Journal of Social Hygiene, by The American Social Hygiene As

That's French for "the ancient system," as in the ancient system of feudal privileges and the exercise of autocratic power over the peasants. The ancien regime never goes away, like vampires and dinosaur bones they are always hidden in the earth, exercising a mysterious influence. It is not paranoia to believe that the elites scheme against the common man. Inform yourself about their schemes here.

Journal of Social Hygiene, by The American Social Hygiene As

Postby admin » Thu Mar 05, 2020 11:18 am

Social Hygiene
VOL. I, DECEMBER, 1914 NO. 1
by The American Social Hygiene Association, Inc.
Office of Publication, the Waverly Press, Baltimore, MD.

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CONTENTS:

• The American Social Hygiene Association, by Charles W. Eliot
• The Fight for a Red Light Abatement Law, by Franklin Hichborn
• Can the Law Protect Matrimony from Disease?, by Edward L. Keyes, Jr.
• The Regulation of Prostitution in Europe, by Abraham Flexner
• Education and the Social Hygiene Movement, by G. Stanley Hall
• Play Leadership in Sex Education, by Clark W. Hetherington
• The Bionomics of War, by Vernon L. Kellogg
• Diagnosis and Advice in Venereal Diseases, by B.S. Barringer and Archibald McNeil
• The Interest of Life Insurance Companies in Social Hygiene, by Lee K. Frankel
• The Relation of Education in Sex to Race Betterment, by Winfield S. Hall
• Report of the Committee on Prostitution, of the National Conference of Charities and Correction, by Maude E. Miner
• Law Notes
• The Library
• Law Notes:
o Social hygiene legislation in 1914
• The Library:
o What shall we read?
• Books and Periodicals Reviewed:
o Daniels. The girl and her chance.
o Coulter. The children in the shadow.
o Mosby. Causes and cures of crime.
o Nearing. Social sanity.
o Begbie. The crisis of morals.
o Cabot. What men live by.
o Munsterberg. Psychology and social sanity.
o Thwing. The family.
o Gordon. The anti-alcohol movement in Europe.
o Michels. Sexual ethics.
o Aldrich and others. Eugenics.
o Nearing. The super race.
o Tapp. Sexology of the Bible.
o Steinhardt. Ten sex talks.
o Metropolitan -- Ellis. White slave agitation.
o Forum -- Whitlock. The white slave.
o Atlantic -- Repplier. The repeal of reticence.
o Ladies' World -- Maxwell. Telling children about sex hygiene.
o Survey -- Mitchell. Children and sex idealism.
o Popular Science -- Metcalf. Eugenics and euthenics
o Popular Science -- Miller. Psychological limits of eugenics.
o Forum -- Saleeby. Progress of eugenics.
o Quarterly Review. -- Tredgold. Heredity, environment, and social reform.
o American Journal of Sociology -- Johnson. Eugenics and so-called eugenics.
o Atlantic -- Holmes. Decadence of human heredity.
o Suddeutsche Monatshefte -- von Kemnitz. Die Verheimlichung der Geschlechtakrankheiten.
o Quarterly Review -- Pernet. Syphilis.
o Medical Review of Reviews -- Burrows. Public responsibility for venereal prophylaxis.
o American Medical Association Journal -- Hazen. Syphilis in the American negro.
o American Journal of Sociology -- Trawick. The church and the problem of crime.
o Psychological Review -- Weidensail. Psychological tests for criminal women.
o Harper's Weekly -- Creel. Where is the vice fight?
o Critic and Guide -- Purcell-Guild. Prostitution, the oldest problem of all.
o Pearson's -- Laughlin. A single standard.

Social Hygiene is supplied to all members of The American Social Hygiene Association, Inc. The annual dues are five dollars a year. The magazine will be sent to persons not members of the Association at two dollars a year, single copies are sold at fifty cents each.

Correspondence should be addressed and checks made payable to The American Social Hygiene Association, Inc., 105 West 40th St., New York City.

James Bronson Reynolds, William F. Snow, M.D., Editors
Copyright, 1914, by The American Social Hygiene Association, Inc.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:19 am

THE AMERICAN SOCIAL HYGIENE ASSOCIATION1 [1. President's address to the annual meeting of The American Social Hygiene Association, New York City, October 9, 1914.]
CHARLES W. ELIOT
President Emeritus, Harvard University


The American Social Hygiene Association -- a combination of two bodies of national scope and similar purposes which had been in existence but a few years -- is a new organization, the motives and objects of which have not yet been clearly and widely made known. To all those who have been active in contriving and establishing this new agency for promoting public health and morality, it seems requisite that a clear and comprehensive statement should now be made concerning the objects and aims of the Association. Since its field of work is a very difficult one, in which the best intentions might fail to produce any beneficial result, it is desirable to make clear to the public not only the objects and aims of the Association, but also the means by which it intends to pursue them; and since active work in this field is apt to excite apprehension or even strong antagonism in the minds of excellent people, it is quite as desirable to indicate what the Association does not mean to do as to describe the positive action it hopes to take.

