rare 
 characters of the world, a perfect example of the 
 exalted and fearless type of ideal womanhood; — 
 one whose maternal protectiveness extended to 
 every young and helpless creature. 
 
 Scope of the Acts. The Acts empowered 
 policemen in plain clothes, acting as spies, to arrest 
 
^o Hygiene and Morality 
 
 any woman in the territory covered by the law. 
 The police were only obliged to ''declare" that 
 they "had reason for believing" the women to 
 be immoral; it was therefore impossible to punish 
 them for arresting innocent women, nor could 
 informers be punished. Women thus arrested 
 were requested to sign a paper called a ''voluntary 
 submission" (and ignorant ones were easily 
 coerced into it) promising to present themselves 
 at the periods ordered for medical examination, 
 and, as an alternative, they had to defend their 
 reputations in court. If they refused to submit 
 to the medical examination, they could be sent 
 to prison for disobedience. If, when examined, 
 they were found to be diseased, they were com- 
 mitted to a hospital prison for compulsory treat- 
 ment. If resistant, they were taken there by 
 the police, and if they left it before being dis- 
 charged they were liable to imprisonment with 
 hard labour for one or two months. Under such 
 a law, as an English writer pointed out, the police 
 spies, acting on hints given them by persons acting 
 in jealousy or revenge, or from motives of black- 
 mail, "held the honour and reputation of every 
 woman among the poorer classes absolutely at their 
 disposal." 
 
Control of Prostitution 71 
 
 Mrs. Butler's Crusade. The women of 
 England, united under Mrs. Butler's leadership 
 in a national association, issued a declaration that 
 the law was an insult and an outrage to every 
 woman in the land, and protested against it on the 
 following grounds : That laws are bound to define 
 offences punishable by law. (No definition of 
 prostitution was given in the Acts. It is indeed 
 most difficult to define it technically and legally, 
 and this difficulty has given rise to active con- 
 troversy in every country where regulation has 
 been in force.) That it was unjust to punish 
 women only, and that the forced medical examina- 
 tions were degrading punishments. That the 
 Acts made it easier for yoimg men to be impure. 
 That the measures of enforcement were brutalising 
 to all who took part in them. That venereal 
 diseases had never been extirpated by such means, 
 because their causes were moral and must be met 
 by moral prevention. That to examine, treat, 
 and isolate women only, while allowing infected 
 men to go free, was a farce. 
 
 But a still higher groimd was taken. Mrs. 
 Butler insisted, in her speeches and writings, 
 that the abolition movement was not merely 
 a sex revolt, but was based on the conviction that 
 
72 Hygiene and Morality 
 
 impurity was as perilous for men as for women. 
 It was as citizens first, and as women secondly, 
 that they were in conflict with legislation that 
 practically created a slave class. In her book. 
 The Constitution Violated, Mrs. Butler defined 
 clearly the 
 
 Legal and Civic Wrongs of Regulation. 
 
 I. The first principle of jurisprudence in en- 
 lightened countries is that a suspected or accused 
 person is protected against self-incrimination. 
 The "voluntary submission" is a self-incrimina- 
 tion. 
 
 II. Enlightened countries hold an accused 
 person innocent until he is proven guilty and 
 so declared by a jury, but under the Contagious 
 Diseases Acts the woman was held guilty until 
 she could prove her innocence. 
 
 III. Constitutional law forbids indecent assault 
 upon the person. The compulsory medical ex- 
 amination constituted an indecent assault. 
 
 Mrs. Butler showed further that the spy system 
 necessitated by these laws subjected women to the 
 arbitrary power of the police and removed them 
 from the protection of the common law, and she 
 made plain the inevitable confusion of the pub- 
 
Control of Prostitution 73 
 
 lie conscience arising from the scruples of those 
 persons who believe that the only wrong thing is 
 disobedience to police regulations. 
 
 The protest embodying these civic and moral 
 declarations is a historic human document which 
 will be looked back upon with more and more 
 veneration as the centuries pass. It was the 
 first formal declaration of the revolt of women 
 against the slavery of prostitution. It appeared 
 in the Daily News on New Year's day, 1870, and 
 was signed by two hundred and fifty of the great 
 moral leaders among Englishwomen. Beginning 
 with Harriet Martjneau, there are many names 
 known to literature, social reform, and advanced 
 movements, and all the active suffragists of that 
 day are enrolled there. Half-way down the col- 
 umn appears the name of Florence Nightingale. 
 
 The Struggle against the Acts. A long, 
 desperate, and unremitting struggle followed the 
 women's protest. Of three hundred prominent 
 men in all walks of life, secular and religious, to 
 whom, as an initial measure, Mrs. Butler first 
 wrote letters of appeal for moral support, scarcely 
 half a dozen gave a word of encouragement. 
 Some declined to consider the subject, but most of 
 
74 Hygiene and Morality 
 
 them were silent. Mrs. Butler then turned 
 for help to the public, and wrote her "Appeal to 
 the People" in 1870. Tens of thousands of the 
 working classes and plain people came to her 
 support. Theirs were the daughters who were 
 chiefly endangered. 
 
 Perhaps no other one woman has been more 
 vilified or more venomously assailed by all the 
 corrupt forces of society than was she. In several 
 instances she narrowly escaped death from mob 
 violence. 
 
 The contest was carried on for thirteen years, 
 and the abolition party grew to a membership of 
 50,000, but during all this time political parties, 
 even that with the great Mr. Gladstone at its head, 
 resisted all appeals and ignored or belittled all 
 testimony making for repeal of the Acts. 
 
 Progress of the Crusade. In 1871, a Royal 
 Commission recommended abolishing the compul- 
 sory examination, and raising the legal age of 
 protection for girls from twelve years (as it then 
 was) to fourteen. The first recommendation 
 was not enacted into law until 1883. The second 
 received some attention. The age of protection 
 for little girls was with difficulty raised to thirteen, 
 
Control of Prostitution 75 
 
 but not until 1885 was it possible to raise it to 
 sixteen, so tenacious and determined was the 
 resistance made to this amendment by the law- 
 makers of the nation. As late as 1880, two mem- 
 bers of Parliament spoke on the floor of the House 
 in favour of reducing the age of protection for 
 little girls to below twelve years. 
 
 In 1880, '81, and 'S2, a Select Committee was 
 appointed to inquire into the whole question of the 
 workings of the Acts, and a number of women 
 were called to testify. Among them was Mrs. 
 Butler, whose evidence was very full, drawn en- 
 tirely from personal knowledge, and couched 
 in language of great, often exalted beauty; of 
 moving and stirring power. 
 
 This Committee, in its report, endorsed the 
 Acts, but did not recommend their extension, and 
 it was felt that this was a victory. In 188 1, and 
 *82, there was also a Select Committee of the House 
 of Lords on the white slave traffic, and in 1885 
 the Pall Mall Gazette published revelations of so 
 shocking a nature regarding the trade that Par- 
 liament, until then most reluctant to act, was 
 driven to pass some protective legislation. The 
 odious Acts were repealed. They still, however, 
 continue in force as to some of their main features 
 
76 Hygiene and Morality 
 
 in distant subjected provinces of the Empire 
 under the guise of "rules." 
 
 Rally of the Regulationists. During the 
 progress of the women's crusade the upholders of 
 regulation in all countries had been gathering 
 re-enforcements and trying to strengthen their 
 position. Government officials, military author- 
 ities, and even physicians reasserted the right of 
 men to enslave and destroy women for their 
 sensual pleasure. The Lancet upheld the regis- 
 tration of prostitutes. At an International Med- 
 ical Congress in Vienna in 1873, strong resolutions 
 were passed urging a convention of all nations 
 and international agreements to establish the 
 compulsory system of supervision of women in all 
 the great seaport cities of the world. 
 
 On that occasion one member present said: 
 *^ From the moment when prostitution shall become 
 a regular and recognised institution, admitted 
 and regulated hy the state, its perfect organisation 
 will become possible.'' Another made an even 
 more astounding proposition based upon the in- 
 oculation theory. Resolutions were framed call- 
 ing upon England to summon a congress to form 
 an international league for the regulation of 
 
Control of Prostitution 77 
 
 prostitution. Rev. C. S. Collingwood, an English 
 clergyman, protested nobly against this proposition, 
 and Mrs. Butler and her allies, alarmed by the 
 rising tide of domination of the regulationists, deter- 
 mined to organise an international movement in 
 opposition to them. Mrs. Butler therefore under- 
 took a continental tour in 1874, the year of the 
 deepest discouragement and when everything 
 looked darkest for the cause she had at heart. As 
 a result of her travels and speeches the foes of vice 
 in every country united into a powerful federation. 
 
 The Abolitionist Congress at Geneva. In 
 1877 this body, the International Federation for 
 the Abolition of State Regulation of Vice, as it is 
 now called, met at Geneva, five hundred strong 
 and representing seventeen coimtries, and passed 
 a notable series of resolutions under the sections 
 into which the congress was organised. 
 
 Section on Hygiene. It was resolved (briefly 
 stated) that self-control in the relation between 
 the sexes is one of the indispensable bases of the 
 health of the individual and the community: — 
 that prostitution is a fundamental violation of the 
 laws of health; that the true function of public 
 
78 Hygiene and Morality 
 
 hygiene is not only to supervise disease, but to 
 do all that makes for public health, which is, in 
 its highest expression, inseparable from public 
 morality: — that all systems of "Morals Police" 
 were complete failures and the medical examination 
 revolting to human nature and worthless as a 
 sanitary measure by reason of its inevitable 
 incompleteness; that it was impossible for the 
 most serious forms of venereal disease to be so 
 discovered or prevented and that it gave a false 
 guarantee of the health of the women subjected 
 to it. 
 
 Section on Morality. Resolved that license 
 is as reprehensible in men as in women : — that 
 the regulation of prostitution destroys the idea 
 of the unity of tL^ m jral law : — that in regulating 
 vice the state forgets its duty to afford protection 
 equally to both sexes, degrades women and incites 
 youth to evil : — that the system of licensed houses 
 raises prostitution to the rank of a profession 
 and sanctions the immoral doctrine that debauch 
 is a necessity for men. 
 
 Section on Social Economy. Exposed the 
 whole condition of the economic dependency of 
 
Control of Prostitution 79 
 
 women, and traced it to the inequality established 
 by law between men and women, pointing to the 
 unequal wages and sex slavery of women as proofs 
 of their charges. 
 
 Section on Legislation. Resolved that the 
 regulation of prostitution lowered women to the 
 grade of chattels, putting them beyond the pale of 
 the law and inducing the state to violate its own 
 penal code and forget its duty of giving protection 
 to the yoimg. 
 
 Decline of Medical Support of Regulation. 
 The congress of 1874 seemed to mark the highest 
 point of medical advocacy of regulation, and at the 
 medical congresses of 1876 and 1877 the subject 
 was not allowed to come up, as it became known 
 that fearless and determined antagonists would 
 appear. At a Regulationist congress in 1894, only 
 three supporters of the "Morals Police" were 
 present. 
 
 It would be interesting and useful to know 
 just how much of the change in the medical at- 
 titude has been due to the influence of women 
 physicians. From the time of the entrance of the 
 heroic Elizabeth Blackwell and her sister Emily 
 
8o Hygiene and Morality 
 
 into this hitherto conservative profession, such 
 women have consistently and steadily presented 
 the nobler and more ethical — more spiritual — 
 aspect of the questions relating to sex physiology 
 and hygiene. Elizabeth Blackwell early declared, 
 in a letter to her sister, her determination not to 
 be intimidated or discouraged in the difficult task 
 of attacking the social evil by methods of educa- 
 tion, and her books and addresses on this subject 
 are classics in their dignity and nobility of 
 position. She was the first to address herself 
 to parents. In 1852 she wrote to them of the 
 Laws of Life in relation to girls, and in 1880 she 
 wrote to them: *'The fact must be clearly per- 
 ceived and accepted that male chastity is a funda- 
 mental virtue in a State ; that it secures the chastity 
 of women, on which the moral qualities of fidelity, 
 humanity, and trust depend, and that it secures the 
 strength and truth of men, on which the intellectual 
 vigour and wise government of a state depend.'* 
 From that time on women physicians as an 
 entire body have stood unitedly for a single stand- 
 ard of morals and for the education of the public. 
 In their ranks there can be found no division or 
 opposing opinions on this subject. They are ac- 
 tive in the warfare against vice, in every country 
 
Control of Prostitution 8i 
 
 where medicine has opened its doors to women, 
 and, in our own country, they have been publicly 
 called upon by their colleagues in the medical 
 profession to carry the teachings of hygiene to the 
 women of the land. Such 'women as Mary Putnam 
 Jacobi, Sarah Hackett Stevenson, and Annie Dan- 
 iels have brought medical science into perfect har- 
 mony with the most advanced civic Standards, and 
 their influence will be lasting. 
 
 The First and Second Conferences for 
 THE Prophylaxis of Syphilis and the Venereal 
 Diseases. In 1899, the first international con- 
 ference of important medical men and laymen 
 met imder this name in Brussels, and the second 
 conference followed in the same city in 1902. An 
 English writer says of the proceedings of these 
 two weighty bodies that they marked the recon- 
 ciliation of justice and morals with science. 
 
 The first conference took up six questions for 
 discussion; they were: I. Systems of regulation 
 now in force; — have they an influence on the 
 frequency and the dissemination of syphilis 
 and other venereal diseases? II. Medical super- 
 vision of prostitution; — is it capable of improve- 
 ment? III. Tolerated houses; — is there, from 
 
82 Hygiene and Morality 
 
 the strictly medical point of view, any advantage 
 in maintaining them, or is it better to suppress 
 them? IV. Police supervision; — how to improve 
 it. V. Number of women entering upon a life of 
 prostitution; — how to decrease it» VI , What 
 general propaganda could be made against pro- 
 stitution ? 
 
 Although much difference of opinion as to 
 "regulation and control" was foimd to exist, 
 as the discussions went on the following con- 
 clusions shaped themselves and were generally 
 admitted. 
 
 1. The intervention of public powers in regu- 
 lation as it exists has not given results of a certain 
 or sufficient efficacy. 
 
 2. The prostitution of minor girls is most 
 dangerous and should be the object of the most 
 radical measures. 
 
 3. Better university instruction in venereology 
 
 is needed. 
 
 4 . The public power should be used to teach and 
 
 to disseminate a knowledge of prostitution. 
 
 5. There should be a uniform system of sta- 
 tistics of prostitution and venereal diseases for all 
 countries. 
 
 Disregarding all points on which there was 
 
Control of Prostitution 83 
 
 an absence of unanimity, the conference passed a set 
 of eight resolutions which were, in brief, as follows : 
 
 Resolutions of the First Brussels Con- 
 ference. I. All governments shall be called 
 upon to suppress absolutely prostitution among 
 minors. 2. Societies of Sanitary and Moral 
 Prophylaxis should be formed in every country. 
 3. It is the duty of governments to promote, 
 by complete and compulsory tmiversity courses, 
 the instruction of truly competent medical special- 
 ists in venereal diseases. 4. Moral teaching 
 should be provided for orphans. 5. The utmost 
 rigour of the law should be applied to men who 
 live upon the profits of prostitution (cadets, 
 souteneurs, etc.). 6. Each country should ap- 
 point a commission to study conditions, investigate 
 the number of hospital beds, dispensaries, and 
 other opportunities for free treatment that are 
 available. 7. Education in sex morality should 
 be offered to the pubHc. 8. There should be a 
 uniform method of statistics adopted in all 
 countries alike, as a basis of correct data for the 
 combat against venereal diseases. 
 
 The Second Brussels Conference. The 
 
§4 Hygiene and Morality 
 
 conference of 1902 discussed public prophylaxis 
 under the following heads : 
 
 A. — As to prostitution — what legal measures 
 are advisable? I. The general protection of 
 minors of both sexes. II. The improvement of 
 public medical relief, hospital dispensaries, etc. 
 III. Contagion: — by midwives; in obstetrics gen- 
 erally; in shops and factories; by instruments; as 
 arising in the management of employment agencies 
 and intelligence offices; as related to the policing 
 of hotels and lodgings. 
 
 B. — ^A penal code for the transmission of 
 venereal disease; should one be adopted? 
 
 The subject of private prophylaxis was con- 
 sidered under the two following heads : I. How 
 to teach the public and especially the young. 
 II. How to improve the public medical service. 
 
 Statistics and special communications closed 
 the sessions. This second conference and indeed 
 both were very remarkable not only for the facts 
 brought out, but also as showing, along with the 
 rapidly advancing tendency of the best medical 
 thought to think in unison with social moralists 
 on this question, two things especially: one, the 
 immense handicap of involuntary, unconscious sex 
 dominance and egotism to men discussing these 
 
Control of Prostitution 85 
 
 problems: the other, the conspicuous ignorance 
 of many great medical specialists in matters of 
 sociology. It is a mistake to suppose that an 
 eminent authority in one line will be equally 
 eminent as an authority in another. As a matter 
 of fact, the general esteem and confidence prof- 
 fered to the medical profession by the public has 
 sometimes encouraged its members to believe 
 that their pronouncements on social conditions 
 are as final as their definitions of medical know- 
 ledge. This has been pointed out by various 
 critics of the proceedings of the two conferences 
 at Brussels. 
 
 Dr. Pileur, an advocate of regulation, ad- 
 mitted that the diversity of opinion on this point 
 was so great as to amount to anarchy. He 
 would allow adult women to practise prostitution 
 with the agreement of three [men] commissioners, 
 and w^ould hold them to strict rules, pimishing 
 them for infraction thereof. In his plan no men 
 are to be punished. 
 