Within the last thirty years, mankind has gained much new knowledge concerning the sources, causes, and modes of transmission of many diseases, and concerning the means of preventing contagion. During the same period, great progress has been made in the treatment of many diseases against which mankind was formerly defenceless. Among contagious diseases the most destructive to the white race are the diseases called venereal; because they are fearfully poisonous and corrupting, and are caused and spread by vices and animal gratifications in which both men and women have part. Fortunately, more new knowledge has recently been acquired concerning the causes and treatment of these diseases than of any others. The lines of transmission of these diseases and their effects on a second generation have been made known. New tests of their presence in the human body have been invented; and new reliefs, partial or complete, have been brought into use. A considerable proportion by no means all of the cases of insanity, general paresis, and blindness have been proved to have their origin in the venereal diseases. Sterility and ovarian and uterine disorders in women frequently result from them. In short, these vice diseases, now known to be often communicated to the innocent, are without doubt the very worst foes of sound family life, and thence of civilization. This remarkable progress of medicine, and especially of preventive medicine, imposes on society new duties and responsibilities with regard to the toleration of vice. So long as society supposed that nothing could be done to prevent or cure the vice diseases and their horrible consequences, the policy of complete silence in regard to them, and of doing nothing to prevent them or to mitigate the sufferings they cause, was at least intelligible, and perhaps justifiable. In the light of present knowledge these policies of silence and inaction are no longer justifiable. In dealing with such portentous evils, society can no longer place first considerations concerning innocency, delicacy, and reticence, any more than in dealing with war. The attack on them must be public and frank; but it should also be high-minded, and free from suggestions which might invite youth to experiment in sexual vice.

The first work to be undertaken by the Association is the work of ascertaining present conditions as regards sexual vice in American cities and towns. These inquiries should be thorough and universal; and the results should be published in the way most likely to inform the leaders of public thought and action. Important surveys have already been made in this field; but much work remains to be done.

Next, the Association should study the various sorts of police action against vice, and the various statutes intended to regulate vicious resorts, to confine them within fixed limits, or to make less public and open the allurements to vice. It is now clearly known that all the preceding police attempts to regulate vice, to prevent the spread of the venereal diseases, and to diminish immorality have completely failed alike in the East and the West, in Europe and in the Americas. To exhibit and to publish this record of the total failure of well-meant police measures must be one of the first labors of the new Association.

A third important object of the Association is to devise and advocate effective police procedure and effective legislation with regard to vice. In some American communities improved laws, courts, or police administration have already been secured. The Association should try to make the best experience of any state, city, or town available, as lesson or example, to all other cities or towns; but this is an operation involving steady watchfulness and labor, and heavy expenditure.

Part of the work of the Association should be contributory to the work of other organizations -- such as those that advocate the suppression of disorderly houses and disreputable hotels, the gratuitous treatment of venereal diseases at public expense to prevent or diminish contagion, the substitution of weak alcoholic drinks for strong, the promotion of total abstinence, and the provision of wholesome pleasures, both out-of-doors and indoors. The Association should always be ready to take part in the prosecution of men or women who make a profit out of obscene publications, indecent shows, immoral plays, and prostitution.

The Association ought to advocate actively the common use of the recognized safeguards against sexual perversions -- such as bodily exercises, moderation in eating, abstinence in youth from alcohol, tobacco, hot spices, and all other drugs which impair self-control, even momentarily. Social hygiene would be effectively promoted by reduction or rejection of the drinking and smoking habits in American communities. In the white race the connection between drinking alcohol and prostitution is intimate.

One of the most difficult tasks of the Association -- but an indispensable one -- is to bring about a serious change in the ethics of the medical profession. The new knowledge about the trailing consequences of the venereal diseases, and of the long-drawn human miseries which result from them, makes necessary an important change in what has been the ethical practice of that profession. It should now be impossible for a conscientious physician to fail to protect from marriage with a man whom he knows to be diseased the woman whom the diseased man is proposing to marry. Every physician who is called upon to treat a man with venereal disease should have it understood with his patient that his confidential relation to him does not include inaction when his patient proposes to commit that crime. In times past the faithful keeping by the physician of the confidences of his patient has been a fine element in the ethics of the profession; but the recent discoveries in regard to the contagion, duration, and far-transmission of venereal diseases have made it necessary to put limits on the physician's pledge of secrecy, lest he become a silent participant in one of the worst of crimes.

Finally, the Association proposes to take active part in bringing about certain educational changes which will touch first parents, then teachers, then adolescents, and lastly children. In the field of social hygiene, as in almost all the different provinces of public and private morality, improvements cannot be firmly established until the rising generations have been thoroughly imbued with them, and have been brought up under right conditions. In its educational propaganda, however, the Association will necessarily proceed conservatively and gradually. It recognizes the obvious fact that it is quite impossible, even if it were advisable, to introduce instruction in social hygiene into the public schools, except to a small degree, and with great reticence. It believes that instruction in sex subjects should never be given to the two sexes together after the age of puberty, and that none but obviously high-minded teachers should even talk with pupils on these subjects. It believes that parents, if adequately informed, are the best persons to teach the elements of parenthood and sex-relations to their children. It knows that the existing normal schools cannot as yet supply any considerable number of teachers competent to deal with these subjects in the elementary and secondary schools. One of the first tasks should be to urge normal schools and colleges to prepare teachers competent to teach the elements of biology in elementary schools, and later the elements of social hygiene to girls and boys in separate classes in the secondary schools. While it endeavors to select books on the various phases of the general subject which it can recommend adults to read, it is inclined to believe that the needed instruction in social hygiene proper can be better given to adolescents orally, with help from photographs, diagrams, and tabulated statistics, than from books. For the present, the Association hopes to do the greater part of its educational work through other organizations -- such as men's clubs, women's clubs, Young Men's and Young Women's Christian Associations, granges, benefit societies, state boards of health, life insurance companies, and medical societies. It means to carry on its work without impairing modesty and becoming reticence in either young or old; and it hopes to promote by all its activities genuine innocence and purity, and the sanctity of family life.

These being its objects and aims, and its conceptions of public service in the field of social hygiene, the Association invites men and women in every part of the country, who are of this mind, to become members of the Association, and to support its work.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:20 am

CALIFORNIA'S FIGHT FOR A RED LIGHT ABATEMENT LAW1 [1. At the election of November 3, 1914, the referendum vote resulted in favor of the Red Light Abatement Law by a substantial majority.]
FRANKLIN HIGHBORN
San Francisco, Calif.


For twenty years or more in California a group of men and women, having a pronounced working understanding but no very definite organization, have been in more or less active opposition to general vice conditions. Up to 1910, the time of the overthrow of the once dominant political machine, most of their activities were directed against race-track gambling. But so long as the machine was in power the race-track gamblers controlled the State Senate Committee on Public Morals. This committee up to the 1909 session succeeded in blocking all legislation which in any way interfered with the gambling interests. But in 1909 a start was made toward securing effective legislation against the gambling element. The 1911 Legislature, freed of machine domination, passed a law under which racetrack gambling has been brought to an end in California. In 1912, the gamblers attempted, by means of an initiated measure, to set aside the anti-gambling act of 1911. But the group opposed to vice conditions organized a publicity campaign, and succeeded in defeating the gamblers' initiated bill by an overwhelming majority of 203,000.

The Red Light Abatement Bill of 1911

At the 1911 session of the California Legislature, fa start was made toward securing the enactment of a Red Light Abatement law. This movement was deemed the logical step to follow the defeat of the gambling element. The personnel of the alignment was practically the same as it had been in the campaign against the gamblers. The opposing lobby was made up of practically the same men who had opposed anti-race-track gambling legislation. In not a few cases the same men who had profited largely from gambling ventures were closely connected with the exploitation of the social evil.

A bill based upon the Iowa Abatement Law was introduced in the Assembly. The Assembly Committee on Public Morals sent to Iowa for information, and spent weeks in consideration of the measure in all its phases. This committee finally filed its report recommending that the bill be enacted.

The Bill Sidetracked

This action brought to Sacramento a powerful opposing lobby. Before action could be taken in the Assembly, the bill, amid a scene of extraordinary confusion, was sent to the Judiciary Committee, where it remained until the Legislature adjourned.

A Campaign of Education

Outside of those who had attended the Public Morals Committee hearings, few in California had, at the close of the 1911 legislative session, a clear idea of the measure's scope and purposes. But following the 1911 session, a campaign of education was quietly but effectively carried on. Leaflets dealing with the issues involved were distributed throughout the state. Lectures were held; civic bodies interested. The campaign of publicity and education was carefully calculated so that interest was at its height at the time the session opened. When the Abatement Bill came up for passage, literally thousands of telegrams and letters poured in upon the members urging them to give the measure their support. For the moment the act held the center of popular interest. Its passage could not have been prevented. In the Assembly of eighty members, only seventeen votes were cast against it. In the Upper House only eleven of the forty Senators voted against it.

The Opposition Increases

With the passage of the bill, the opposition increased its efforts. Pressure was brought upon Governor Johnson to prevent his signing the measure. The Governor was urged to give opponents of the act a private hearing. This the Governor refused to do, but called a public hearing that each side might be heard. The opposition failed to attend this open meeting. The Governor accordingly signed the bill without further delay.

The Referendum Invoked

The opposition's next step was to invoke the referendum to prevent the act going into effect. It is now known that hundreds of names on the referendum petition were forged. At San Francisco 1280 names, after the most casual examination, were rejected on the ground that they were forgeries. A handwriting expert who has since examined the petition states that had all the forged signatures been rejected, there would not be enough valid signatures left to invoke the referendum. However, the Secretary of State has certified to the sufficiency of the petition, and the bill must be put to referendum vote.