 That was his theory: his facts are impressive. 
 He urges the reduction of prostitution to an ir- 
 reducible minimum, and believes that cutting off 
 the minors will bring this about. He states that 
 seventy-five per cent, of all prostitution begins be- 
 
86 Hygiene and Morality- 
 
 fore the age of twenty-one ; further, that of these 
 minor girls fifty per cent, are afflicted with vene- 
 real disease and twenty-five per cent, have syphi- 
 lis. These figures, he holds, are understated and 
 would be higher if investigation could be thorough 
 and precise. He judges by the statistics of such 
 girls as had been finally arrested in Paris as "clan- 
 destines," of whom seventy- two per cent, were 
 found to be diseased when arrested. He holds 
 that the prostitution of minors is the absolutely 
 capital fact in the question of prostitution and 
 insists that if all under twenty-one could be kept 
 out, the number of women choosing the life, who 
 might be called ''chronic'' or "persevering" 
 prostitutes, would be surprisingly small. From 
 a medical standpoint, he considers older women 
 as less liable to disease, and estimates the 
 amount of syphilis among them as seventeen per 
 cent. 
 
 Dr. Neisser stated that the unanimous testi- 
 mony of all nations was that irregular intercourse, 
 especially that of prostitution, was the main source 
 of all ravages by venereal diseases. The three 
 factors in prostitution that are fatal in the hygienic 
 sense are: Frequency of sex relations; absence 
 of choice among persons; constant variety of 
 
Control of Prostitution 87 
 
 persons. Prostitution is the knot around which 
 contamination centres. Individual immoral re- 
 lations are less dangerous, and, if infection then 
 occurs, it has been accidentally introduced from 
 prostitution. Nevertheless, he advocated the 
 recognition and toleration of prostitution as a 
 trade, unavoidable under present social conditions, 
 and believes that it strengthens the control of 
 the police over thieves and criminals to have the 
 management of prostitution within their juris- 
 diction. After expounding this last-mentioned 
 curious social view, he advocated teaching the 
 principle of chastity to young men. 
 
 Henri Minod, an uncompromising abolitionist, 
 quoted from many sources to show that real 
 depravity is not a serious cause of prostitution. 
 Few women find any enjoyment in this life. They 
 regard it, not as pleasure, but as **work." M. 
 Minod quoted some statistics of Dr. Le Pileur, 
 to show the ages at which 582 girls were drawn 
 into prostitution. 
 
 Ages at which Girls were Ruined: 
 
 6 were ruined when from lo-ii years old. 
 2 " " " " 11-12 " " 
 
 8 " " *' " 12-13 " " 
 
 24 ** '* " " 13-14 *• ** 
 
88 
 
 Hygiene and Morality 
 
 50 were ruined when from 14-15 years old. 
 
 142 ** ** 
 
 *' 15-16 
 
 
 106 *' ** 
 
 '* " 16-17 
 
 
 86 " 
 
 " 17-18 
 
 
 67 " " 
 
 ** 18-19 
 
 
 38 " - 
 
 " ** 19-20 
 
 
 24 " 
 
 " ** 20-21 
 
 
 II " " 
 
 " ** 21-22 
 
 
 II " " 
 
 '* *' 22-23 
 
 
 3 " 
 
 " 23-24 
 
 
 I was " 
 
 " 24-25 
 
 
 3 were " 
 
 " 25-26 
 
 
 [A set of figures corroborative of these, though 
 not presented at the conference, are added here 
 as being germane to the heading. They are 
 given by the Rev. G. P. Merrick, in his Work 
 Among the Fallen. 
 
 1 1 ruined before 1 1 years of age. 
 
 36 " 
 
 * 12 * 
 
 
 62 " 
 
 ' 13 ' 
 
 
 104 *' * 
 
 ' 14 * 
 
 
 358 " 
 
 * 15 ' 
 
 
 1,192 " 
 
 ' 16 ' 
 
 
 1,425 " 
 
 ' 17 ' 
 
 
 1,369 " 
 
 ' 18 * 
 
 
 1,158 " 
 
 * 20 ' 
 
 
 947 " 
 
 ' 21 * 
 
 
 703 " 
 
 ' 22 * 
 
 
 He also makes statements that agree with those 
 
Control of Prostitution 89 
 
 of M. Minod, viz., that out of 100,000 cases 
 personally kno\^Ti to him he had not found one 
 hundred who did not loathe the life. Drink, said 
 he, was a necessity to nerve them to endure it.] 
 
 Certain ones of the members of the conference 
 of 1902 advocated laws making the transmission 
 of venereal disease a penal offence. The weak 
 points of this proposal were forcibly presented by 
 Miss Blanche Leppington, of England, who pointed 
 out: I. Danger of unjust accusation; II. Op- 
 portunities for blackmail; III. Dangers of pub- 
 licity; IV. Avoidance of such retaliation by the 
 self-respecting and its exploitation by the vile; 
 V. Resultant estrangement of patients from 
 physicians; VI. Resultant fostering of quackery. 
 Careful reading of the full proceedings leaves 
 the settled conviction that the advocates of 
 toleration and regulation have a weak case, con- 
 tradict themselves and one another, and grasp 
 wildly at the most absurd social remedies; while 
 the abolitionists are logical, rational, unanimous, 
 and show some knowledge of human nature and 
 of social conditions. Again avoiding all con- 
 troversial themes, the second conference agreed 
 unanimously on the following resolutions: That 
 there should be full, adequate, free hospital treat- 
 
90 Hygiene and Morality 
 
 ment for all cases of venereal disease; that pa- 
 tients should not be regarded as guilty persons, 
 but simply as patients; that teaching in sex 
 hygiene should be given to soldiers; that the 
 education of the public should be continued and 
 that emphasis should be laid on the doctrine that 
 the health of young men is improved by conti- 
 nence ; that uniform statistics should be kept ; that 
 the physiology of sex should be taught in the 
 schools of all countries to the children of all ages. 
 This done, the conference adjourned without 
 fixing a date for reassembling, leaving the socie- 
 ties that had been formed at its instigation to 
 carry on the work in their own countries. 
 
 The Societies of Sanitary and Moral Pro- 
 phylaxis. Among these national societies newly 
 formed to carry on educational missions in regard 
 to venereal diseases, the American Society of San- 
 itary and Moral Prophylaxis, under the presidency 
 of its founder, Dr. Prince A. Morrow of New York 
 City, stands easily in the lead by reason of its 
 singleness of purpose (certain others still wrest- 
 ling with the vexed question of regulation), the 
 unassailable dignity of its tone in promulgating a 
 teaching which harmonises the soundest medical 
 
Control of Prostitution 91 
 
 science with a high morality, and its resultant 
 widespread influence. Its membership is open to 
 men and women, to the professions and to the 
 laity, and this association, as well as the State 
 Societies to which it has given the impulse, offers 
 the needed opportunity for all who desire to 
 ally themselves with the new crusade for the 
 attainment of the single moral standard and the 
 extirpation of the diseases of immorality. 
 
 Regulation Passing from the Continent. 
 The reports of the Brussels Conference show that 
 regulation is being discredited in the countries 
 where it has long been under trial. Norway 
 abolished the Morals Police in 1888, and since 
 then the Norwegian women have defeated pro- 
 visions that they believed portended a return to 
 regulation. 
 
 Denmark and Sweden both reported a probable 
 early cessation of police control with retention 
 of medical inspection only. Italy has abolished 
 regulation. 
 
 France has had two government commissions 
 studying the subject; one, appointed in 1901, 
 had no results. The second, appointed in 1903, 
 upon which one woman was placed, gave a verdict 
 
92 Hygiene and Morality 
 
 of banishment for regulation ; decided that prosti- 
 tution is not a legal offence coming under the 
 penal law, but is a social phenomenon to be 
 combated, but not with force; agreed that it should 
 be made punishable to "procure" even adults, 
 even with their own consent, and framed a number 
 of resolutions looking to a rational and humane 
 discouragement of prostitution as a business, 
 as well as to the treatment of venereal diseases. 
 Their conclusions have not yet been enacted 
 into legislation, but the force of public opinion 
 will probably soon prevail over the small group 
 of determined regulationists who still resist them. 
 
 Danger op Regulation not Past. In spite 
 of all the available testimony against it, tolerated 
 and licensed vice still finds advocates. Argu- 
 ments in its favour have been advanced, and 
 efforts made to introduce regulation systems in this 
 country. Doubtless such efforts will be repeated, 
 from time to time, and it is therefore most im- 
 portant that the moral public should be well 
 grounded in the lessons taught by English and 
 continental experience, and ready to make intel- 
 ligent resivStance to any such attempted invasion.* 
 
 > See Appendix A. 
 
Control of Prostitution 93 
 
 There have always been, and perhaps always 
 will be, some honest and well-intentioned apol- 
 ogists for regulation. The existing writings and 
 speeches made by members of this class, how- 
 ever, such as may be found in the transactions of 
 a society organised in England during the cru- 
 sade against the Contagious Diseases Acts, 
 whose aim was to support regulation, show, 
 alongside of perfectly good intentions, an extreme 
 mediocrity of intelligence, a very limited point 
 of view, and a profound ignorance of their sub- 
 ject. Such banal opinions as that erring girls 
 would find, in the police, wise and benevolent 
 friends, who would lead them back to their fami- 
 lies; and that inscribed women would become so 
 accustomed to the routine of their supervised lives 
 as to miss it if discontinued, show sufficiently the 
 worth of their information. 
 
 On the other hand, all accounts teem with 
 evidence of the disastrous results of regulatory 
 legislation, and this evidence will now be summed 
 up, at the risk of a certain amount of repetition, 
 in order to bring all the arguments of the op- 
 position into one place. 
 
 Brutalising Effect of Regulation on 
 
94 Hygiene and Morality 
 
 Character. A terrible revelation is that of the 
 brutalising effect of regulatory enactments upon 
 the natures of those who administer and enforce 
 them. This was strikingly shown in all the 
 evidence laid before the Select Committee in 
 England, and appears again in the reports of 
 the Brussels conferences. Officers of the army 
 and military surgeons were seen to have reverted 
 to the brute ; as in the case of the one who ordered 
 an establishment for his regiment in advance, 
 and, knowing well that many would be little girls, 
 excused this on the ground that "In India pro- 
 stitution begins in the cradle'*: and of the other, 
 who granted permits for licensed houses. A men- 
 acing disregard for the good of the civil community 
 was suggested in the testimony of such men, that 
 *' diseased women, if incurable, were expelled from 
 the cantonment." But, it was asked, — ^where did 
 they go? For, unless they could die at once, they 
 must go somewhere and be a danger to their 
 environment. 
 
 Equally disturbing evidence of the decline of 
 traditional chivalry under the effects of the super- 
 vision of vice is at hand in the suggestion of a 
 German surgeon, who, angered by the failure of in- 
 scribed women to appear regularly for examination. 
 
Control of Prostitution 95 
 
 would have had them whipped for absence; and 
 in that of a French doctor who proposed imprison- 
 ing each woman for several days before examina- 
 tion, in order to prevent their tampering with 
 symptoms. The quarrels and disputes between 
 medical and police supervisors have also been 
 numerous and undignified. 
 
 In reading such material, one feels keenly that 
 the supervision of vice degrades the medical pro- 
 fession to a plane little higher than that of the 
 cadet or souteneur. 
 
 The Insult to Religion. The insult to 
 religion was deadly. There was (and still is) 
 a wide-spread belief in distant provinces that 
 licensed prostitution was a part of the Christian 
 religion. The editor of The Sentinel pointed out 
 the incongruity of ordinances passed "in the year 
 of our LOR.D" for licensing vice, and Mrs. Butler, 
 in her evidence, said, "Few things shock the sense 
 of the coimtry more than the fact that religious 
 teaching is allied with state regulation of vice." 
 Even as late as 1908 the statement appeared 
 in an English journal that one reason for an 
 outbreak of syphilis in an African province was 
 "the introduction of Christianity." 
 
96 Hygiene and Morality 
 
 The Sanitary Inefficiency of Regulation. 
 The entire mass of testimony makes it clear that 
 state regulation, licensing, and medical examina- 
 tion does not diminish venereal disease. Con- 
 flicting and contradictory columns of statistics 
 do not alter this conclusion. Dr. Mounier of 
 Utrecht says that statistical methods are futile 
 in the clearing up of disputes as to the efflcacy of 
 regulation. Figures showing results favourable 
 to regulation were based on imperfect knowledge. 
 One prominent error, made before the discovery 
 of the Spirochcete pallida, was in the confusing 
 of venereal ulcer w4th syphilis. The difference 
 between them was not understood. Remembering 
 that venereal ulcer is the least serious and most 
 readily cured of the venereal diseases, it will at 
 once be clear that its figures might easily show 
 an improvement which, if credited to the graver 
 disease, would be most misleading. Again, re- 
 membering the variable period of inoculation of 
 the SpirochcBte pallida, and the latency of the 
 gonococcus, possibilities of error are evidently 
 many. Still another source of error lay here: 
 it has been found that syphilis shows a certain 
 variability when observed over long periods of 
 time, having its epochs of increase and decrease. 
 
Control of Prostitution 97 
 
 This obscure and, to many, unknown phenomenon 
 makes observations over short time-periods of 
 little value. 
 
 The reasons for the sanitary failure of regulation 
 may be tabulated as follows: 
 
 I. The One-Sided Examination. It is sur- 
 prising that the plan of examining women only 
 while men were unexamined should ever have 
 been advanced as worthy of being taken seriously. 
 Morrow says of this: ''The prostitute is but the 
 purveyor of the infection; — she simply returns 
 to her male partner, the prostituant, as he is 
 called, the infection which she has received from 
 another prostituant. In the ultimate analysis 
 it will be found that the male is the chief male- 
 factor." Again he says: ''The health officer of a 
 port might as well attempt to prevent the importa- 
 tion of infectious disease from a plague-infested 
 vessel by quarantining the infected women while 
 permitting the infected men to go free." This 
 weakness has been admitted in official circles, and 
 Neisser and others at the conference of 1902 ad- 
 vocated examining every man who entered a house 
 of ill-fame. The naivete of this suggestion speaks 
 for itself. Men would not submit to it. This 
 
gS Hygiene and Morality- 
 
 precaution has been tried occasionally in armies 
 and navies and has been rejected as a "degrada- 
 tion" involving ''loss of respect" to the men. 
 
 II. Length of Time between Examinations. 
 The usual time of one or two weeks between 
 examinations is too long. A woman may appear 
 free from disease at one time and develop an in- 
 fectious discharge before the next. This has 
 also been recognised and more frequent examina- 
 tion recommended — even one or two weekly. 
 But aside from the great expense to the tax- 
 payers (many of whom are women) in supporting 
 a staff large enough to make this everywhere 
 possible, it is acknowledged that even the most 
 enslaved women would rebel. 
 
 III. Mediate Contagion. Mechanical trans- 
 mission of disease or "mediate contagion" is 
 believed to be possible. The woman in this case, 
 remaining uninfected herself, passes on to one man 
 an infection which she has received from another. 
 
 IV. Clandestine Prostitution. The diffi- 
 culty of the "clandestine" is perhaps the most 
 obstinate of all. So great is the detestation of 
 
Control of Prostitution 99 
 
 police and medical control among women that the 
 greatest zeal and energy on the part of the officials 
 cannot prevent numbers of them from practising 
 secretly. While all medical authorities agree 
 that these are the most dangerous prostitutes, 
 the most unfaltering believers in regulation can 
 give no suggestion for strengthening this weak 
 link in the chain. This weakness has been realised 
 in every country where regulation has been tried. 
 Pontoppidan wrote in 1903 that 5000 women 
 were inscribed by the police of Paris, in that year, 
 while there were 50,000 clandestines. Figures 
 for Berlin in 1896 were even worse; viz., 4039 
 women inscribed, while the number of clandestines 
 equalled that of Paris. Dr. Kathe Schirmacher 
 has recently stated that the police of Paris, in 
 the last thirty years, had arrested 725,000 women 
 and had inscribed 155,000. Twenty-five per cent. 
 of those inscribed, she added, had disappeared. 
 
 V. Regulation Increases Vice. Ample tes- 
 timony is at hand to show that immoral practices 
 increase with the sense of security imparted by 
 official inspection. In the words of Dr. C. Bell 
 Taylor, there is ''multiplied indulgence springing 
 from the apparent immunity." In armies it has 
 
loo Hygiene and Morality 
 
 been understood that the government purposed 
 providing the regiments with "clean girls," and 
 in civil communities young men speak openly of 
 the advantages of licensed houses. The more 
 wide-spread immoral practices are, the greater 
 of course must be the danger of infection. 
 
 VI. Ignominy Attaches to Treatment. Un- 
 der regulation the ignominy attaching to the 
 compulsory treatment deters respectable patients 
 from seeking medical aid; brings the special 
 hospital into disrepute and fosters the industry 
 of quacks, who offer secrecy and regard for the 
 sensitive pride of the individual. The seriousness 
 of this danger is widely recognised. 
 
 Pont oppidan, after a moderate and rational 
 review of the whole subject, says: "Control is 
 entirely without positive value as a security." 
 
 Immoral Nature of Regulation. Aside from 
 sanitary inefficiency, regulation stands con- 
 demned on the following counts: 
 
 I. It corrupts and demoralises the police 
 and offers endless opportunities for blackmail 
 and extortion. Here it may be emphasised 
 that, although there is in the United States no 
 
Control of Prostitution loi 
 
 legal regulation of vice, yet there is blackmail and 
 extortion because the police, under the pressure 
 of corrupt social elements have developed a system 
 of protection for vice which approaches closely to 
 an official alliance with it. 
 
 2. It exposes innocent women to persecution. 
 Numerous instances of this kind are on record. 
 Respectable girls have been reported to the police 
 from motives of revenge or jealousy, and self- 
 supporting women have been driven from positions 
 and their property manipulated away from them. 
 Cases have been known where such victims have 
 been driven to suicide. 
 
 3. That it perpetuates a class of women who 
 are deprived of the protection of the law has been 
 referred to. For such women, no matter what 
 their just grievance, justice in the courts would 
 be a thing unheard of. Even without regulation 
 it is doubtful whether legal justice exists for these 
 unfortunates. 
 