The Campaign Organized

When it became evident that a state-wide campaign must be made for the bill, the group that had conducted the publicity campaign in 1912 against the gambler's initiated law set about planning a similar publicity campaign to secure ratification of the abatement measure. Two committees were organized, the one covering the counties of Southern California, and the second covering the counties north of Tehachapi pass, the natural division of the state. A publicity campaign has been inaugurated, based on the same lines as that so successfully carried on against the gamblers. Every community of the state has been canvassed, and the names of prominent supporters of the bill secured. The Northern Committee's lists contain, for example, the names of over 16,000 such supporters. From the Committee's headquarters in San Francisco, the work of publicity is carried on in every community of Northern California. Similar work is being done through the Southern Committee, which has it headquarters at Los Angeles. The two organizations look forward to securing ratification of the act by a majority as large as that by which the gamblers were defeated two years ago -- that is to say, by a majority of over 200,000.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:21 am

CAN THE LAW PROTECT MATRIMONY FROM DISEASE
EDWARD L. KEYES, JE., M.D., PH.D.
Professor of Genito-Urinary Surgery, Cornell University Medical College


The banishment of transmissible and hereditary disease from matrimony is surely one of the most important results to be anticipated from social hygiene. Every educational, moral, and hygienic advance in the movement tends more or less directly toward this end. The community is beginning to realize the dangers of more or less latent uncured venereal disease both to mother and child -- invalidism, and sterility to the one, blindness and destruction to the other. Our young men are in a fair way to learn that chastity will be demanded of them as a necessity for the fulness of their moral and physical development, no longer to be regarded as a remote and impersonal ideal. Our health boards are struggling bravely toward a solution of the difficult problems of segregation, reglementation, and the registration of venereal diseases.

In these and in many other ways we are striving to safeguard matrimony from contamination. But such more or less indirect measures are manifestly inadequate to protect an innocent partner from one whose "honor" is rooted in dishonor, as well as from that carelessness and ignorance which are still so widespread.

Hence it is that the physician is frequently approached by youths and maidens who require as a preliminary to their marriage a complete physical examination to determine their fitness for the marriage state. But these are only an insignificant few, a relatively virtuous few, who reap from such an examination little more than the gratification of being officially assured of that cleanliness of which they already had a moral presumption. They do not protect the community against its real menace.

No wonder, then, that the community should endeavor to protect itself by enacting laws requiring a certificate of health as an essential preliminary to marriage. The spread of such laws marks the progress of the social hygiene movement. Michigan (in 1899) and Utah (in 1909) have enacted laws making venereal disease a bar to matrimony, but providing no assurance of the facts. Pennsylvania (in 1913) has enacted a similar law, requiring only the applicant's own statement by way of health certificate. Meanwhile Washington (in 1909), North Dakota, Oregon, and Wisconsin (all in 1913) have passed similar laws, but requiring a physician's certificate.

Obviously the law that requires only the applicant's own statement offers no great safeguard of the public health. To be sure, it calls attention to the importance of health in matrimony. But the notice is not a very impressive one, and quite fails to reach the careless, the ignorant, and the pervert. These can be reached only by requiring the physician's guarantee.

But does the physician's guarantee settle the matter? There is good reason to doubt it. The State of Washington, the first in the field, has actually abolished the requirement, and in other states the law has evoked a storm of adverse criticism that bids fair to end in repeal.

At first sight the physician's prenuptial sanitary guarantee, as it is called, appears a very panacea. But inspection of the existing laws show them to be riddled with difficulties. Thus no state requires the physical examination of the prospective bride. We may admit the impracticability of requiring such an examination. Yet its omission nullifies the intent of the law. As well try to eradicate venereal disease from the community by segregating only the prostitutes, as to attempt to protect the coming generation from disease, while neglecting to examine their mothers. (One may pause at this point to contemplate that singular clause of the Washington-North Dakota law that permits the man "so afflicted" to marry a woman over forty-five years of age.)

Further, the allotted fee for this medical examination, even when, as in Wisconsin, it requires physical examination and "the application of the recognized clinical and laboratory tests of scientific search," varies from two to three dollars. Obviously the intent of such a law is that the blood of each applicant shall be submitted to the Wassermann test for syphilis. But only the best trained laboratory men are qualified to make such a test. Accordingly the embattled physicians of Wisconsin raised a shout of protest, in answer to which the Attorney General rendered the following decision: "If there are clinical and laboratory tests, such as the Wassermann test, which require special study and special apparatus for their application, and which only a very small per cent, of the licensed physicians of scientific attainments can apply, I am convinced that the law was not intended to require and therefore does not require such tests." There being no other laboratory test for most cases of syphilis than the Wassermann test, and a negative diagnosis of syphilis unsupported by such a test having no value whatever, the law is, once again, a fool.

But we have not yet touched the essential, underlying fallacy in all such laws. It is this. In the present state of medical knowledge a few weeks of preparation, and a willingness to perjure himself, may enable the patient with infectious syphilis to defy the most conscientious examination. Even the Wassermann test may fail to disclose the presence of his disease. Moreover, we must recognize, as a most unwelcome corollary, the fact that the syphilitic of ten years' standing, though he may be guaranteed against the possibility of transmitting his disease in any way, shape, or form, to wife or to child, may nevertheless be unable to rid himself of his positive Wassermann reaction. He is forced to disclose a taint that he cannot transmit.

The situation is indeed a curious one. Many a physician fails to comprehend it. Let this be our excuse for some rather technical details. Our comments must suffer from their brevity. The subject would not be exhausted were each of our paragraphs lengthened to a page.

The infectiousness of syphilis is at its height even in the fortnight that intervenes between the acquisition of the disease and its first manifestation. During this interval no test or examination reveals it. Then various lesions of the disease appear and vanish. But, unless controlled by salvarsan (or "606")? its infectiousness continues unabated during a year or so, tends to diminish during the second year, usually disappears in the third year, but may continue longer. The extreme limit of possible infectiousness has not been determined with certainty. The mother may infect the child she bears ten or twelve years after her own infection. But she cannot infect her husband, nor he her, for nearly so long. Hutchinson, the great English authority of the passing generation, permitted practically all his patients to marry in the third year of the disease, and such is the general English practice to this day. Yet Fournier, of the same generation, and the greatest of French authorities, recently said that were the case in his own family he doubted if he would permit matrimony at the end of seven years. Most of our contemporaries agree that the disease, if properly treated, can not be transmitted after five years. Meanwhile the lesions, the physical signs of the disease, disappear for months or even years at a time. Yet, even in these periods of seeming calm, the patient may be infectious.

I shall never forget the face of the gay cavalier, who returned to me one day, saying, "You told me that my kiss was infectious even when my mouth seemed clean; didn't you?"

"Yes."

"Well; you were right!"

But during these years the Wassermann reaction, if not interfered with by treatment, is usually positive.1 [1. A positive reaction (with certain reservations), means active syphilis, a negative reaction means syphilis not present or not active (with many exceptions).]

Yet during the infectious period of the disease the Wassermann reaction in the blood may become negative under treatment by salvarsan even before the lesions disappear. What is far worse, it often remains negative even after the reappearance of active, infectious lesions. Under vigorous treatment, and in the early months especially, a negative Wassermann reaction is therefore no criterion whatever that the disease is absent or inactive. And the lesions of this period usually leave no scars. Hence it is that this terrible disease may, at its very height of infectiousness, be concealed by a few weeks of treatment and a brazen lie.

Quite the opposite error may occur. No method of performing the Wassermann test is absolutely free from the imputation of giving a positive reaction in persons who have no syphilis. Such reactions are indeed rare. One or two authorities deny them absolutely, but most admit a positive error of from five to thirty-five per cent. Unfortunately it is absolutely impossible with the means now at our command to prove anyone free from syphilis. Therefore these cases with a positive Wassermann reaction, but no other evidence of syphilis, may well remain "suspect;" but they are not proven. We know that a positive Wassermann reaction may result from certain other conditions (e.g. severe diabetes) and we cannot therefore assume that a positive Wassermann reaction unsupported by clinical evidence of syphilis is proof of the existence of this disease.

A still further difficulty confronts us. There is, to be sure, a small percentage of syphilitics whose disease is unsuspected for many years, but who finally break out with some characteristic lesion. Such cases are estimated at about one or two per cent, among male syphilitics, and from seven to nine per cent, among women. But there is a much larger proportion of cases who have been through the early and infectious years of their disease but whose treatment has entirely failed to control the positive reaction. They remain clean. They are certainly forever free from the possibility of transmitting infection in any manner to wife or child; yet they continue to have a positive Wassermann reaction. No matter how vigorously they are treated, this reaction remains unshaken. Does this mean that they are doomed to some terrible relapse of the disease? We do not know. We have only employed the Wassermann reaction for a few years and, as far as we have gone, we can only say that in many instances, at least, such persons show no sign of any tendency to relapse, and inasmuch as such positive reactions have been encountered in patients who have been apparently well and without treatment for twenty or thirty years, we shall evidently be another generation in estimating the precise meaning of the phenomenon.

But the relation of this to a marital guarantee is obvious. If such a patient presents himself for examination his Wassermann is found to be positive. He states that his disease is ten or fifteen years' old, yet it may be quite impossible for him to prove this, and the incentive to lie is so great that we have no right to take his word for it. We should have to cast him out as a candidate for matrimony.

These uncertainties in the diagnosis of syphilis would seem to be an absolute bar to the recognition of such a diagnosis as the foundation of a guarantee for matrimony. They form so important a bar that we need not delay to consider the difficulties (though they be only one degree less important) that hedge the diagnosis of gonorrhea.