 4. Regulation bears with special hardship on 
 the poorest women. Indeed, it may be said that 
 only the very poor and defenceless are exposed 
 to its full horrors. The fact that immoral women 
 who are able to command ample means are 
 safe against the severities of the law has been 
 
I02 Hygiene and Morality 
 
 frequently mentioned by writers belonging to 
 different countries. 
 
 5. It puts governments in the position of en- 
 dorsing the assumption that women may be sacri- 
 ficed for men's pleasure. It even tends to make 
 it appear that women are the chief offenders 
 and the primary corrupting influence, and may 
 therefore be treated with a disregard of justice 
 and decency. On this point M. Jules Favre 
 said: ''The worst that could befall the public 
 health is nothing to the corruption of morals and 
 national life engendered, propagated, and pro- 
 longed by the system of official surveillance." 
 Again, with regulation, the state is placed in a 
 position not clearly different from that of the 
 individual agents of immorality, and all taxpayers, 
 women as well as men, are compelled to pay 
 for the maintenance of officials to supervise 
 prostitution. A German member of the Reich- 
 stag, speaking on this point, said: ''The state 
 which officially tolerates and guarantees houses 
 of prostitution assumes the role of Procurer, a 
 delinquent whom the German penal code punishes 
 with imprisonment and hard labour." 
 
 6. It destroys respect for women and thus 
 tends to make men unmanly and cowardly. And 
 
Control of Prostitution 103 
 
 the flourishing and unrestricted commercial pros- 
 titution which has been permitted to develop in 
 the United States breeds this same contempt and 
 unmanliness. 
 
 7. It blights that high ideal of parenthood 
 and especially of motherhood that consecrates the 
 functions of physical life. And the very existence 
 of prostitution, regulated or unregulated, brings 
 on this blight. No one has dwelt upon this truth 
 more earnestly than Mrs. Butler. In her testi- 
 mony before the Commons Committee she said : 
 
 There is nothing in the physical being of a man that 
 corresponds to the sacredness of the maternal functions 
 in a woman, and these functions, and every organ 
 connected with them, ought to be held in reverence 
 by man. When this reverence ceases to be felt 
 through the habitual outrage of any class of women, 
 however degraded that class may already be, the 
 demoralisation of society at large is sure to follow. 
 
 80 Finally, it is clear that the various systems 
 of police protection and state licensing of prostitu- 
 tion have been the breeder and the main security 
 of the most shocking of modern evils, the white 
 slave traffic. 
 
 Systems of "segregation" deserve the same con- 
 demnation as regulation and for the same reasons. 
 
CHAPTER II 
 
 THE WHITE SLAVE TRAFFIC 
 
 nPHAT this trade in girls for immoral purposes 
 ■*- has grown naturally and inevitably out of the 
 continental system of regulated vice is too evident 
 to be contested. The existence of this traffic was 
 at first undreamed of by Mrs. Butler and her asso- 
 ciates, but they soon came into collision with it. In 
 1879, Mr. Alfred Dyer received information that 
 a young English girl was detained against her will 
 in a licensed house in Brussels, and intended com- 
 mitting suicide as the only escape. By the aid of 
 a Belgian clergyman she was rescued, and then 
 began a life and death struggle for the exposure 
 of the evil. In time the British Society succeeded 
 in obtaining the names of many men and women 
 who were systematically engaged in this trade 
 in London, as well as the addresses of fifty licensed 
 houses in France, Belgium, and Holland, to 
 
 which the girls were sold. They also succeeded in 
 
 104 
 
The White Slave Traffic 105 
 
 exposing all the methods and practices in the 
 trade. It was shown that the exculpatory state- 
 ments of the police were false in every particular ; 
 that girls were decoyed under pretence of obtaining 
 employment, and that there were systematic 
 methods of intimidation. It was proved that 
 girls were asked in foreign tongues whether they 
 came willingly, and then, not understanding, or 
 thinking they were entering domestic service, they 
 were inscribed as having come of their own free 
 will. Again, they were listed under false names 
 and then threatened with imprisonment for 
 ' ' forgery ' ' if they rebelled . All street clothes were 
 taken from them. A skilful system involved 
 them deeply in debt to their captors. If resistant, 
 they were beaten and starved. Padded cells were 
 found in the houses which were visited daily by 
 the police, even the windows and doors being 
 covered. It was also shown that the names, 
 persons, and pursuits of the foreign agents in 
 England were perfectly well known to the police 
 and had been so for years, but "the state of the 
 English law did not authorise" their arrest or 
 extradition. As investigations went deeper the 
 traffic in England was traced back to the year 
 
 1857- 
 
io6 Hygiene and Morality 
 
 The experience gained in this crusade led Mrs. 
 Butler to say: 
 
 As an inevitable and necessary accompaniment 
 of the establishment of licensed houses of prostitu- 
 tion under government patronage all over the world, 
 there exists the most extensive slave traffic in the 
 interests of vice. This fact has become . . . fully 
 acknowledged during the last few years. 
 
 In a memorandum to the Committee of the 
 House of Lords M. de Laveleye wrote : 
 
 The white slave traffic is carried on . . . and 
 will not be suppressed as long as prostitution con- 
 stitutes, on the continent, a traffic, not only tolerated 
 but legalised, privileged, and licensed in the same way 
 as any other traffic. The legal organisation of de- 
 bauchery is the chief support of the odious trade 
 against which we are seeking a remedy. . . 
 This state of things, which places prostitution on the 
 footing of a recognised commerce, must naturally 
 produce a most dire effect on the police and on all who 
 are brought into contact with these abominable 
 institutions. . . . The traffic in women, that is 
 to say, the letting on hire of human beings for de- 
 bauchery, as of horses and other cattle, is a system 
 contrary to all morality and all sense of right and 
 ought to be universally forbidden. As long as these 
 establishments remain legalised institutions, the traffic 
 which supplies them will not be stopped. 
 
 The Share of Law in the White Slave 
 
The White Slave Traffic 107 
 
 Traffic. The members of the British Society- 
 were not long in discovering how much the laws 
 of the country had to do with the extent and the 
 security of the trade in girls. Briefly stated, the 
 features of the laws relating to the protection of 
 girls were, at that time, as follows: To abduct 
 a girl under twenty-one for immoral purposes 
 was a felony, if she belonged to a propertied 
 class or family. If she was propertyless, it was 
 only a misdemeanour to abduct her under sixteen. 
 Thus a penniless girl, sixteen years old, could be 
 lawfully decoyed for immoral purposes, as she 
 could claim no protection from the state or its 
 agents the police. (And here again let it be recalled 
 that women wage-earners and women taxpayers 
 were helping to provide the public funds needed 
 for maintaining such legislation.) But still worse 
 was the discovery that girls having neither parents 
 nor guardians might safely be abducted even 
 under sixteen, as the law provided no penalty 
 at all for such act, nor any protection for such 
 girls. Here w^as obviously a deliberate and in- 
 tentional legal omission devised by legislators with 
 the sole and single purpose of maintaining a 
 supply of victims, — not, perhaps, for the white 
 slave trade, but for the institution of prostitution. 
 
io8 Hygiene and Morality 
 
 This cannot be too plainly stated. Such careful 
 legal fencing could not be accidental; and that 
 it was indeed not accidental was fully proved, 
 later, by the long and stubborn resistance of the 
 lawmakers to any amendment. 
 
 Another strange feature of these strangely un- 
 chivalrous laws, was that a father, having reason 
 to believe, but not possessing legal proof, that 
 his daughter was in a house of prostitution, could 
 not secure a search-warrant to look for her, nor 
 could any benevolent friend do so. 
 
 Facts Learned of the Trade in Girls. The 
 following facts were brought out as to the trade 
 in girls : girls between sixteen and twenty were the 
 most desirable, because the most docile. 
 
 It was important to entrap only healthy girls, 
 as, if any were found to be diseased and to require 
 hospital care, the trade lost money. 
 
 A skilled system of falsehood was practised in 
 order to evade the fairly strict laws of continental 
 countries relating to minors. 
 
 The police were always in sympathy and some- 
 times in guilty complicity with the agents and 
 the tolerated houses. One European police offi- 
 cial explained their attitude thus: ''We cannot 
 
The White Slave Traffic 109 
 
 injure establishments legally authorised and in 
 which so much capital is vested." The English 
 committee declared: "Reliance on the police has 
 misled all who have tnisted to it." 
 
 Intelligence offices, all licensed, were the main 
 avenues of the trade. The girls were called 
 "colis" (packages) and the' business was perfectly 
 organised, with routes, ports, agents, and travellers ; 
 cargoes and technical phraseology, prices and 
 values all worked out. 
 
 English birth certificates (false) were bought 
 for a small sum. 
 
 Four fifths of the girls so enslaved were orphans. 
 
 A close relation was fotmd to exist between the 
 city authorities and keepers or ow^ners of tolerated 
 houses. The first exposure in Brussels implicated 
 the mayor and two aldermen, all of whom resigned. 
 
 The Struggle for Improved Legislation. 
 The history of the attempts made to amend these 
 laws is highly instructive, as showing the different 
 points of view of the governed and the governing, 
 and the opposition of interests between enfran- 
 chised men and unenfranchised women. 
 
 The Society sent a memorial to the proper 
 minister in 1880 asking for a deputation to be 
 
no Hygiene and Morality 
 
 received. A year went by without answer. On 
 making a second appeal, the committee were in- 
 formed that official inquiry had been made and 
 it had been found that the Society had overstated 
 the case. A petition signed by looo women 
 was then presented by Mrs. Butler in 1881. An 
 inquiry by the House of Lords followed. Two 
 years later the Lords reported, making various 
 recommendations for the better protection of 
 girls. The House of Lords passed these measures, 
 and the House of Commons defeated them. The 
 same thing was repeated in 1884. In 1885 a third 
 bill, in which the ''age of consent" was set at 
 fifteen years, was about to be killed in the House 
 of Commons, when the Pall Mall Gazette'^ brought 
 out its revelations which aroused the public wrath 
 and drove the legislators to act. 
 
 The White Slave Traffic in the United 
 States. As the revelations of the international 
 traffic in young girls were unfolded, leaders of 
 communities formed National Vigilance Leagues 
 to carry on a war of extermination against it. 
 There are now Leagues in Great Britain, Germany, 
 France, Russia, Sweden, Norway, Belgium, Hol- 
 
 » July 10, 1885. 
 
The White Slave Traffic m 
 
 land, Italy, Spain, Portugal, Switzerland, Austria, 
 and the United States, the latter having been 
 formed in 1906 with O. Edward Janney, M.D., of 
 Baltimore, as its president. These Leagues have 
 brought about an international agreement by 
 which the governments of the countries repre- 
 sented bind themselves to a concerted action in 
 suppression of the white slave trade. In 1907, 
 Congress passed an act designed to crush the 
 traffic in foreign girls, as the limitations of the 
 constitution of the United States confine its 
 jurisdiction to immigrants. This act provided 
 that any person who should keep, maintain, 
 support, or harbour any alien woman for immoral 
 purposes within three years after her arrival in this 
 coimtry should be punishable for misdemeanour 
 by five years' imprisonment or $5000 fine. The 
 federal government has no power over traffic 
 in American women, carried on within the States 
 themselves. 
 
 In the process of enforcing the law regarding 
 aliens the United States District Attorney at 
 Chicago was directed to take the proper steps 
 for securing the conviction of certain persons 
 who were suspected of violating the statute. The 
 raids upon houses of prostitution and arrests of 
 
112 Hygiene and Morality 
 
 their inmates that were raade with this end in 
 view brought to hght a mass of evidence of a 
 terrible, much of an unspeakable nature, and the 
 District Attorney, Edwin W. Sims, and his assist- 
 ant, H. D. Parkin, as well as convicting a number 
 of procurers, felt it their duty to make known 
 to American parents the conditions imperilling 
 their daughters, as it was evident that a profound 
 state of ignorance prevailed as to the existence 
 in our country of so vile a trade. They therefore 
 wrote a series of articles for a popular magazine 
 in which the facts they had learned were most 
 clearly and explicitly stated. Their investigations 
 led them to believe that some 65,000 American 
 girls and 15,000 aliens are being entrapped yearly 
 for the white slave trade. The methods by which 
 they are taken vary: promises of employment, 
 bogus messages, plausible invitations, deceptive 
 marriage ceremonies, even real marriage. The 
 runaway marriage is a device frequently used 
 with country girls of American families. The 
 District Attorney believed that there was a syndi- 
 cate which carried on a business in the ruin of 
 girls as steady, regular, and systematic as any 
 great business of a legitimate kind, and that its 
 ramifications extended to the Pacific with dis- 
 
The White Slave Traffic 113 
 
 tributing centres in nearly all the large cities. 
 Recent Congressional commissions of inquiry be- 
 lieve that no definite syndicate exists, but that 
 there is a general understanding between the 
 agents in different cities. This is, of course, 
 equally menacing and serious, and does not relieve 
 the situation of its darkness. 
 
 Of the details of the life, Sims repeats almost 
 the very words of the English investigators into 
 the Brussels conditions. He writes: 
 
 When a white slave is sold and landed in a house 
 or dive she becomes a prisoner ... in each of these 
 places is a room having but one door, to which the 
 keeper holds the key. Here are locked all the street 
 clothes, shoes, and ordinary apparel . . . the finery 
 provided for the girls is of a nature to make their ap- 
 pearance on the street impossible. Then, in addition 
 to this handicap, the girl is placed at once in debt to 
 the keeper for a wardrobe . . . she cannot escape 
 while she is in debt, and she can never get out of debt. 
 . . . Not many of the women in this class expect to 
 live more than ten years — perhaps the average is less. 
 Many die painful deaths by disease [venereal] many 
 by consumption, but it is hardly beyond the truth 
 to say that suicide is their general expectation. 
 . . . The facts that I have stated are for the awaken- 
 ing of parents and guardians of girls. 
 
 Among the individual instances described by 
 
 8 
 
114 Hygiene and Morality 
 
 the District Attorney was that of a Httle girl 
 who was fourteen years old when stolen, and who, 
 besides being used as a scrubwoman by day, in 
 two and one half years' time had been compelled 
 to earn eight thousand dollars for her owner. 
 
 The statement made at the Brussels conference, 
 that the number of chronic or persevering pro- 
 stitutes, if separated from the others, would be 
 surprisingly small, is borne out by Sims's declar- 
 ation that only about twenty per cent, of all 
 prostitutes are willingly such, or have chosen or 
 preferred the life, while all the other eighty per 
 cent, have either been forced into it by poverty 
 and destitution, or have been betrayed, trapped, 
 enticed, or sold into it. 
 
 The National Vigilance League has published 
 a pamphlet called The Nation and the Traffic in 
 Women, addressed to the American people, in 
 which ample facts as to the present situation 
 are set forth with moderation and as entire ab- 
 sence of sensationalism as the extraordinary truth 
 permits. 
 
 The facts speak for themselves, and the ultimate 
 responsibility for these conditions, in an unscru- 
 pulous use of property, and in the protection 
 secured for vice by corrupt sordid elements of 
 
The White Slave Traffic 115 
 
 society who have been permitted to seize the 
 machinery of government for their own evil 
 and mercenary purposes, is laid squarely where it 
 belongs, at the doors of the business commtmity 
 and respectable citizens of the country. 
 
 Mention is made of a city ''where the author- 
 ities seem to regard the slavery of young girls 
 as a part of the legitimate business of the city." 
 Of another, where the money to build slave pens 
 was furnished by the business men of the town. 
 Procurers of young girls, it is pointed out, "are 
 useful to the politicians, and, when arrested, 
 escape through political influence — ^while smart 
 lawyers are employed to defend them when 
 arrested." 
 
 The hopes of dealing an effectual blow to the 
 white slave trade were painfully frustrated by 
 the decision of the Supreme Court of the United 
 States early in 1909, which set free the traders, 
 accused by the federal authorities, on the ground 
 of the unconstitutionality of that clause in the 
 immigration law under which they were pro- 
 secuted. This leaves the future status of white 
 slave traders to the slow and uncertain action 
 of the legislatures of the States of the Union, 
 many of which, it has been found, have failed 
 
ii6 Hygiene and Morality 
 
 entirely to provide adequate protection for young 
 girls. 1 
 
 The Laws of Protection for Girls in the 
 United States. How high the standards of the 
 States are likely to be may be conjectured from 
 the provisions of those laws designed to give 
 protection to girls, which are commonly known 
 as the laws of the age of consent. 
 
 This age, beyond which there is no legal pro- 
 tection for girls against seduction and violation of 
 the person, nor punishment for men committing 
 such acts, was originally fixed by the common 
 law at ten years. 
 
 No American State took any steps toward rais- 
 ing this age until 1864. From that time to the 
 present, the insistent urging of women has brought 
 about some gradual amendment, though, with 
 the fixing of a higher age limit, the corresponding 
 penalties have usually been reduced, and thirteen 
 States name no penalty at all for violation of the 
 law. The following data are taken from the 
 History of Woman Suffrage, by Susan B. Anthony 
 and Ida Husted Harper, and are there carried up 
 
 1 The federal law of 19 10 which, at the time of writing, is 
 before Congress, has not had time to prove its effectiveness. 
 
The White Slave Traffic 117 
 
 to the year 1900. It has been thought best to 
 retain that year as a dividing Hne, and leave 
 changes made since that time for mention in 
 future revisions. 
 
 Three States then had the age of ten years fixed 
 as the age of protection against rape. They were 
 Florida, Georgia, and Mississippi. Florida, how- 
 ever, recognised two grades of protection : the age 
 of consent (ten) , and the age of protection (sixteen 
 at first, later raised to eighteen). Certain details 
 will be given on a subsequent page. 
 