Laws requiring such examinations may be good in so far as they express the public horror of marital contamination, stimulate parents to insist upon absence of venereal disease as a condition to matrimony, and protect the community against the more flagrant cases. But a little wit and medical knowledge readily deceive the law. Among the many men who have consulted me for an assurance that they were not infectious there is one unforgetable case:

He was a splendid, honest, vigorous specimen who after ten years of roughing it had amassed his "pile" and come to New York. At one of the larger hotels he met a lady whose charms promptly captivated him. In a week they were engaged to wed. He could see no reason for delay, but she made him confess that in his youth he had had a gonorrhea. She sent him to a physician of her acquaintance for a guarantee. This physician, much to the patient's surprise, discovered evidence of latent disease and instituted a vigorous course of local treatment, the result of which was an inflammation of such intensity as to persuade the poor victim that the physician was right. But he was suffering so much that he applied to a second physician for advice and by him was brought to me. I could find no evidence that anything was wrong, except that the patient had been injured by over-treatment. But it took two months to overcome this injury and to establish the fact that the man had no gonorrhea. Then he was guaranteed and wed with all due ceremony. I subsequently learned that at the time of her engagement the lady had been covered with a syphilitic eruption which she required a few weeks to get rid of. Such a woman would elude any law.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:22 am

THE REGULATION OF PROSTITUTION IN EUROPE
ABRAHAM FLEXNER
Assistant Secretary, General Education Board, New York City


In discussing the regulation of prostitution in Europe, I propose in the first place briefly to describe regulation, and in the second, to call attention to certain prevalent misconceptions in relation thereto. Arguments are often presented in behalf of some proposed method of dealing with prostitution in America on the ground that "they do this or that in Europe." The last word in every discussion bearing on the licensing of prostitution, the toleration of houses of prostitution, the segregation of prostitutes, the medical inspection of prostitutes is -- "Well, at any rate, this is the way they do in Europe." It is assumed that European wisdom, born of long experience, ought to influence American policy. Now I am so unfamiliar with American conditions in respect to this evil, that I cannot undertake to say how far or in what respect European experience is applicable to America; but I shall try briefly to state what European experience actually is.

Two methods are employed in dealing with prostitution in Europe. The first is called "regulation." the second is somewhat unfortunately called "abolition.77 Regulation means that prostitution is tolerated on certain conditions; abolition means, not, as one might suppose, the abolition of prostitution or even an effort to abolish prostitution, but simply the abolition of regulation and legalized toleration. In a word, regulation endeavors to get along with prostitution by subjecting it to certain rules which practically constitute a license to practise prostitution subject to these rules. Abolition refuses to countenance prostitution at all as a recognized means of livelihood. This is the first of the current misconceptions with which I shall have to deal. It is not infrequently represented that regulationists are men who face facts; who frankly admit the existence of prostitution and do the best they can with it; while abolitionists are ethical enthusiasts, religious fanatics, women or womanish men, theorists or, in the case of the English, hypocrites, who, as the saying is, refuse to admit the existence of prostitution, shut their eyes to it, bury their heads in the sand, and so on. It is important at the start to get this common misrepresentation out of our minds. Nobody denies the existence of prostitution; nobody buries his head in the sand; nobody lets it alone or wants to let it alone. Regulationist and abolitionist are absolutely agreed that prostitution exists and on a vast scale; that it is infinitely damaging; that something must be done about it. They disagree only as to what that something must be. Regulationists favor its license on certain terms although they object to the use of the word license; abolitionists oppose license and favor measures of a very different character.

Time was when regulation prevailed throughout almost the whole of Europe. It has now died out in Great Britain, Holland, Denmark, Norway, and Switzerland excepting only the city of Geneva. It cannot be said to be vigorous any longer even in a single one of the countries in which it still exists. The system is on its last legs in France, Belgium, Germany, Austria-Hungary, Sweden, and Italy. In only two towns, Hamburg and Budapest, do the municipal authorities as a whole any longer tenaciously cling to it. When we are told that regulation is practised in Europe we may confidently reply that the system has died out in many countries and is moribund almost everywhere else.

As to the details of regulation. The word is ordinarily employed in America as if regulation were a definite policy, formulated in unambiguous terms. Such is not the fact. No two countries and no two cities still adhering to regulation practise it in the same way. Wide diversity prevails in respect to points of fundamental and essential importance. I have not the time to enumerate these divergencies. They affect the question as to who can be enrolled, as to how enrolment takes place, as to what enrolment means, and as to what happens if the rules are broken. How are these diversities to be accounted for? If regulation operated successfully in any one place, every other city employing the system would copy the successful model. Regulation varies from place to place because it does not operate successfully anywhere. When, therefore, it is urged that regulation be adopted in America because it is used in Europe, I suggest that it be asked what form of regulation is meant and what degree of success it achieves in the place in which it is employed.

If I may, for the sake of brevity, characterize regulation in general terms, I should say that essentially and generally in regulated communities the prostitute applies to the police for permission to carry on her trade; her name and abode are registered; she agrees to live in a particular place; to avoid certain localities; to avoid certain associations; to refrain from certain acts; and to appear at regular intervals for medical examination. These rules aim to secure chiefly two objects: the preservation of public order and the promotion of public health. Prostitution is a menace to both these things -- a menace to public order, since the prostitute, if unrestrained, will offend against decency, and will make common cause either with outright criminals, or with other hardly less odious social parasites and vultures; a menace to public health, because venereal disease is the sure concomitant of all promiscuous sexual intercourse. Unrestrained prostitution means therefore disorder and the diffusion of venereal disease. If, now, regulation hopes effectively to grapple with prostitution on either of or both these grounds, if regulation hopes to preserve public decency or to promote public health, it is obviously necessary that all, or at any rate most, prostitutes should be regulated. On the face of the matter, it is clear that, if a minority only are inscribed, the policy cannot be said to control or materially to affect the situation, from either the standpoint of health or the standpoint of order. As a matter of fact, no regulated city inscribes prostitutes enough to control the local situation. There are from 50,000 to 60,000 prostitutes in Paris: only 6000 are regulated; there are 20,000 to 30,000 in Berlin: 3300 are registered; there are 3000 in Brussels: 182 are registered. In most cities the number of inscribed women is so small that the system is the merest farce: Havre registers 136, Munich 173, Stuttgart 22, Augsburg 6, Bremen 75, Rome 225, Geneva 86; and in general these totals are everywhere decreasing, despite the steady increase in the size of the cities themselves. When you are told that prostitution is registered in Europe, you may reply that nowhere is more than an unimportant fraction registered, and that the bulk of it is everywhere handled without regulation, even in communities in which regulation is said to exist.

A word by way of explaining why this is and must be so. Contrary to common belief, prostitution is usually a transient status. There are indeed a number of women who may be termed professional and practically permanent prostitutes, women who lead a life of prostitution as long as they can secure patronage enough to earn a livelihood. But this body of professional and irreclaimable prostitutes is by no means the larger part of the prostitute army that exists at a given moment in any European city. The rest, the majority indeed, are women who are not permanently or professionally engaged in prostitution, but who practise prostitution for a while or intermittently, touching the edge of the morass, but not sinking into it. Not infrequently they are mere children -- girls from fourteen to seventeen years of age. Again they are working girls, now temporarily demoralized, again supplementing their irregular or insufficient wages by earnings derived from immoral conduct. There are, further, women, who, though professional prostitutes, practise their calling so cautiously that the law cannot lay hold of them. I have said that, in order to succeed, regulation must begin by inscribing at least the majority of those practising prostitution. But if the majority of those practising prostitution belong to the various categories I have just enumerated -- if, in other words, the majority of those practising prostitution at a given moment are not really full-fledged professional prostitutes, it is clear that their inscription by the police is impossible: for police inscription by branding a woman as a professional prostitute would convert the temporary, transient prostitute into a permanent, professional prostitute -- precisely what society does not want to do. Shall a mere child be registered and branded as a professional prostitute? Humanity revolts at the very suggestion; yet regulation cannot be effective without it. Time was when the police, bent on making regulation as effective as possible, registered prostitute children on a large scale. The horrible practice has been almost entirely stopped and regulation has decayed accordingly. The same line of argument applies to incidental prostitutes. Is society interested in branding a woman as a professional prostitute and practically forcing her to continue the life, or is society interested in holding her back in the hope that she may subsequently return to an orderly and decent way of living? Obviously the latter. Inscription must therefore be limited to women who practise prostitution as their sole means of livelihood. If, however, the child prostitute and the incidental prostitute are not enrolled and cannot be enrolled, regulation is bound to fail by reason of the fact that it is applicable to only a small part of the prostitute army. When therefore the registration of prostitutes is recommended to American cities I suggest that the question be asked who is to be registered, and I suspect that the argument will not get much further.

As a matter of fact, the case is rather worse than even the foregoing statement suggests. Let us admit that children cannot be registered, that incidental and occasional prostitutes must not be registered. A substantial number of professional prostitutes remain: why not do what can be done for order and sanitation by controlling these? It is a specious argument; but on close examination without cogency. For not the most powerful and autocratic police forces of Europe have yet shown themselves capable of cataloging the professional prostitutes of their respective cities. A small number of helpless and stupid prostitutes can be apprehended, can be listed, can by arbitrary jail and workhouse sentences be compelled to comply more or less with the police regulations; but only a small number. The majority -- the majority, I mean, not of all prostitutes, but of avowedly professional prostitutes -- cannot be registered. They are too cunning to be trapped; they elude the vigilance of honest policemen; they corrupt the dishonest; they disappear here and reappear there. From time to time, the police of Paris, Berlin, Hamburg, Vienna, and Budapest have made vigorous efforts to corral the unregistered professional prostitutes. Failure has always resulted. The lists melt as fast as they are increased; and the general tendency is downwards. By vigorous efforts 1574 women were newly enrolled in Paris in 1901; 1880 dropped out the same year. In Berlin, Vienna, Stockholm, and elsewhere the number of disappearances and the number of new enrolments keep close together. Nor does disappearance mean that the women leave town; they simply hide or change their abodes. Regulation therefore nowhere succeeds even in permanently registering a substantial number of those women who practise prostitution as their sole means of livelihood.