 Two States, Kentucky and West Virginia, gave 
 protection up to twelve years. One, New Hamp- 
 shire, to thirteen years. Ten, Alabama, Illinois, 
 Indiana, Maine, Missouri, Nevada, New Mexico, 
 South Carolina, Virginia, Wisconsin, to fourteen 
 years. Two, Iowa and Texas, to fifteen years. 
 Nineteen, Arkansas, California, Connecticut, Da- 
 kota, District of Columbia, Louisiana, Maryland, 
 Massachusetts, Michigan, Minnesota, Montana, 
 New Jersey, Ohio, Oregon, Pennsylvania, Rhode 
 Island, Tennessee, Vermont, Washington to six- 
 teen years. Nine, Arizona, Colorado, Delaware, 
 Idaho, Kansas, Nebraska, New York, Utah, 
 Wyoming, to eighteen years. 
 
 Some brief account of the ways in which 
 
ii8 Hygiene and Morality 
 
 amendments to these laws have been brought 
 about will be instructive as showing that it is 
 not easy to improve them. 
 
 Arkansas raised the protected age from twelve 
 to sixteen in 1893. But the penalty, which had 
 previously been not less than five years nor more 
 than twenty-five, was reduced to one year. 
 
 In California the Women's Christian Temperance 
 Union asked the legislature in 1887 to raise the 
 protected age from ten (as it then was) to eighteen. 
 The legislature raised it to fourteen. In 1895 
 the women secured an amendment fixing it at 
 eighteen. The governor vetoed it. In 1897 the 
 women tried again, and secured a bill fixing sixteen 
 as the protected age; this was finally passed and 
 became law. 
 
 Dakota raised the age from ten to fourteen in 
 1887. In 1895, the women of Dakota tried to 
 obtain legislation fixing the age at eighteen, but 
 only succeeded in getting sixteen years enacted 
 into law. Moreover the penalty was lowered and 
 the following clause introduced : 
 
 No conviction can be had in case the female is 
 over ten years and the man tinder the age of twenty 
 and if it appears to the satisfaction of the jury that 
 the female was sufficiently matured and informed to 
 
The White Slave Traffic 119 
 
 understand the nature of the act and to consent 
 thereto. 
 
 In Delaware the age of seven years only was 
 legally protected against the brutality of man 
 until 1889. In that year the women of the State 
 petitioned the legislature and secured fifteen 
 years, but the penalties were lowered and no 
 minimum penalty was fixed. In 1895 the women 
 brought another plea and obtained eighteen years. 
 It is, however, very difficult to secure convictions 
 and in cases where men have been convicted they 
 have been pardoned. 
 
 In Florida, the women of the Christian Temper- 
 ance Union made many attempts to have the age 
 of consent and of protection both raised, from, re- 
 spectively, ten and sixteen years to eighteen. 
 Their bills were always laid on the table. In 
 1 90 1, they made a valiant effort with two bills: 
 the one, raising the age of protection against 
 rape from ten to fourteen, passed the House but 
 was lost in the Senate; the other, raising the age 
 of protection from sixteen to eighteen, was finally 
 forced through by a small majority and in the 
 face of all manner of obstructive devices, but no 
 minimum penalty was attached to it. The age 
 
I20 Hygiene and Morality 
 
 of protection against rape remained at ten years, 
 with loopholes for the evasion of the penalty. 
 
 In Georgia, the suffrage association of Atlanta 
 tried to raise the protected age from ten to eight- 
 een. The bill was killed in committee. In 1899, 
 the attempt was again made. The Women's 
 Christian Temperance Union also came forward, 
 asking for twenty-one years. A bill raising 
 the age to twelve was brought in and defeated. 
 Reconsidered at the plea of the women, it was re- 
 defeated more emphatically. 
 
 In Indiana, bills urged by women to raise the 
 age above fourteen have never been permitted to 
 come out of committee. 
 
 Iowa amended her law in 1886, raising the age 
 from ten to thirteen. In 1896, the Women's 
 Christian Temperance Union secured an advance 
 to fifteen, with heavy penalty, but a clause pro- 
 vides that the man cannot be convicted on the 
 testimony of the injured person without corrob- 
 orative testimony. 
 
 In Kansas, immediately after women obtained 
 municipal suffrage, the age of consent was raised 
 from ten to eighteen years. The law of Colorado 
 was also carried by the women's vote in their first 
 year of exercising the franchise. - 
 
The White Slave Traffic 121 
 
 Michigan raised the age of consent from ten to 
 fourteen in 1887. In 1895, an amendment to 
 eighteen was introduced and passed, but the day 
 after the friends of the bill, thinking it safe, had 
 gone home, it was reconsidered and changed to 
 sixteen. 
 
 Minnesota altered the age from ten to sixteen in 
 1 89 1. Thousands of women had petitioned in 
 vain for eighteen. 
 
 New York raised its protected age for girls in 
 1887 from ten years to sixteen. A few years later 
 there was an attempt made to reduce it to twelve. 
 The women made themselves heard in indignant 
 protest and the effort was relinquished. In 
 1895 the age of eighteen was legally secured. It 
 is, however, almost impossible to secure convictions 
 and many flagrant cases of assault on little girls 
 go tmpimished, the writer's long experience as a 
 district nurse having brought a number of such 
 cases to her personal knowledge, where the mis- 
 creants have been sheltered behind political and 
 police -protection. 
 
 It is natural to wonder what arguments men 
 can find for defending such standards on the floors 
 of legislatures: this has been answered by Dr. 
 Elizabeth Blackwell from English history, and 
 
122 Hygiene and Morality 
 
 American records show the same reasons given. 
 One is, the need of protecting men against black- 
 mail for false charges, and the other, the physical 
 fact of the early oncoming of puberty in little girls. 
 That it is possible for a child of twelve to become 
 pregnant has seemed to legislators of this type 
 reason enough for regarding her as a matured 
 woman. 
 
SOURCES OF MATERIAL USED IN THE PREPARA- 
 TION OF PART II 
 
 American Society of Moral and Sanitary Prophylaxis. Trans- 
 actions. All volumes. 
 Amos, Sheldon, A Comparative Survey of Laws in Force for 
 
 the Prohibition, Regulation, and Licensing of Vice In 
 
 England and other Countries. London, 1877. 
 Blaschko, A., Syphilis und Prostitution vom Standpunkte der 
 
 offentlichen Gesundheitspflege. Berlin, 1893. 
 Booth, C, The Iniquity of State-Regulated Vice. London, 
 
 1884. 
 British Committee of the I. F. A. S. R. V. The Shield. 
 
 London. 
 Brussels. Conference Internationale pour le Prophylaxie de 
 
 la Syphilis et des Maladies Veneriennes. 1899. 
 
 , The same. Second Conference, 1902. 
 
 Butler, Josephine E., A Grave Question. London, 1885 or 
 
 1886. 
 Butler, Josephine E., Personal Reminiscences of a Great 
 
 Crusade. London, 1896. 
 Butler, Josephine E., Principles of the Abolitionists. London, 
 
 1885. 
 Butler, Josephine E., The Revival and Extension of the 
 
 Abolitionist Cause. London, 1887. 
 Committee of Fifteen, The, The Social Evil, with Special 
 
 Reference to New York. New York, 1902. 
 Congres des Sciences Medicales, Compte Rendu R6sum6, 
 
 Troisieme Session, Vienne, 1873. Paris, 1876. 
 Doll^ans, E., La Police des Moeurs. Paris, 1903. 
 Dyer, A. S., The European Slave Trade. London, 1880. 
 
 123 
 
12 4 Hygiene and Morality 
 
 Dyer, A. S., The Slave Trade In European Girls to India. 
 London, 1893. 
 
 Fiaux, F. L., La Police des Moeurs. Paris, 1888. 
 
 Geneva. Conference du Geneve, 1899. Federation Abolition- 
 iste Internationale. Compte Rendu. Geneva, 1900. 
 
 Guyot, Yves. Prostitution under the Regulation System, 
 1884. 
 
 House of Commons, Select Committee to Inquire into the 
 Contagious Diseases Acts. Report, 3 vols., 1880, 1881, 
 1882. 
 
 House of Commons, Select Committee on the Contagious 
 Diseases Acts. Minority Report. Reprinted from 
 Parliamentary Papers, 340, Session of 1882. 
 
 House of Lords Committee, Prostitution in Hong Kong. 
 (Parliamentary Paper C. 309.) 
 
 House of Lords Committee on the Law Relating to the Pro- 
 tection of Young Girls. Report, 1881. Appendix. 
 
 House of Lords Committee on the Law Relating to the Pro- 
 tection of Young Girls. Reports and Papers. Vol. ix. 
 
 Joest, Wilhelm, Du Japon en Allemagne par le Sib^ris. 
 [Routes, ports, cargoes, etc., of white slave trade.] 
 
 Ladies' National Association for the Abolition of Government 
 Regulation of Vice. Publications, London. 
 
 Ladies' National Association for the Repeal of the Contagious 
 Diseases Acts, Reports, Liverpool, 1871. Tracts on the 
 Contagious Diseases Acts, 1871, 1883. 
 
 London Committee for Suppressing the TrafiSc in British 
 Girls. Reports 1881, 1885, 1886. 
 
 McClure, S. S., The Tammanyising of a Civilisation. In 
 McClure's Magazine, November, 1909. 
 
 Martineau, Harriet, Autobiography. Edited by M. W. Chap- 
 man, London, 1877. 
 
 Martineau, Harriet, Letters on State Regulation of Vice. In 
 Daily News, 1859. 
 
 Scheven, Katharina, Denkschrift liber die in Deutschland 
 bestehenden Verhaltnisse in Bezug auf das Bordellwesen. 
 In Schriften des Bundes Deutscher Frauenvereine, Heft. 
 VL, 1904. 
 
 Schirmacher, Kathe, M.D., The Work of the Extra- Parlia- 
 
Sources of Material Used 125 
 
 mentary Commission in France. Translated from 
 Der Abolitionist. In "The Shield," October, 1909. 
 
 "Sentinel" Tracts. The Licensing of Sin in India. 
 
 Service de S4ret^ publique et de Salubrite. Rapport. 
 Brussels, 1880. 
 
 Stansfeld, Right Hon. James, M.P., The Failure of the 
 Contagious Diseases Acts as Proved, etc., London. 
 
 Stansfeld, Right Hon. James, M.P., Lord Kimberley*s 
 Defence of the Government Brothel System, etc. 1882. 
 
 Stead, W. T., Josephine E. Butler: A Life Sketch. London, 
 1888. 
 
 Taylor, C. Bell, M.D., The Statistical Result of the Con- 
 tagious Diseases Acts as Deduced from the Parliamentary 
 Papers. 1872. 
 
 Turner, George Kibbe. The Daughters of the Poor. In Mc- 
 Clure's Magazine, November, 1909. 
 
 White Slave Traffic. In Pall Mall Gazette, July, 1885. 
 
Part III. The Prevention of 
 Venereal Disease 
 
 137 
 
CHAPTER I 
 
 UNDERLYING PRINCIPLES OF PREVENTION 
 rjROSTITUTIGN TO BE PREVENTED. The genU- 
 
 ^ ine prevention of venereal disease is only 
 made possible by the prevention of prostitution. 
 Prostitution cannot be retained and the diseases 
 fostered in it be eliminated. Prostitution must 
 be rooted out, unless modem civilised states are 
 content to look forward to the same fate which 
 befell ancient Rome. 
 
 The English women, as they worked on through 
 their crusade, came to see what at first they had 
 not realised, that what they were making war 
 upon was actually the social institution of prosti- 
 tution itself. Thirty-five years ago Mrs. Butler 
 said, in a public address: "That we are, and have 
 been all along, contending for more than the 
 mere repeal of these unjust and unholy Acts of 
 Parliament, is proved by certain signs which are 
 
 becoming more and more clear and frequent." 
 9 129 
 
130 Hygiene and Morality 
 
 She went on: "We were perhaps ourselves un- 
 conscious — some of us are probably yet uncon- 
 scious — how great is the undertaking upon which 
 we have entered," and she then added with great 
 solemnity, "it only very gradually dawned with 
 perfect clearness on my mind that it is the old, the 
 inveterate, the deeply-rooted evil of prostitution 
 itself against which we are destined to make war." 
 Mrs. Butler was saddened by seeing that some 
 men, who had aided her against the special 
 tyranny of special laws, grew cold and fell away 
 as they found that her purpose struck at the 
 very existence of prostitution itself. But her 
 ideals of lofty personal and civic morality are 
 now justified and sustained by those discoveries 
 and teachings of science which, in her day, were 
 still unheard, as to the causation and propagation of 
 venereal diseases and even more so as to heredity. 
 What men will not refrain from under persuasion 
 alone, they will learn to refrain from under the 
 warnings of medical and sanitary science, when 
 these teachings are widely disseminated through- 
 out all social circles. Just as the great mass of 
 people have responded with readiness and in- 
 telligence to the doctrine of the pre vent ability 
 of tuberculosis, so, when they understand, will 
 
Principles of Prevention 
 
 ^ 131 
 
 they respond to the doctrine of the far easie, 
 preventabihty of venereal diseases. 
 
 Even if the immoral projects of some writers 
 could be realised in the use of immunising vaccines 
 or serums to enable men to continue indulgence 
 with greater security, venereal diseases would 
 still continue to exist while prostitution exists, and, 
 unless every man and woman in the world could 
 be so vaccinated, there would be no security that 
 the reckless, the unthinking, and the unsuspecting 
 innocent would not continue to fall victims to, 
 and to become carriers of, these deadly scourges. 
 Nor is it credible that the aroused moral sense of 
 humanity would consent to the general compulsory 
 vaccination of syphilis and gonorrhoea as it does 
 to that of smallpox, because moral sense, or even 
 plain every-day common- sense, will distinguish 
 between diseases which cannot be extirpated by 
 moral living and the exertion of self-control 
 through the power of the intelligent will, and 
 diseases which can be so extirpated. The deliber- 
 ate use of immunising substances with the inten- 
 tion of making it hygienically safe for men to 
 continue a brutal misuse of women such as falls 
 far below the practices of animals in vileness, 
 could only be tolerated in a society that was 
 
^32 Hygiene and Morality 
 
 Uady for its own ruin. If such a practice is to 
 be recommended as desirable for military recruits, 
 and regarded as hopeful by military authorities, 
 then this is only one more reason for the im- 
 perative social necessity of replacing the outworn 
 military ideals by those of a higher conception of 
 human brotherhood.^ 
 
 However great may be the boon science has to 
 bring to the present victims of immorality in the 
 form of merciful antitoxins which may shear 
 disease of its worst terrors, as diphtheria has been 
 shorn by the serum of Behring, it will nevertheless 
 remain true that real prevention does not rest 
 there. Dr. Prince A. Morrow, president of the 
 American Society of Sanitary and Moral Prophy- 
 laxis, says: "It is not a question of making prosti- 
 tution safe, but of preventing the making of 
 prostitutes." This lofty teaching is now being 
 reiterated by ever larger numbers of the foremost 
 leaders of medical science. 
 
 There are, in truth, no other diseases whose 
 absolute prevention lies so wholly in human 
 power as these. 
 
 » Various articles and books have been written on this 
 line, which the author hesitates to mention because of the 
 possibility of seeming to recommend them. 
 
Principles of Prevention 133 
 
 Knowledge is Essential. The first essential 
 in a campaign of prevention is full, open, and 
 serious instruction for all classes of society 
 upon the situation as it exists to-day ; instruction 
 without exaggeration, but also without conceal- 
 ment, of the present extent of disease of venereal 
 origin, and with the most emphatic and positive 
 information upon the real source of danger in 
 prostitution. It will be found that not only is 
 the extent to which venereal diseases have been 
 allowed to prey upon the national stock utterly 
 undreamed of by great numbers of highly intelli- 
 gent persons, but that their very existence is, to 
 thousands of others, only the vaguest hearsay, 
 while to thousands more absolutely unknown. 
 Now, as in combating typhoid fever and the 
 plague the first thing needful is that all shall know 
 that there are such diseases, whence their origin, 
 and how they may be cut off at their source, so 
 it is essential that every citizen shall know that 
 there are venereal diseases, where they arise, and 
 how they may be exterminated. 
 
 Therefore, a wide- spread campaign of popular 
 education must be the first movement made. 
 This has already been begun by the national 
 societies founded for the purpose, and, as their 
 
134 Hygiene and Morality 
 
 task is a most difficult one, they should have 
 the active support of every right thinking man 
 and woman. Extreme difficulties meet this move- 
 ment at the outset, arising from the peculiarly 
 personal origin of these diseases, the prevailing 
 false modesty as to the reproductive functions, and 
 the generally dense ignorance of the physiology 
 and hygiene of the generative organs. The vulgar 
 prudery and hypocrisy of a past age compelled all 
 such subjects to be tabooed, as being indelicate or 
 improper. Perhaps this point of view has been 
 encouraged by those whose interests were selfish 
 or evil; certainly nothing could bettei serve 
 such interests than the veil of silence and the 
 cloak of embarrassment drawn over subjects so 
 vital, pertaining to functions by nature so sacred, 
 but by man so horribly debased. The function 
 of reproduction, for which the organs of generation 
 have been evolved, though it has been dragged 
 through the mire of vulgar thoughts and cruel 
 abuse, is yet the noblest, as it should be the most 
 held in reverence of all human powers. Repro- 
 duction is natural, and should no more be re- 
 garded vulgarly than are the changes of the 
 seasons. It is a type and symbol of immortality. 
 It is indeed a jDresent and visible immortality, 
 
Principles of Prevention 135 
 
 and its humble physical phenomena should never 
 obscure its exalted significance. The generative 
 act should only be performed in the sincerity of 
 aspiration to bring a new being into the world. 
 Such being the truth, the depravity of exercising 
 so miraculous a power for the sole desire of a 
 passing pleasure of sensation, often combining 
 with it drunkenness, and orgies in which all 
 human dignity and decency are cast away, is so 
 complete that the decay and fall of nations would 
 seem to need no further explanation. 
 
 The generative organs do not suffer by non-use. 
 This statement is now being emphasised with 
 great earnestness by our foremost medical teachers. 
 Nor does the general health suffer by their non- 
 use. This is also emphasised, and is the basis of 
 the modem scientific teaching upon sex hygiene 
 that is now being given to young men in the uni- 
 versities of many countries. 
 
 It must be seen to that no children are allowed 
 to grow up in the future in ignorance or with 
 secret vulgarised notions of sex physiology. The 
 simple truth, told them little by little from the 
 earliest age at which they begin to ask questions 
 and in a way which will appeal to their idealism; 
 then later teaching in the schools in biology, 
 
136 Hygiene and Morality 
 
 physiology, and nature study, will go far toward 
 prevention, by introducing a new ideal. The teach- 
 ing of older boys and girls should point to their 
 responsibilities to future generations. 
 
 As a woman physician has well said, young 
 men who might be deaf to the appeal of an indi- 
 vidualistic morality may be moved to response 
 by the presentation of their debt to race and 
 country. 
 
 The education of fathers and mothers must, 
 in the future, include the principles of heredity, 
 the toxic effect of unholy passions upon tempera- 
 ment and character, and the study of eugenics, the 
 new science for the improvement of the race of 
 man. 
 
 First and last, women need to be encouraged 
 to revolt against a status of political and legal 
 inferiority which is the direct cause of their 
 economic and social degradation. 
 
 Practical Means of Prevention. These 
 may be divided into two classes : one, the means of 
 individual care or personal prevention of disease 
 as such; the other, the means of social or deep- 
 lying prevention of the causes of disease. The 
 former is the more immediate, the latter more 
 
Principles of Prevention 137 
 
 fundamental. The former will soon prove to be 
 insufficient without the intervention of the latter. 
 A comparison with other forms of infectious 
 disease may serve as illustration. 
 
 When typhoid fever is epidemic, all persons are 
 warned to boil their drinking water; yet' Boards 
 of Health are not satisfied with that individual 
 precaution, but hold it necessary to protect 
 remote sources of water supply, no matter how 
 great the initial outlay of money. 
 
 In the warfare against tuberculosis, the first 
 thing taught is the proper disposal of sputum, 
 but no one rests satisfied with that, and presently 
 it becomes evident that the whole question of 
 housing and of occupation presses for solution, 
 bringing with it the details of rent, of land monop- 
 oly, and of private ownership of the means of 
 industry. Or, just as, in the expectation of raising 
 a certain kind of crop, the farmer begins several 
 years in advance by planting something quite 
 different, or by expending capital on accessories, 
 so must the social prevention of the social evil 
 with its train of disease be arrived at by remote 
 and indirect routes. 
 
 The personal precautions, being the most im- 
 mediate, may be considered first. 
 
138 Hygiene and Morality 
 
 Personal Prevention of Venereal Disease: 
 Childhood. From earliest childhood there must 
 be prevention of all habits known as self-abuse 
 or masturbation, namely, all stimulation of the 
 delicate nerve centres and fibres that are con- 
 nected with the genital organs. Every nurse 
 knows that such habits may arise even with babies, 
 in complete innocence, of course, and that, if not 
 checked, they may be less innocently continued 
 by older children with grave danger both to health 
 and morals. Mothers should be impressed with 
 the dangers of this habit to the delicate and un- 
 developed nervous system of the child. Many do 
 not know how real these dangers are, and regard 
 the habit as an unimportant one, believing that it 
 will be outgrown, as sometimes it may be. Nurses 
 should teach the routine of absolute cleanliness 
 of the parts, the avoidance of overwarm clothing, 
 of idle luxurious living, of rich stimulating food, 
 and above all, of alcoholic drinks for children, 
 as all of these tend to excite the nervous system, 
 while local irritants, such as uncleanliness or thick 
 clumsy clothing, may act directly upon the nerves 
 of the skin. Children should sleep in beds alone, 
 with plenty of fresh air, and, if necessary to break 
 up a tendency to self-handling, their hands 
 
Principles of Prevention 139 
 
 should be so confined as to prevent tendency 
 from becoming habit. Mothers should provide 
 regular, skilled medical inspection for all children, 
 that no abnormal condition may be overlooked. 
 Sometimes such cases require surgical interference. 
 The hygiene of the older child calls for ample 
 physical and manual training, daily bathing with 
 cool water, friction, and rough towels; regularity 
 of all excretory functions; fresh air and not too 
 much sedentary or solitary or monotonous occu- 
 pation. In talking with mothers upon these 
 subjects, nurses should have fortified themselves 
 by careful instructions from the wisest medical 
 men or women. Sensational prophecy of the 
 possible results of masturbation may do great 
 harm, yet negligence or timidity in controlling 
 it may do even more. It is important that all 
 mothers should understand that the younger the 
 child is who forms the habit the more injurious 
 is the practice in its effects upon the nervous sys- 
 tem. Furthermore, it is the conviction of Dr. 
 Morrow that masturbation tends to incline its 
 victims toward immoral habits and leads young 
 men to debauchery. 
 
 Dr. Blackwell, in her book. The Human Element 
 in Sex, deals instructively with masturbation, 
 
I40 Hygiene and Morality 
 
 specifying its chief evils as, i, the injury to the 
 mind through the nervous system, and, 2, the 
 danger of habit-formation with resultant loss of 
 self-control, with all the dangers that follow upon 
 this loss of mastery over one's self, even to the 
 destruction of health, insanity, or suicide. She 
 says in another place: ''Precocious physical de- 
 velopment hinders moral development/' 
 
 Lowenfeld, in discussing mental working power, 
 says that it is oftener injured by masturbation 
 than by excesses, adding: 
 
 and it is not always a case of very early or excessive 
 masturbation; in many cases of this habit there are 
 also painful reflections, such as self-reproach, self- 
 accusation, anxiety for consequences, recollection of 
 religious teachings, which affect the nervous system 
 and through it the mental working power. 
 
 Older Children. For older children there 
 should be definite warnings of the dangers which 
 they may meet, as carefully and explicitly given 
 as directions in taking a perilous journey. To 
 leave little girls, especially, in ignorance of what 
 these dangers are, is as wicked as it would be 
 to expose them to wild beasts. Such warnings 
 should be given at an early age. The little girl 
 of twelve has a simple seriousness and sagacity, 
 
Principles of Prevention 141 
 
 which may be looked for in vain if she remains 
 untaught and undiscipHned up to sixteen or sev- 
 enteen, when youthful gaiety often runs into 
 recklessness. 
 
 Such warnings need not cloud the happiness of 
 childhood more than other necessary knowledge 
 of danger which is likely to be met, and even if it 
 does, better that than the tragic fate which now 
 overtakes thousands of little girls. That kind of 
 sentimentality which regards the ignorance of 
 children in the face of the worst of perils as 
 desirable and lovely, is a sickly and unsafe, it 
 may be even a treacherous sentimentality. It 
 would at least seem to be beyond contradiction 
 that the age at which the laws cease giving pro- 
 tection to little girls should be the age at which 
 they are to be armed with the knowledge which 
 will help them to protect themselves. 
 
 Youth. Equally criminal is it to let the boys 
 go to boarding-school or college without the 
 most serious and intimate counsel and w^arnings 
 against the horrible diseases lurking amidst the 
 "wild oats" that they may thoughtlessly sow. 
 
 It is estimated by the records of the sickness 
 insurance system of Germany that 25% of uni- 
 
142 Hygiene and Morality 
 
 versity students become infected with venereal 
 diseases. We have no such statistics to guide us, 
 but the writer has learned from the personal 
 knowledge of the head of a large hospital in a great 
 university centre, of the numbers of young men 
 who come in for treatment for loathsome diseases. 
 A painful feature of this calamity is that "the 
 mothers are never told the truth ; the fathers come 
 and some reassuring falsehood is sent home." It 
 is thus evident that, in such cases, the mere fact 
 of the mother knowing the truth is greatly dreaded. 
 Therefore, if it could be certain that all mothers 
 would learn the truth, is it not likely that a power- 
 ful deterrent to evil courses in university life 
 might be brought into play? If this is the result 
 of silence and ignorance, the questions arise: 
 ''Is this really shielding the sanctity of home 
 life? Are not these mothers guilty of a serious 
 shirking of duty by not knowing, if their knowing 
 would mean even partial prevention?" 
 
 Early Adult Life. It is a hopeful sign that 
 the ancient heresy of ''physical necessity" for 
 irregular indulgence by men, so long upheld by 
 them, tacitly assented to by women, and even 
 sometimes taught by high medical authorities, is 
 
Principles of Prevention 143 
 
 now being gradually repudiated and denied by 
 the most eminent physicians and hygienists. 
 To maintain it has been, indeed, an insult to 
 all those men whose lives are and have been 
 pure, and one must wonder that such men have 
 so long permitted so detestable a doctrine to 
 go unchallenged. Young men may now be 
 taught, with all the authority of science, that 
 the same virtue which is desirable for their 
 sisters is good for them, and that ''physical 
 necessity," like drug habits, only grows coarser 
 and ranker by indulgence and weakening of the 
 will power. Self-control is an evidence of a 
 strong and manly nature and of a well-balanced 
 physical endowment. 
 
 Marriage. Medical statistics show that the 
 vast majority of all innocently contracted cases 
 of venereal disease are those contracted by wives 
 and children through the institution of marriage: 
 that fifty per cent, of the sterility of wives and 
 from twenty to twenty-five per cent, of the steril- 
 ity of husbands is caused by the gonococcus: that a 
 large per cent, of miscarriages and a heavy infant 
 mortality are due to the SpirochcBte pallida: that 
 fully eighty per cent, of blindness from birth and 
 
144 Hygiene and Morality 
 
 twenty -five per cent, of all blindness is gonorrhoea! : 
 that the secondary symptoms of inherited syphilis 
 often cause loss of sight or hearing: that from 
 fifty to seventy-five per cent, of all gyneco- 
 logical operations, often involving amputation of 
 the female organs of generation, and an indefinite 
 proportion of all cases of chronic, life-long in- 
 validism in women result from the deadly power 
 of persistence of the gonococcus and its tendency 
 to remain latent in the male organs, suddenly to 
 kindle an acute inflammation in the virgin tissues 
 to which it may gain access: it is therefore plain 
 that the most extreme precautions of personal pre- 
 vention need to be taken before the risk of mar- 
 riage is run. No parent should allow a daughter 
 to marry without securing authentic proof 
 that the promised husband is free from disease. 
 This is incontestably a duty of parents of the 
 utmost gravity and importance, neglecting which 
 all their previous care, expense, and nurture 
 lavished on the daughter may go for naught. 
 An honourable and virtuous man will willingly 
 give such testimony, and might rightly demand 
 on his side assurances from the parents as to their 
 daughter's inheritance. Such inquiries are not 
 impossible. They could all be conducted by 
 
Principles of Prevention 145 
 
 the trusted physicians of one or both families 
 with entire privacy and dignity. Fathers find 
 ways to inform themselves of the business standing 
 of prospective sons-in-law, and health is far more 
 precious than money. 
 
 What personal prevention can there be for an 
 innocent partner in marriage, if in later years 
 infection is brought to her from prostitution? 
 It would seem that here, as in the case of the 
 college boy, the knowledge that the truth would 
 surely become known might in many cases act 
 as a deterrent. At present the victim (usually 
 the wife) is kept in ignorance of the real cause of 
 her illness. Certainly, if there is any inalienable 
 right of the individual, it is to know what is the 
 matter with one when one is ill. But at present 
 two barriers are interposed: one is the general 
 ignorance of the laity in matters of health pre- 
 servation; the other is medical reticence. Only 
 when women have sufficient general knowledge 
 of health and disease, and courage to insist on 
 the truth and to accept it when offered, can the 
 second barrier be broken down. Already many 
 physicians are chafing against the shackles of the 
 ** medical secret," and they are sometimes severely 
 blamed for their share in the general blindfolding 
 
146 Hygiene and Morality 
 
 of the public in regard to venereal diseases. Yet 
 to speak the truth in individual cases exposes 
 them to suits-at-law and other most trying ex- 
 periences. It can, however, hardly be doubted 
 that the certainty of truth being known would 
 in time have a salutary preventive effect upon 
 married men. It would at least be a simple justice 
 to their victims. 
 
 « 
 Prevention of Accidental Infection. Re- 
 membering the characteristics of the SpirochcBte 
 pallida, its extreme virulence while living, but 
 short life period outside the body; and those of the 
 gonococcus, with its equal or even greater virulence 
 and perhaps somewhat greater tenacity of life 
 outside the body; remembering that neither is 
 conveyed by dust or through the air, but only by 
 material objects, it should be possible for every 
 one to guard against accidental infection, without 
 suffering from exaggerated alarm. Common drink- 
 ing cups, as in railway cars and public places, 
 should be absolutely avoided. Individuals should 
 carry their own cups. Progressive railroads are 
 now providing individual drinking cups of paper, 
 to be used once and then thrown away. They 
 should be demanded of every public service cor- 
 
Principles of Prevention 147 
 
 poration. Towels, too, in common use, must al- 
 ways be regarded as possible carriers. They 
 should never be applied to the face and eyes unless 
 freshly laundered. In general, it should be a 
 matter of universal practice never to rub or 
 even touch the eyes except with a clean piece of 
 linen — ^never with the fingers or finger nails, as 
 they carry all manner of infectious germs. 
 
 The face should not be washed directly from 
 basins that are used indiscriminately, especially 
 for rinsing the mouth. Rubbing the face with 
 a clean wet towel may be substituted in travelling. 
 
 Eating utensils which have been washed and 
 dried may be regarded as probably safe, yet in 
 many places it would no doubt be an added 
 security to carry one's own fork and spoon. The 
 fresh cleanliness of bed linen cannot be too care- 
 fully looked into when travelling. The conditions 
 of public laundries should also be a matter of 
 investigation by housekeepers. The seats of 
 public water-closets may always be regarded as 
 being more or less doubtful, and when used, may 
 be covered with a clean piece of paper. Many 
 cases of gonorrhoea are caused by the dirty or 
 ill-kept seats of public conveniences, especially 
 in crowded places. Public bath tubs should be 
 
14^ Hygiene and Morality 
 
 used with precautions of thorough cleansing, 
 and if doubtful, had better be let alone. No ob- 
 ject should ever be put to the lips or eyes which 
 may have been so handled by other persons, such 
 as pencils, pens, sticks, etc. To put money into 
 the mouth should be forbidden by the Boards 
 of Health. The importance of having individual 
 towels, face-cloths, napkins, utensils, etc., is 
 now generally recognised in institutions, homes, 
 asylums, and schools. Such articles are, if used 
 in common, of course capable of conveying many 
 kinds of infection, and it will be seen that the 
 avoidance of mechanical contagion of venereal 
 disease is much like that of tuberculosis and 
 pus diseases, the chief difference being that of the 
 absence of danger from dust in the one and its 
 great danger in the others. 
 
 In caring for cases of venereal diseases, nurses 
 and others should observe as rigid a technic of 
 disinfection as in diphtheria or other acute in- 
 fectious fevers. All discharges from the mucous 
 membranes, ulcerated or suppurating tissues, eyes, 
 mouth, or nose should be received on clean waste 
 material and promptly burned. Clothing and bed 
 linen should be boiled or sterilised, then well 
 sunned and aired. The danger of infecting 
 
Principles of Prevention 149 
 
 laundresses by unsterilised elothing should always 
 be remembered. Complete isolation of dishes 
 and utensils should be observed and they should 
 be periodically boiled. Patients with mucous 
 patches should never expectorate carelessly, for, 
 though the dried germs are not dangerous, there 
 is always the possibility of direct contact in some 
 manner before the death of the germs. Nor 
 should such patients sneeze or cough w^ithout 
 carefully protecting their surroundings by covering 
 the nose or mouth. This, indeed, should be the 
 usual routine for all persons at all times. 
 
 It is the right of every nurse, for self -protection, 
 to know what she is taking care of, and it should 
 be impressed upon all nurses that they must in- 
 variably insist upon knowing the diagnosis in 
 the cases they care for. It has not infrequently 
 happened that nurses, kept by the attending 
 physician in ignorance of the venereal origin 
 of patients' maladies, have contracted them. It 
 is also true that if all nurses were sufficiently 
 well taught and trained, it should be second nature 
 with them to avoid all infectious contact. The 
 proper precautions being observed, nurses and all 
 others should comprehend clearly that there is 
 no danger whatever from the simple presence 
 
150 Hygiene and Morality 
 
 of cases of venereal disease amidst other people, 
 and no more danger in caring for them than 
 there is with cases of ordinary sepsis. Acciden- 
 tal infection arises solely from ignorance; this 
 cannot be too strongly emphasised. Proof is 
 amply given by the results of well-managed ve- 
 nereal wards, where infection of attendants and 
 nurses does not occur. French experts have 
 recently recommended the inclusion of adult ve- 
 nereal patients (with the possible exception of 
 extreme cases) in the general wards of hospitals 
 for the sake of the better moral and mental in- 
 fluence, and explain that the recommendation is 
 perfectly practicable because with the proper 
 technic of care such patients need not be regarded 
 as dangerous from the stand-point of infection. 
 
 In conclusion it should be remembered that there 
 are probably no other diseases where early and 
 competent medical advice is more all-important. 
 If quackery is always a blunder, here it is a fatal 
 one, and nurses should use their whole power as 
 teachers to impress this on their communities. 
 All the social circumstances connected with 
 the time of cure and return of such patients 
 to normal life make the necessity for the best 
 medical oversight one of paramount importance. 
 
Principles of Prevention 151 
 
 Social Prevention of Prostitution. In 
 order to approach social methods of preventing 
 prostitution in a perfectly intelligent way there 
 should first be three main lines of inquiry, which 
 can here be simply indicated, in the briefest 
 fashion, as lines on which there is work waiting 
 for women to do. They are : 
 
 First, to discover the extent of prostitution. 
 Second, to ascertain its various reasons for exist- 
 ence, — ^what they are and how much diversity 
 they have to shov/. Third, to penetrate to the 
 social arrangements in which these reasons are 
 imbedded, and to see how much there is here 
 that is artificial and needless. 
 
 The right attitude of mind with which to under- 
 take such inquiry is, that it is rational to believe 
 that prostitution and its resultant diseases can be 
 reduced to a minimum, and that it is possible 
 for that minimum to be discovered. To be con- 
 vinced that it can be and inflexibly determined 
 that it must be discovered is no more visionary 
 or theoretical than it has been in the past to 
 believe in all the dawning possibilities of human 
 progress. There was a time when it was thought 
 that the plague, typhus, smallpox, and other 
 infectious diseases could not be conquered, 
 
152 Hygiene and Morality 
 
 Science has indeed not banished any of these ills 
 entirely from the earth, but it has given society 
 the knowledge of how to keep them down to their 
 lowest terms. 
 
 The Extent of Prostitution. It is doubtful 
 whether correct figures could be obtained at present 
 of the entire extent of prostitution. This would 
 be the first task to undertake in initiating an ag- 
 gressive campaign against the institution as such. 
 But, taking the world over, being guided by the 
 statements that are made by officials and social 
 students regarding single cities and coimtries, it 
 is hardly doubtful that there are, in all, several 
 million women set aside in this life. It was stated 
 at the Brussels congress, conservatively, that there 
 were fifty thousand in England. Taber Johnson 
 estimates the number in the United States at 
 about half a million who are in houses of ill-fame, 
 and believes there may be as many more outside 
 of such places. In exerting the imagination to 
 picture this number of women pariahs and to 
 call them together in one mass before the mental 
 vision in order to personify them, and to consider 
 the problem of their relation to disease, it is 
 to be remembered that this dreary race does not 
 
Principles of Prevention 153 
 
 perpetuate itself. Prostitutes quickly become 
 sterile, and few leave children. Their lives, 
 moreover, are very short. Some authorities 
 estimate the average life of the prostitute as 
 ten years; some believe it to be even less, — a 
 five-year average. Between these two estimates 
 it may be possible there is a mean, but even this 
 is sufficiently short, especially as it does not sig- 
 nify their working life, so to speak, but the act- 
 ual span of life. In from five to ten years they 
 die, many from pneumonia, tuberculosis, alco- 
 holism, and suicide, while practically all of them, 
 says Dr. ^lorrow, finally become cases of venereal 
 disease of one form or another. Now, if it were 
 only this half-million or so of women in our own 
 country who were doomed to early disease and 
 premature death for no better or more useful 
 reason than to gratify the brutal and selfish 
 lusts of men that will finally destroy those very 
 men themselves, this alone would be a disgrace to 
 modem hygiene and civilisation. It may be il- 
 lustrated by supposing that a half-million women 
 were set apart at any one time in our great country 
 to be infected with leprosy or to be compelled to 
 die of diphtheria. AU the health boards of the 
 coimtry would be in a state of desperate activity, 
 
154 Hygiene and Morality 
 
 and the daily press would find no headlines suf- 
 ficiently sensational. But it is actually even 
 worse than this, for, in order to fill the vacancies 
 caused by disease and death, some 50,000 fresh and 
 once at least pure, clean, and innocent young 
 girls must be annually drafted into this death- 
 dealing business. 
 
 Solely as a matter of public health, without 
 regarding moral considerations for a moment, 
 this is a danger of paramount importance, yet it 
 meets with less concern from health boards than 
 half-a-dozen smallpox cases. Indeed, the dis- 
 covery of one smallpox case is telegraphed all 
 over the country, but the fact that numbers of 
 young girls are set aside yearly to die of venereal 
 disorders and their tragic accompaniments is 
 ignored by sanitary departments and the" press. 
 
 From this point of view, too, the extent of 
 prostitution as the source of venereal disease 
 must be noted in the light of the computation 
 of experts, that for every abandoned woman 
 there are at the least five profligate men. Dr. 
 Morrow estimates, from carefully collected data, 
 that, of the young men in this country reaching 
 their sixteenth year (numbering 770,000 annually), 
 at least sixty per cent, or over 450,000 of each 
 
Principles of Prevention 155 
 
 year's cohort, will, at some time of life, become 
 infected with venereal- disease, and that twenty 
 per cent, of such infection will occur before the 
 end of the twenty-first year. 
 
 Reasons for the Existence of Prostitution. 
 
 What are these reasons and how diverse are they ? 
 The statements of the United States District- 
 Attorney, as wxll as of speakers at the Brussels 
 conferences, indicating that about four fifths of all 
 prostitutes are unwillingly such, though painful, 
 have a hopeful aspect, as they point definitely to 
 the conclusion that prostitution is capable of 
 being reduced to an easily controllable minimum. 
 If these four fifths of unwilling members of the 
 sad arm.y could be withheld from entering this 
 life, it would not be an insoluble problem to deal 
 with the remaining fifth. Distributed, as they 
 would be, over the whole country, the number of 
 *' chronic or persevering" prostitutes with which 
 each community had to deal would not be an 
 unmanageable number. If they were irreclaim- 
 able, they could be kept in colonies, tenderly 
 and wisely cared for, as are the insane and feeble- 
 minded. If this ideal method should be too ad- 
 vanced, then, when there were really only the 
 
156 Hygiene and Morality 
 
 prostitutes by preference to consider, and then 
 only, might direct legislation of a punitive char- 
 acter for women be spoken of without bitter 
 injustice and wrong. 
 
 The only true prevention for such chronic or 
 determined evil-doers, and the prevention that the 
 future must show how to apply, is, not to have 
 them bom. Who can say, now, that they are not 
 the inevitable hereditary consequences of their 
 parents' sexual excesses? 
 
 Unwilling victims of a stupid social order should 
 not be regarded as true prostitutes, but as sacrifices, 
 as human loss and waste due to pure mismanage- 
 ment. The underlying reason for their lapse is 
 poverty or the unequal struggle against want. 
 All medical and social experts who have studied 
 this problem agree that prostitution is a disease 
 of poverty. Testimony on this point is so abun- 
 dant that it is not necessary to prove the point 
 here, but it may be recalled that the favourite 
 buttress for the arguments of those who uphold 
 prostitution and licensed vice is the dictum that 
 "there must always be prostitution because there 
 will always be poverty." 
 
 Poverty, then, must be so far eradicated or at 
 least so far mitigated that it cannot honestly be 
 
Principles of Prevention 157 
 
 given as an explanation of prostitution. This is 
 the social prevention of venereal diseases which 
 are fostered in prostitution. 
 
 It will now^ be clear how far-reaching and remote 
 are the paths along which the prevention of 
 venereal diseases must be pursued. They lead 
 even farther than the road to the prevention of 
 typhoid fever, which follows the water-courses 
 back to the pure springs of the head-waters. And 
 they are obstructed by the same obstacles in the 
 mercenary interests that have become parasitic; 
 but besides all these they are blocked by one 
 obstacle which no other contagious disease has 
 ever had to meet, namely, the selfish and hitherto 
 uncontrolled pleasure of indulgence of the individ- 
 ual man. The prevalence and power of this pleas- 
 ure-lust make it hopeless to expect that a majority 
 of men will give it up themselves of their own 
 volition; and vain, therefore, is it to look to their 
 management for prevention of prostitution. It 
 will be found again, as Mrs. Butler found, that 
 many will readily lop off the worst manifestations 
 of this institution, such as the white slave traffic, 
 who will never whole-heartedly undertake the 
 eradication of the institution itself. Already this 
 is clear in the articles which are now appearing 
 
158 Hygiene and Morality 
 
 in the periodicals and daily papers upon the white 
 slave trade; horror of the trade is freely expressed, 
 with shame and contrition for its existence, but 
 one may search vainly through the lay press for 
 any bugle-call to men to put an end to prostitu- 
 tion. This must be the work of women, and to 
 do it they must possess the instrument which is as 
 indispensable in controlling the acts of legislatures, 
 which lie behind all social conditions, as is the 
 microscope to the physician in his research work, 
 or the scissors to the mother who is cutting out 
 her children's clothes. 
 
 Enfranchisement of Women the First Step. 
 Long ago Dr. Taylor said that every method had 
 been tried for the prevention of venereal disease 
 except one, and that was the teaching of conti- 
 nence to young men. But Dr. Taylor was wrong, 
 though a good and noble man; for in his day no 
 one had ever dreamed of trying the remedy of 
 giving power and authority to the mothers of young 
 men. And it is passing strange that so few even of 
 the men sincerely desirous of wiping these scourges 
 of disease from the earth should think of this 
 remedy, even when, as at the Brussels conferences, 
 they have racked their brains for suggestions 
 
Principles of Prevention 159 
 
 and have put forth some that seem almost childish 
 in their grasping at straws. For now it is possible 
 to see the beginnings of what women will do with 
 this matter of prostitution and venereal disease 
 when they have full political power. To-day, the 
 only parts of the world where this combined 
 problem is progressing toward solution are those 
 parts where women have been in possession of the 
 ballot long enough to show some results of their 
 direct influence. ^ 
 
 Only the determination of women who are 
 politically free, expressed through the machinery 
 of government by the right use of popular govern- 
 ment's only instrument, the ballot, can effect the 
 downfall of prostitution as a social and commercial 
 institution. Some broad-minded men there are 
 who do see this. Professor James Stuart said to 
 Miss Emily Ford, of England, when she asked 
 what could be done to stop commercialised vice, 
 ''Go on trying for woman suffrage''; while in our 
 own country there are medical members of the 
 American Society of Sanitary and Moral Pro- 
 phylaxis who take the same position. 
 
 Social Steps in Prevention. There must be 
 
 » See Appendix B. 
 
i6o Hygiene and Morality 
 
 full and ample protection for children from the 
 very cradle, — yes, even earlier. It must be 
 possible for every child to be well bom, and the 
 pregnant mother must be protected first from 
 want, poverty, and sweated labour. 
 
 Child labour must be abolished and child-cul- 
 ture substituted for it. Children that are forced 
 into the labour market are almost foredoomed to 
 prostitution and venereal disease because their en- 
 f eeblement and premature exhaustion weakens will 
 power, retards useful education, and warps their 
 natures, whilst the exposure to all sorts of moral 
 dangers cannot be avoided by little wage-slaves. 
 The need of ample legal protection for little girls 
 has been sufficiently shown by the facts of the 
 ''age of consent" laws. These laws and the re- 
 sistance of legislatures to their amendment, 
 show only too plainly that they have been in- 
 tentionally framed and kept, not for the protection 
 of girls, but for the protection of men while keeping 
 an open door through which a sufficient supply 
 of young girls may be continually passed into ruin. 
 This is a painful reflection, but it is the only 
 possible conclusion from the facts. 
 
 But further, for the real protection of girls not 
 only legislation, but vigilant administration and 
 
Principles of Prevention i6i 
 
 unswerving enforcement of law must be had. 
 Now, the former, or some appearance of it, may 
 indeed be secured as a concession from men, but 
 the latter can never be hoped for until women 
 possess the same public and legal powers that 
 men now possess.^ This is a point that is almost 
 invariably overlooked. The flippant query so 
 often heard, "Shall we have women police?" 
 needs to be answered seriously in the affirmative ; 
 women are urgently, desperately needed as police 
 wherever yoimg children and growing creatures 
 are out in the world, and the time may not be 
 far off when such police, with the training of the 
 nurse or the teacher, shall be more numerous 
 than those we are now familiar with. Then, and 
 for the first time, there will be real "morals police." 
 Widowed mothers must not be compelled to act 
 as father and mother both, by being driven to earn 
 their children's bread outside the home while 
 trying to keep their little ones in the home. 
 Through this double burden women have been 
 driven to the streets, or their little ones have 
 found the way there. There are seas of senti- 
 mentality poured forth about the home, — but it 
 never seems to be the home of the working people 
 1 See Appendix C, 
 
i62 Hygiene and Morality 
 
 that is meant. Yet these are the majority of the 
 homes. To one of America's deepest-hearted 
 and most clear-seeing women, a sight that seemed 
 too intolerable to be borne was the sight of a 
 working mother whose abundant milk dripped to 
 the floor as she scrubbed business offices for sixteen 
 hours a day. Who can tell how such sins against 
 family life will end? 
 
 The real protection of mothers and of children 
 will be, as to prostitution and venereal disease, 
 what the protection of the head-waters is to 
 typhoid fever; for, as Judge Lindsay's recent true 
 story has shown, it is absolutely essential for the 
 children to he ruined at a tender age, if a vicious 
 and corrupt class is to he maintained.^ 
 
 The fundamental and crying need in the protec- 
 tion of older girls is a living wage. It is only 
 too well known that employers in every country 
 where women are disfranchised have not infre- 
 quently given to their young employees, along 
 with their wage pittances, the suggestion that it 
 is always open to them to earn more without 
 difficulty. The researches recently made by the 
 National Consumers' League into the relation 
 between the cost of living and the wages paid 
 
 > See Appendix D. 
 
Principles of Prevention 163 
 
 to girls in industry in New York City, striking as 
 they have been in their demonstration of gross 
 inequahty, give cause for added thought in view of 
 the official information that that city is the centre 
 of the white slave trade. ^ 
 
 Hours of work need to be shortened for all 
 workers. Overwork, monotony, and chronic fa- 
 tigue make all work hateful and destroy healthful 
 ideals, while the long hours of work leave no time 
 for natural enjoyment or pleasure in life. 
 
 It is often said, as a piece of superior wisdom, 
 that men cannot be made moral by law. It is 
 only superficially true. Conditions which make 
 young boys and girls, yoting women and men, 
 or older women and men immoral by necessity 
 can be and should be altered by the law. Indeed 
 they must be, because the whole modem social 
 structure rests finally on the support given to it by 
 laws. Intelligent social legislation, when rightly 
 enforced, is like the fence that keeps marauders 
 out of an orchard. Vainly does the gardener put 
 forth his best work if the fence is not there and 
 the despoilers are. If we could get rid of maraud- 
 ers, we might do without fences, as the French 
 gardens need none. 
 
 « See Appendix E. 
 
164 Hygiene and Morality 
 
 The influence of unenfranchised woman is 
 nulHfied and frustrated precisely as are the 
 efforts of the unprotected gardener. Her fence 
 will be the ballot, but she must build it herself. 
 The marauders who threaten her are all the 
 vicious and dangerous elements among men who 
 know that her supremacy means the ultimate dis- 
 appearance of that social evil on which they base 
 all their profitable exploitation of the young and 
 the helpless. These enemies, though the most 
 venomous, are the most silent; they are never 
 heard in arguments against woman suffrage. ^ 
 
 English women writers, medical women and 
 the leaders of the suffrage movement both m Eng- 
 land and in our own country, declare in the most 
 explicit terms that the real hostility to the advance 
 of women comes from those who exploit prostitu- 
 tion, while, on the other hand, at the foundation of 
 the terrible earnestness of the women of England 
 to gain the Parliamentary franchise is the burning 
 and unflinching determination to free womanhood 
 from this disgrace. In this country the story is 
 the same, though not so well understood by the 
 great mass of women. 
 
 The fear of the "bad woman's vote" has long 
 
 » See Appendix F. 
 
Principles of Prevention 165 
 
 been dangled as a spectre before the eyes of timid 
 good women. How fictitious this fear is may- 
 be realised by summing up the testimony proving 
 that eighty per cent, of the *'bad women" need 
 not have been bad; that almost all prostitution is 
 commercial, and that its promoters rely chiefly 
 for their supplies on the ruin of children of tender 
 years, eking out with young girls snared in their 
 silly and thoughtless age; that the white slave 
 trade is now and always has been supported and 
 protected by men politically corrupt ; that in Col- 
 orado, where all women vote, the ** bad women" 
 actually cast just one third of one per cent, of the 
 vote of Denver 1 ; that the women of that State, 
 though in the minority, have succeeded in placing 
 model statutes for the protection and training 
 of children upon the books, and have helped to 
 maintain in power against bitter enemies the one 
 man fearless enough to enforce and reinforce 
 them, while in the three other enfranchised 
 states not a word is ever heard about a ''bad" 
 vote; that in New Zealand prostitution has been 
 reduced to its lowest terms, while commercialised 
 vice is practically extinct there. Well did Dr. 
 
 1 Dr. Aylesworth, in his Carnegie Hall address, Nov. 17, 
 1909- 
 
1 66 Hygiene and Morality 
 
 Aylesworth say, ''These women [the prostitutes] 
 exert a hundred fold more influence upon poli- 
 ticians through their business than through their 
 ballots." 
 
 A New Ideal Needed. A new ideal needs to 
 be formed; an ideal of the worth and dignity 
 of human life, and of a commanding place and 
 power that must be assumed by women in all that 
 pertains to the cherishing and ennobling of the 
 race. This ideal must be built upon the single 
 standard of sex morality and it must be attained 
 by a gradual process of assumption of knowledge 
 and authority by women, to the end that they may 
 finally produce a nobler and a finer race of men. 
 
SOURCES OF MATERIAL USED IN THE PREPARA- 
 TION OF PART'III. 
 
 Abbott, Edith, Women in Industry. 1909. 
 American Society of Sanitary and Moral Prophylaxis. 
 Publications. 9 East 42d St., New York City. 
 
 The Boy Problem: For Parents and Teachers. 
 
 The Young Man's Problems: For Teachers. 
 
 The Relations of Social Diseases with Marriage, 
 
 and their Prophylaxis. 
 How My Uncle, the Doctor, Instructed Me in Mat- 
 ters of Sex. 
 Health and the Hygiene of Sex: for College Students. 
 Anthony, Susan B., and Harper, Ida Husted, History of 
 
 Woman Suffrage. 4 vols. 
 Arendt, Sister Henriette (for five years assistant police 
 officer in Stuttgart, in charge of women prisoners before 
 and after their discharge), Menschen die den Pfad 
 Verloren. Stuttgart, 1907. 
 Aves, Ernest, Report to the Secretary of State for the Home 
 Department on the Wages Boards and Industrial 
 Conciliation and Arbitration Acts of Australia and New 
 Zealand. London, 1908. (Blue Book.) 
 Blackwell,JElizabeth, M.D., Counsel to Parents on the Moral 
 
 Education of Their Children. 1880. 
 Blackwell, Elizabeth, M.D., The Human Element in Sex, 
 
 1884. 
 Blackwell, Elizabeth, M.D., The Laws of Life, with Special 
 
 Reference to the Physical Education of Girls. 1852. 
 Blackwell, Elizabeth, M.D., Medicine and Morality. 
 Blackwell, Elizabeth, M.D., Pioneer Work in Opening the 
 Medical Profession to Women. 1896. 
 
 167 
 
i68 Hygiene and Morality 
 
 Blackwell, 'Elizabeth, M.D., The Religion of Health. 
 Blackwell, Elizabeth, M.D., Wrong and Right Methods of 
 
 Dealing with Social Evil. (No date; about 1860-70.) 
 Broadhead, State Regulation of Labour and Labour Dis- 
 putes in New Zealand. 1908. 
 Bureau of Labour, Labour Conditions in Australia (Bulletin, 
 
 Vol. X., 1905). 
 Bureau of Labour, Minimum Wages Act of 1908 in New 
 South Wales, p. 86. (Bulletin No. 80. January, 1909.) 
 Conference on the Care of Dependent Children, Washington, 
 
 D. C, January 25, 26, 1909. Proceedings. 
 Eugenics Education Society. Publications. London. 
 Immigration Committee, Report. Importing Women for 
 
 Immoral Purposes. (Senate Document No. 196.) 
 Jacobi, Mary Putnam, M.D., Common-Sense Applied to 
 
 Woman Suffrage. New York, 1894. 
 Kelley, Florence, Some Ethical Gains Through Legislation. 
 
 New York, 1905. 
 Lowenfeld, Die geistige Arbeitskraft. In Grenzfragen des 
 
 Nerven und Seelenlebens. Vol. vi. 
 Macrosty, State Arbitration and the Minimum Wage in 
 Australasia. In Trade Unionism and Labour Problems, 
 edited with an Introduction by John R. Commons, p. 
 195. New York, 1905. 
 Martindale, L., M.D., Under the Surface. Brighton, England. 
 National American Woman Suffrage Association, Political 
 Equality Leaflets: 
 
 Blackwell, Alice Stone, Fruits of Equal Suffrage, i., 
 
 ii. 
 Holder, Lady, Equal Suffrage in Australia. 
 Kelley, Florence, Woman Suffrage: Its Relation to 
 
 Working Women and Children. 
 Macnaghten, R. E., Women's Vote in Australia. 
 Nathan, Maud, Wage Earner and the Ballot. 
 Russell, Charles Edward, Woman Suffrage in New 
 
 Zealand. 
 Wells, Mrs. Borrman, New Zealand's Experience. • 
 New York Probation Association. First Report. 165 W, 
 lOth St., New York City. 
 
Sources of Material Used 169 
 
 Oregon and Illinois Briefs relating to Overwork. The Con- 
 sumers' League, 105 E. 22d St., New York City. 
 
 Roosevelt's (President) Homes Commission Report. (Sen- 
 ate Document No. 644.) 
 
 Royal Commission on the Poor Laws. Minority Report. 
 London, 1909. 
 
 University of London, Eugenics Laboratory Lecture Series. 
 London. 
 
APPENDIX A 
 
 ATTEMPTS TO INTRODUCE REGULATION INTO THE 
 UNITED STATES 
 
 St. Louis: Attempt made in 1870 under pretext of 
 suppressing prostitution. The words "or regulate" 
 introduced into a clause of the city charter established 
 a system of supervised vice which continued until 
 1874, when it was abolished by the force of public 
 indignation. 
 
 California: In 18 71 the legislature had a bill 
 brought before it for legalising and regulating vice. 
 The wife of a member drew up and had presented a 
 bill identical with the first except that the word 
 **man" was substituted throughout where the word 
 ** woman" appeared in the original bill. The ob- 
 noxious bill was withdrawn. 
 
 Cincinnati: In 1874 an attempt was made to 
 regulate vice by enactment but it was defeated. 
 
 Pennsylvania: In 1874 a bill was presented in the 
 
 legislature for the State regulation of vice. Fifty-two 
 
 171 
 
172 Hygiene and Morality 
 
 medical men sent a noble protest, affirming the single 
 moral standard. The bill was defeated. 
 
 District of Columbia: Regulation by the Board 
 of Health was proposed in 1875 and was defeated. 
 
 New York State: About the same date similar 
 legislation brought before the legislature was defeated 
 by the power of Elizabeth Cady Stanton, Susan B. 
 Anthony, and their allies. 
 
 [Data taken from A Comparative Survey of Laws ^ 
 etc., by Sheldon Amos.] 
 
APPENDIX B 
 
 EXAMPLES OF THE KIND OF LEGISLATION WOMEN ARE 
 ESPECIALLY INTERESTED IN AND WORK FOR 
 
 Wyoming: Equal pay to men and women teachers 
 of equal qualification. 
 
 Age of protection for girls raised to i8. 
 
 Penalties for neglect, abuse, or cruelty shown to 
 children. 
 
 Prohibition of the labour of boys under 14 in mines. 
 
 No cigarettes, liquor, or tobacco to be sold or given 
 to persons under 16. 
 
 Free public kindergartens established. 
 
 Licensed gambling forbidden. 
 
 Provision for the care and custody of deserted or 
 orphan children and children of infirm, indigent, or 
 incompetent persons. 
 
 Colorado: State home for dependent children 
 established. Two of the five members of the board 
 of managers must be women. 
 
 Provision that at least three out of six members of 
 the board of county visitors shall be women. 
 
 173 
 
174 Hygiene and Morality 
 
 Mothers made joint guardians of their children 
 with the fathers [this equaHty of parents exists in 
 only thirteen of the States of the Union]. 
 
 Age of protection for girls raised to i8. 
 
 State industrial home for girls established; three 
 of the five members of the board of managers to be 
 women. 
 
 Protective care for the feeble-minded provided. 
 
 Woman physician placed on the board of the asy- 
 lums for the insane. 
 
 Juvenile courts and truant schools established; 
 education compulsory to the i6th year. 
 
 Union high schools established. 
 
 Advanced regulations for child labour and an eight- 
 hour day for children of 1 6 or under. 
 
 Prohibition for over eight hours a day for women 
 working in occupations that require standing. 
 
 To contribute to the delinquency of a child made a 
 criminal offence. 
 
 Idaho: Gambling made illegal. 
 Age of protection for girls raised to i8. 
 Industrial reform school established. 
 Equalisation of married women's rights in property. 
 
 Utah: Equal pay for men and women teachers 
 equally qualified. 
 
Appendices 175. 
 
 Age of protection for girls raised to i8. 
 
 Sale or gift of cigarettes, tobacco, opium, or any- 
 other narcotic to persons under i8 forbidden. 
 
 Provisions for protection of children against neglect 
 or ill treatment. 
 
 Free kindergartens established. 
 
 [The above examples have been taken from pam- 
 phlets by Alice Stone Blackwell: Fruits of Equal 
 Suffrage, I. and II. Only those that are specially 
 pertinent to the subject under discussion in the text 
 have been chosen, whilst the pamphlets themselves 
 give numerous other examples without assuming 
 to show a complete list. It is pointed out that laws 
 of this character are much better enforced where 
 women are enfranchised. The leaflets are published 
 by the National American Woman Suffrage Associa- 
 tion, 505 Fifth Avenue, New York City.] 
 
 New Zealand: Legal standard of morality and 
 conditions of divorce made the same for men and 
 women. 
 
 Legal separation from worthless husbands obtain- 
 able summarily and without expense. 
 
 Testator's Family Maintenance Act prevents a 
 man from willing away his property without making 
 suitable provision for wife and family. 
 
1 76 Hygiene and Morality 
 
 Old-age pensions for aged persons of both sexes ; an 
 old couple may receive a joint pension in their own 
 home. 
 
 Government asylums for inebriates established. 
 
 Health of women workers and of workers of both 
 sexes under 18 carefully protected; hours of labour 
 and legal holidays with payment regulated [the 
 eight-hour day is legal] ; payment of wages to learners 
 in trades secured and workers' compensation for 
 accidents defined with great advantage to the working 
 people. 
 
 Purer code of morals established by alterations in 
 the criminal code. 
 
 Adoption of children regulated by law and baby 
 farming prevented. 
 
 Industrial schools and technical schools established. 
 
 [From Woman Suffrage in New Zealand^ pub- 
 lished by the International Woman Suffrage Alliance. 
 Leaflet No. i.] 
 
 Australia: On the federal domain the chief gains 
 so far are: 
 
 Equal pay for equal work in government depart- 
 ments. 
 
 Naturalisation laws made equal for men and wo- 
 men. 
 
 Unified marriage and divorce bills. 
 
Appendices 177 
 
 In the separate (Australian) states the gains are: 
 wages boards; children's courts; old-age pensions; 
 protection for wage -earning children ; married women's 
 property acts ; aid for the illegitimate mother ; reforms 
 in the drink trade. 
 
 [From Where Women have the Vote, published 
 by the National Union of Women's Suffrage Societies, 
 25 Victoria St., Westminster, London; quoting Miss 
 Alice Zimmern's Women's Suffrage in Many Lands. 1 
 
 12 
 
APPENDIX C 
 
 SOME STATISTICS OP CRIMINAL ASSAULT UPON YOUNG 
 
 GIRLS ^ 
 
 By Mary Burr, Delegate to the International Congress 
 
 of Nurses of the National Council of Trained 
 
 Nurses of Great Britain and Ireland. 
 
 Statistics are usually considered very dry, but 
 when those figures mean ruined lives, as they do in 
 this paper, then they assume an aspect which should 
 command our very closest attention. In endeavour- 
 ing to gather these statistics, it was originally intended 
 to draw as far as possible upon private sources. 
 These, however, proved inadequate, and a dozen 
 different societies which deal with wronged women 
 and children were approached for whatever informa- 
 tion they could give. 
 
 The results proved somewhat curious; from only 
 
 iRead at the International Congress of Nurses, London, 
 July, 1909. Reprinted in the British Journal of Nursing, 
 Nov. 6, 1909. 
 
 178 
 
Appendices 1 79 
 
 two did I receive any definite information — the 
 National Society for the Prevention of Cruelty to 
 Children and the Church Penitentiary Association. 
 
 Of the other societies, six referred me to some one 
 else, and even the National Vigilance Society, from 
 which I expected much, referred me to the Director 
 of Public Prosecutions; the remainder said they did 
 not deal with such cases. 
 
 One lady flatly refused to furnish information 
 which she considered private to a congress of which 
 she knew nothing. 
 
 It made one wonder if this work, which so closely 
 affects the national well-being, is a private preserve, 
 reserved to those who work in it. It almost appears 
 so. Information was sought on four points only: 
 
 1. The number of cases of criminal assault com- 
 mitted upon young girls and children. 
 
 2. The number of cases in which prosecution 
 followed. 
 
 3. The result of the prosecution. 
 
 4. The ages of the victims. 
 
 The idea was to find out as far as possible the 
 extent of this awful evil; what proportion of the 
 offenders were punished and the degree of punish- 
 ment inflicted, because, of various cases which had 
 come to my knowledge, only a very small proportion 
 were brought to justice. As so little information 
 
i8o Hygiene and Morality 
 
 was obtained from the societies from which I had 
 hoped to gain so much, I took the advice of one secre- 
 tary, and bought the Blue Book of Criminal Statistics, 
 and here is the result. 
 
 Comparative statistics are given for 15 years 
 from 1893 to 1907; the details of 1907 only are given. 
 In those 15 years there were 2302 cases of defilement 
 of girls under 13 years of age, and 2442 cases of 
 defilement of girls under 16 years of age, making the 
 terrible total of 4744 cases reported to the police. 
 
 Of these 3425 were tried — 1660 for assault on 
 girls under 13, the remaining 1765 being for girls 
 under 16. 
 
 The details of the cases for 1907, which are included 
 in the above figures, are as follows : — Reported to the 
 police, 149 cases concerning girls under 13, and 178 
 concerning girls under 16; total, 327. Of these, 97 
 of the first and 135 of the latter were tried, a total 
 of 232 cases, roughly about two thirds. Five cases 
 were thrown out, 82 were acquitted, 145 convicted. 
 The punishment of those convicted was penal servi- 
 tude in 23 cases for terms varying from four to twenty 
 years, five and seven years being the usual sentence ; 
 one man was flogged; the remainder received terms 
 of imprisonment from fourteen days to two years. 
 
 One curious fact in this grim document is the 
 distinction drawn between girls under and over 13. 
 
Appendices i8i 
 
 All the sentences of penal servitude were given in 
 the former cases, and not one in the latter; apparently 
 a girl over 13 and under 16 may be treated in the 
 most dastardly manner and the sentence be anything 
 between fourteen days and two years. 
 
 This does not conclude the terrible sum of immoral- 
 ity among the males of this Christian land, for during 
 the years quoted — 1893 to 1907 — ^there were also 
 3407 cases of rape, and 12,280 cases of indecent 
 assault upon women over 16, reported to the police, 
 altogether making the ghastly total of 15,687 cases 
 reported, and with the 4744 cases under 16, we have 
 the tremendous number of 20,431 — ^an annual average 
 for the fifteen years of 1362 women's lives wrecked. 
 Such is the information from the Blue Book. 
 
 The Rev. Thomas George Cree, Hon. Secretary of 
 the Church Penitentiary Association, sent me a very 
 interesting little pamphlet. Juvenile Immorality, in 
 which he states that he sent out a circular to all 
 the homes and refuges on their list asking for the 
 number of such children under 16 dealt with during 
 the last three years (up to October, 1908). Re- 
 plies from 40 penitentiaries were received; 7 did 
 not take such cases, the 33 which did returned 347 
 cases. From 55 refuges the number of cases returned 
 was 745; total for three years, 1092. 
 
1 82 Hygiene and Morality 
 
 Some of the details are as follows: — 8 cases be- 
 tween 6 and 8 years of age; i8 between 9 and 11 
 years; 11 cases of 12 years; 14 cases of 13 years; 
 121 cases of 14 years; and 301 cases of 15 years. 
 
 In one town the Chief Constable reports that hardly 
 a child over 14 years has not fallen. From another, 
 that children under 14 absolutely solicit in consider- 
 able numbers. In another, lads marked with badges 
 solicit. On inquiring why prosecutions are so few, 
 the reply comes from all quarters that so often the 
 culprit is the father, step-father, uncle, or brother 
 of the victim. In a covering letter, Mr. Cree writes 
 that, besides the numbers already quoted, fully 
 1000 more cases were known, but the parents would 
 not allow the rescue workers to deal with them. 
 
 He says convictions are very few, as relations are 
 often the culprits, and prosecutions must be taken 
 in hand within six months after the commission of 
 the crime ; and, when there is danger of an infant being 
 born, the child is restrained by threats from saying 
 an3rthing until its state is manifest. 
 
 Also young children are subject to cross-examina- 
 tion by lawyers, and he states a case of a child of 10 
 being cross-examined for a full hour, but the evidence 
 could not be shaken, and the case was sent to the 
 Assizes. 
 
 From the Society for the Prevention of Cruelty 
 
Appendices 183 
 
 to Children came the statistics for last year — 838. 
 cases, 146 prosecuted, 46 being dismissed. 
 
 Of collected cases there are 20, 18 of these being 
 under 16, one being only 3 and another 5 years of age. 
 In two the fathers were the culprits, and in one the 
 brother was suspected. In six of these cases nothing 
 was done, either because parents would not prosecute, 
 or for want of sufficient evidence. Two of these cases 
 were very bad. One, a girl, went to a gardener's for 
 fruit at midday on Sunday, did not return home 
 until 6.30; then went out, presumably to chapel. 
 Nothing more was seen of her until her body was taken 
 from the river on the following Tuesday morning. 
 On examination, the child was found to have been 
 violated. The gardener was severely censured at 
 the inquest, and an open verdict given. 
 
 The other was of a child of 12, who was outraged 
 while her mother was lying dead. The child accused 
 her father of the crime, but, as it could not be proved, 
 he was let off. 
 
 Out of II cases which were investigated, 3 were 
 discharged, i because there was, as the Judge said, 
 "No corroboration," and i "not proven." Of the 6 
 convicted, i was let off with a fine, and the others 
 received sentences varying from six months to ten 
 years. 
 
 Of the two cases over 16, one was a girl of 17 
 
1 84 Hygiene and Morality 
 
 mentally deficient, and the culprits (several youths, 
 one of whom confessed to the wrong-doing) were all 
 discharged by the magistrates. The other, also a girl 
 of 17, was seized from behind, a drugged handkerchief 
 stuffed into her mouth, and she was dragged into the 
 bracken off the high road across a Surrey heath. 
 There she was outraged, and when she recognised her 
 assailant, he tried to pour poison down her throat, 
 fortunately without much success. Chiefly because of 
 the attempt to poison he got seven years. I think 
 it should have been for life. 
 
 If such is the condition of things as they are known, 
 what number of cases are there unknown? If there 
 are 327 cases reported during a year, how very many 
 hundreds are there unreported? Yet men who are 
 supposed to protect the weak take every advantage 
 of that weakness. Governments come and go, yet 
 this terrible evil remains unchecked. Why have not 
 these cases been put in the same category as murder? 
 Do our law-makers consider it worse to kill the body 
 than to outrage its honour and sully its soul? 
 
 It is useless to try, as some may do, to blame for- 
 eigners ; only one culprit among all the reported cases 
 for 1907 was an alien. 
 
 These men, who defile women and violate their 
 own offspring, are British. They have the power of 
 helping to make the laws which we women must 
 
Appendices 185 
 
 obey, and, judging from these statistics, make them 
 as easy as possible for the indulgence of their own 
 lusts. 
 
 If this is not so, why must cases be instituted within 
 six months of the offence? Why must a child, whose 
 whole moral and physical nature has been so recently 
 outraged, be subjected to cross-examination by a 
 lawyer (a man) upon so delicate a matter? 
 
 And, lastly, how is it possible to expect corrobora- 
 tive evidence in the majority of such cases? 
 
 If such a state of things is the result of the absolute 
 political power of men, the sooner women have votes 
 the better it will be for the nation, and the sooner 
 will its moral and physical condition be improved. 
 
 INADEQUATE PROTECTION TO GIRLS 
 
 " A sinister chapter to which too little attention has 
 hitherto been paid is the failure of our legislatures 
 and courts to afford to young girls protection from 
 seduction, assault, and enslavement in infamous 
 houses. The difficulty involved in obtaining the 
 conviction of malefactors is known only to the few 
 faithful souls who have attempted to obtain due 
 punishment of these grave offences. Mothers in any 
 community are more deeply stirred by these offences 
 than by any others, but judges and juries vary be- 
 
i86 Hygiene and Morality 
 
 yond belief in their treatment of criminals guilty 
 of crimes against girls. 
 
 " In one western State a woman worked fourteen 
 years to obtain the enactment of a workable statute 
 to punish crimes against female minors. At last 
 such a law was passed and vigorously enforced. Four- 
 teen criminals were sent to the penitentiary. Then 
 a young lawyer offered his services to one of the 
 criminals, to free him by showing that the law was 
 tinconstitutional because the title should have read 
 *to define and punish crimes against female minors' 
 whereas in fact the two words 'define and' were 
 missing from the title, though the necessary definition 
 was contained in the body of the statute. Upon 
 this frivolous ground the Supreme court of the State 
 held the statute invalid, and nine of the fourteen 
 criminals were forthwith freed. The others were too 
 poor or too ignorant to obtain counsel, and they 
 remained in the penitentiary."^ 
 
 EXAMPLES OP LAWMAKING IN NEW YORK STATE 
 
 The maximum punish- Section 1566 of the 
 ment that can be given penal code of New York 
 to a "cadet," or man State, which is conspicu- 
 
 1 Woman Suffrage: its Relation to Working Women and 
 Children, by Florence Kelley, published by the National 
 American Woman Suffrage Association. 
 
Appendices 
 
 187 
 
 ously placed in the sur- 
 face cars fixes one year's 
 imprisonment and $500 
 fine as the maximum pen- 
 alty for stealing or giving 
 away a transfer ticket 
 worth five cents. 
 The offence of ''procuring" is graver, and is pun- 
 ishable with the same degree of severity as is the 
 offence of spitting on the floors of cars and public 
 buildings. 
 
 who lives upon the earn- 
 ings of prostitutes, in 
 New York State is six 
 months in the workhouse. 
 The statute makes this 
 offence a misdemeanour. 
 
APPENDIX D 
 
 PROTECTION OF WIDOWED MOTHERS 
 
 The possibilities of protection extended by the 
 state to mothers with children who are dependent on 
 them, not only for care but for a livelihood, are in- 
 dicated by the systems of industrial insurance or 
 compensation now in force in almost every civilised 
 country except this one. Every European country, 
 at the present time, compensates the widows of 
 workmen who have been killed in industry. In Eng- 
 land the widow receives a sum of money, while in 
 most other countries she receives a pension equal to 
 a part of her husband's earnings. This continues un- 
 til she remarries, and serves to protect the orphans. 
 In Germany the orphans are thus provided for imtil 
 their fourteenth year, — ^the age at which they are 
 allowed to begin earning. 
 
 One of the chief aims of the women of Australia, 
 
 lately organised into a political association in order 
 
 to concentrate effectively upon social legislation, is 
 
 i88 
 
Appendices 189 
 
 to bring about a higher degree of economic security 
 for women who have children to support. 
 
 The idea that mothers, who provide citizens for 
 the state, are as fully entitled to state support or 
 pensions during the time when the children need 
 their care as are soldiers, who fight for the state, is 
 gradually making its way as a part of the new ideal. 
 
 The subject of industrial compensation may be 
 found in Workingmen's Insurance, by William Frank- 
 lin Willoughby, which is now under revision and is 
 to be published by the Russell Sage Foundation. 
 Of Australian methods Miss Alice Henry, Hull House, 
 Chicago, writes that the united experience of all 
 workers there supports the plan of the maternal sub- 
 sidy. Its abuse may be readily prevented by careful 
 administration. Though not yet universal, the prac- 
 tice of enabling deserving widows or deserted mothers 
 to keep the home together is spreading in all the 
 States. South Australia gives rations for children 
 if more than one in a family. New South Wales, 
 Western Australia, and Victoria board the children 
 with their mothers to the age of twelve. See Report 
 Interstate Conference of Workers among Dependent 
 Children, and Reports, State Children's Department, 
 Adelaide, Australia; also State Children in Australia 
 by Miss Spence. 
 
APPENDIX E 
 
 MINIMUM WAGE BOARDS 
 
 "The minimum wage boards were established ... in 
 response to an anti-sweating agitation. . . . The social 
 sanction of the minimum wage determinations rests 
 upon the common interest of society in maintain- 
 ing among all classes of people a standard of living 
 comporting with the general wealth and civilisa- 
 tion of the community, and guaranteeing healthy 
 social progress. . . . Minimum wage boards . . . 
 are composed of not less than four nor more than 
 ten members representing equally the employers 
 and employees in the trade under their jurisdic- 
 tion with a chairman elected by the other members 
 but who is not one of the original members of 
 the board. A separate board is formed for each 
 trade." 
 
 [Bulletin of the Bureau of Labour, vol. x., 1905, pp. 
 61, 62, Washington.] 
 
 '* Equal pay for equal work has been partially 
 
 recognised for the first time in Australia under 
 
 private enterprise by a recent 'determination' of 
 
 190 
 
Appendices 191 
 
 the Drapery Trade Wages Board. It is already 
 in force in the Federal Public Service, in the 
 Junior Grade of the State Education Department, 
 and now a beginning has been made in private 
 enterprise." 
 
 [Vida Goldstein in Jus Suffragii, organ of the 
 International Woman Suffrage Alliance, January 15, 
 1 9 10. Edited by M. G. Kramers, 92 Kruiskade, 
 Rotterdam.] 
 
APPENDIX F 
 
 THE LIQUOR TRAFFIC AND ITS ATTITUDE TOWARD 
 WOMAN SUFFRAGE 
 
 The National American Woman Suffrage Associa- 
 tion prints a leaflet reproducing what it calls a "secret 
 circular" which was distributed by an association of 
 brewers and wholesale liquor dealers in a western 
 State at the time of a campaign to introduce a woman 
 suffrage amendment into the State constitution. 
 This circular came into the possession of the daily 
 press and may be found in newspaper files. It is 
 stated that its authenticity has never been denied. 
 Part of its text runs as follows : 
 
 "It will take 50,000 votes to defeat woman suffrage ; 
 
 there are 2000 retailers in . That means that 
 
 every retailer must bring in 25 votes on election 
 day. ... 
 
 " We enclose 25 ballot tickets showing how to vote; 
 we also enclose a postal card addressed to this as- 
 sociation. If you will personally take 25 friendly 
 
 192 
 
Appendices 
 
 193 
 
 voters to the polls on election day and give each one a 
 ticket showing how to vote, please mail the postal 
 card back to us at once. You need not sign the card. 
 Every card has a number, and we will know who sent 
 it in. Let us all pull together and let us all work. 
 Let us each get 25 votes.'* 
 
INDEX 
 
 A 
 
 Abolitionist Congress in Geneva, 77 
 
 " ** " " resolutions of, 77-79 
 
 Accidental infection in syphilis, 31, 38-39 
 Acquired Syphilis, 10 
 
 Age of consent, U. S. laws concerning, 1 16-12 1 
 Ages when girls are ruined, 87-88 
 Alcoholism in syphilis, 15, 25-27 
 Antibodies, 10 
 Anti-serum treatment, gonorrhoea, 48 
 
 B 
 
 Blindness, in gonorrhoea, 46, 51 
 Breeding-place of the venereal diseases, 34 
 Brussels Conference, first, 81 
 
 ** " resolutions, 83 
 
 " " second, 81, 83-89 
 
 ** " resolutions, 89-90 
 
 Butler, Mrs. Josephine E., 69 
 
 Cancer and syphilis, 24 
 Chancroid, 52 
 
 Clandestine prostitution, 98, 99 
 Colles, phenomenon named after, 19 
 Congenital syphilis, 16-17 
 Constitutional forms of gonorrhoea, 46 
 Contagious Diseases Acts, The, 68 
 Continental System of Regulation of Vice, The, 66 
 
 195 
 
196 Index 
 
 Control of prostitution, 59-103 
 
 Course of gonorrhoea, 43 
 
 Crime and syphilis, 27-29 
 
 Crusade of women under Mrs. Butler, 71 
 
 D 
 
 Dangers of regulation, 93-103 
 
 Diplococcus gonorrhoeae, 40 
 
 Donne, 5 
 
 Double standard of morals. The, 60-62 
 
 E 
 
 Enfranchisement of women needed, 158-159, 164-166 
 Extent of prostitution, 152-154 
 
 Girls, trade in, 108-109 
 Gonococcus gonorrhoeae, 40 
 Gonorrhoea, 40 
 
 " and syphilis, 51, 52 
 
 ** course of, 43 
 
 " history of, 41-43 
 
 " mortality from, in prostitutes, 50 
 
 " organism of, 40 
 
 Great Britain, regulation in, 67-75 
 Gummata, 16 
 
 H 
 
 Hard chancre, 12 
 
 Heredity, syphilis, 18 
 
 History, white slave trade, 104-105 
 
 Hours of work, 163 
 
 Immunity, gonorrhoea, 48 
 '* syphilis, 20 
 
Index 197 
 
 [ chancroid, 52 
 Incubation period -< gonorrhoea, 43 
 
 ( syphilis, 11 
 Infantilism, 17 
 Initial sore of syphilis, 12 
 International Federation against vice, formation of, 77 
 
 Laws covering age of consent in U. S., 1 16-12 1 
 
 " share of, in white slave trade, 107-108 
 Legislation, efforts to amend, 1 09-1 10, 171 ff 
 Liquor traffic and woman suffrage, 186-187 
 
 M 
 
 Martineau, Harriet, warnings by, 68 
 
 Mediate contagion, 98 
 
 Metchnikoff, Elie, 5 
 
 Minimum wage boards, 185-186 
 
 Modes of transmission, gonorrhoea, 47-48 
 
 " " syphilis, 37-39 
 
 Moral standard, double, the, 60-62 
 Morals police, 64 
 Morbidity of gonorrhoea, 49 
 
 " ** syphilis, 29, 31 
 
 Mortality from gonorrhoea in prostitutes, 50 
 Mucous patch, syphilis, 13 
 
 N 
 
 National Consumers' League, inquiry into wages, 162-163 
 National Vigilance Leagues, iio-iii 
 Need of knowledge, 133-136 
 Neisser, experimental work of, 9 
 
 " micrococcus of, 40 
 
 " serum diagnosis of, 9-10 ■ 
 Nervous system and syphilis, 22-24 
 Numbers of young men infected, 154-155 
 
 One-child sterility, 45 
 
198 Index 
 
 Para-syphilltic diseases, 23 
 
 Pasteur Institute, 8 
 
 Persevering prostitutes, numbers of, 86 
 
 Poverty and prostitution, 156 
 
 Prevalence of gonorrhoea, 49 
 
 " " syphilis, 29 
 
 Prevention of venereal diseases, 129-130 
 
 *' (individual), 138 
 
 ** ** childhood, 1 40-1 41 
 
 *• ** youth, 141-142 
 
 " ** marriage, 143-145 
 
 " " accidental, 146-149 
 
 ** (social) childhood, 160 
 ** '* girlhood, 162 
 
 '* " motherhood, 160, 188-9 
 
 Primary lesion, syphilis, 12 
 ** stage " 12 
 
 " " length of, 12 
 
 " infection in gonorrhoea, 43 
 Profeta, phenomenon named for, 20 
 Progress of crusade against venereal disease, 74-75 
 Prostitutes, mortality of, gonorrhoea, 50 
 Prostitution, 34-36 
 
 " of minor girls, 86 
 
 " attempts at legislation in U. S., 171 
 
 Protest of women against regulated vice, 71 
 Puberty and syphilis, 17 
 
 R 
 
 Race suicide, the true, 52 
 
 Reasons for prostitution, 155-156 
 
 Regulation of prostitution, 59; efforts to secure legislation in 
 
 U. S., 171 
 Regulationists in Medical Congress, 1873, 76 
 Report on Criminal Assault, 176 ff 
 Resolutions, first Brussels Conference, 83 
 
 second " " 89-90 
 
Index 199 
 
 Sanitary inefficiency of regulation, 96-99 
 Schaudinn, discovery, of, 5-6 
 
 " organism of, 5 
 Second stage of gonorrhoea, 44-45 
 
 " " " syphilis, 13-14 
 
 Select Committee, House of Commons, 75 
 
 ** " ** " Lords on white slave trade, 75 
 
 Share of laws, in white slave trade, 107-108 
 Social legislation needed, 163 
 Societies, Sanitary and Moral Prophylaxis, 90-91 
 Soft chancre, 52-53 
 Source and spread of syphilis, 32 
 Spirilla refringens, 6 
 Spirocheete balanitis, 7 
 " pallida, 5 
 
 " " destroyed by heat, 7 
 
 " " demonstrated in tissues, 8 
 
 Stages of gonorrhoea, 44-45 
 " " syphilis, primary, 11 
 " " " secondary, 13 
 " tertiary, 14 
 Statistics of gonorrhoea, 49-52 
 
 ** " syphilis, 29-31 
 Sterility of gonorrhoea, 45-50 
 Struggle against Contagious Diseases Acts, 73-74 
 Supreme Court decision, 115 
 Syphilis, 3, 
 
 ** acquired, 10 
 
 ** and carcinoma, 24 
 
 ** and crime, 27-29 
 
 *' cause of, 4-5 
 
 '* alcoholism in, 15, 25-27 
 
 ** congenital, 10, 16-17 
 
 " course of, lo-ii 
 
 " history of, 4 
 
 " mucous patches of, 13 
 
 " and the nervous system, 22-24 
 
200 Index 
 
 Syphilis, organism of, 5 
 
 " prevalence of, 29 
 
 " rash of, 13 
 
 *• source of, 32 
 
 '* stages of, 11-14 
 
 " statistics of, 29-31 
 
 " and tuberculosis, 24-25 
 
 " and gonorrhoea, 51, 52 
 
 Tertiary syphilis, 14 
 Third stage, gonorrhoea, 46 
 Three stages, gonorrhoea, 43 
 Tolerated houses, 65-67 
 Treponema pallidum, 7 
 Tuberculosis and syphilis, 24-25 
 
 Venereal sore, 52-53 
 
 W 
 
 White slave trade, Europe, 103-104 
 
 United States, I lO-i 1 5 
 Widowed mothers, protection of, 185, 188-189 
 
 Y 
 
 Young men infected, numbers of, I54~I55 
 
 Z 
 Zeissl, 22 
 
M Selection from the 
 Catalogue of 
 
 G. P. PUTNAMS SONS 
 
 Complete Catalogue sent 
 on application 
 
A History of Nursing 
 
 The Evolution of the Methods of Care for the Sick 
 from the Earliest Times to the Foundation of the 
 First English and American Training Schools for 
 Nurses. 
 
 By LAVINIA L. DOCK, R.N. 
 
 Secretary of the American Federation of Nurses and of 
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 and M. ADELAIDE NUTTING, R.N. 
 
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 The story is not told in a dry technical fashion, but 
 presents its pictures from the standpoint of general human 
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 The history is amply illustrated, and contains 3 copious 
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 a great deal of matter not to be found in other books, and with the 
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 New York London 
 
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 Nurses, St. Vincents Hospital. 
 
 Essentials of Dietetics 
 
 In Health and Disease 
 
 A TEXT-BOOK FOR NURSES 
 
 By AMY ELIZABETH POPE, Author, with 
 
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 of "Practical Nursing" and Instructor in the Presbyterian 
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 and 
 
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 'Director of Domestic Science in the Public Schools 
 Saratoga Springs, N. Y. 
 
 Crown 8vo. Illustrated, $i.oo net 
 
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 in the nursing-school curriculum. It is also adapted to use as a 
 dietary guide for the home. At least one-third of the women 
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 being prepared to take charge of hospitals or to do settlement 
 work, and in both these branches of the nursing profession hardly 
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 buying, preservation, cooking, and serving of food. To do this 
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 principles to the body, of the proportions in which they are con- 
 tained in the different foods, and of the effect on them of acids, 
 heat, salt, digestive ferments, etc. 
 
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 NEW YORK LONDON 
 
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 Quiz Book of Nursing 
 for Teachers and Students 
 
 By 
 Amy Elizabeth Pope 
 
 Joint-Author of " Practical Nursing ** and ** Essentials 
 
 of Dietetics" 
 and 
 
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 Together with Chapters on Visiting Nursing 
 
 By Margaret A. Bewley, R. N. 
 
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 and 
 
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 G. P. PUTNAM'S SONS 
 
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Second Edition, Revised and Enlarged 
 
 Short Talks with Young 
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 up for the children of from one year to six years of age." 
 
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 iently handled and the print is very clear." — The Criterion, 
 
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