I have already repeatedly said that regulation proposes to itself two objects: the preservation of order and the promotion of public health. The mere fact that in regulated cities only a minority are controlled by the police, and these but temporarily, really absolves me from the necessity of discussing regulation on its merits. For if only a minority are registered the policy can at best do little to procure the objects on behalf of which the system was instituted. I do not wish, however, to take advantage of this obvious argument. I prefer to describe and to discuss the situation from the standpoint of experience.

What is the effect of regulation on public order? Does regulation assist or does it interfere with the preservation of quiet and decency? Consider for one moment. Regulation recognizes prostitution as a legitimate, even if deplorable, means of gaining a livelihood. The woman who has registered with the police is thenceforth authorized to practise prostitution. She has, indeed, no other way of gaining subsistence, for the law stamps her a professional prostitute. To this end she must find customers. Where shall she find them? Obviously on the streets, in cafes, theatres, and other resorts. Regulation begins by conferring upon the prostitute the right to procure and to solicit business. Street walking and soliciting in the streets and elsewhere are therefore universal in regulated towns. These practices are objectionable because they offend against public decency; because, by making professional prostitution more profitable, they make it more alluring; because, by increasing the amount of business transacted by the prostitute, they increase the amount of disease she spreads. Any policy that concedes to prostitution prominence is mischievous because the volume of the traffic is thereby increased; and the damage done increases in the same ratio as the volume of the traffic. Regulation necessarily concedes prominence to prostitution, for the law cannot enroll a woman and then deny her all opportunity to prosecute the business which it has just authorized. So far from assisting public order and decency, regulation is absolutely inconsistent with order and decency.

If now the registered prostitute is allowed to solicit trade by parading the highways, it is impossible to deny the same advantage to the more numerous unregistered or clandestine prostitutes who compete with her. Street-walking and street-soliciting cannot be confined to the relatively small number of registered women. In the first place it is impossible for the police to discriminate between registered and unregistered prostitutes; in the second place it is too absurd to deny to the unobtrusive and non-registered woman what is granted to the obtrusive registered woman; and finally the unregistered prostitute is in position to buy protection from the policeman whose duty it may be to put her under arrest. Assuredly the demoralization of the police is not the least of the objections to regulation. For regulation by conceding to registered prostitutes certain privileges denied in theory to non-registered prostitutes requires that the police deal in one way with one set of prostitutes and in another way with another set of prostitutes. The result is that a situation is created in which the police are subjected to serious and not infrequently fatal temptation. It is true that the street conditions in European cities have improved in recent years, but regulation can have had nothing to do with it; for street conditions have improved while regulation has been dying out, and street conditions are best in cities like Amsterdam where regulation has been entirely suppressed.

There is a common notion that regulation involves the toleration and segregation of disorderly houses, and you have all doubtless heard regulation advocated for American cities on the ground that in Europe prostitution is confined to disorderly houses which are set off to one side so as not to offend decent people. This is another myth. The so-called tolerated house is not an essential part of the regulatory policy. Many cities have suppressed houses of prostitution even though they continue the attempt to regulate prostitution. The tolerated house does not exist in Berlin or Munich. More than this, houses of prostitution have practically died out even in most cities where there is no objection to them on the part of the authorities. I have said that at this date it is calculated that there are 50,000 prostitutes of all kinds in Paris. Only 387 live in the forty-seven houses of prostitution that still exist in the French metropolis. There are only six tolerated houses in Vienna, six in Brussels, ten in Stuttgart, ten in Frankfort. In Budapest where the police encourage the establishment of houses of prostitution, there are at this date only thirteen of these establishments. Hamburg is one of the few towns where tolerated houses or bordels still exist on a large scale, and in Hamburg, despite the increasing population, their number and the number of inmates are steadily declining. Partisans of regulation in America who quote European experience in favor of tolerated houses may therefore be fairly reminded that disorderly houses do not exist in most European cities and that they are dying out even where they are favored.

Still another myth is widely credited in this country. We have all heard arguments based on alleged European experience in favor of segregating prostitution. The proposition is highly plausible. Prostitution exists on a large scale; it cannot be summarily stamped out of existence; its proximity to decent people is demoralizing and offensive. Let us therefore suffer it to betake itself quietly to some remote section of the town where it can neither demoralize the weak nor offend the fastidious. This, we are assured, is the way they do in Europe.

It is significant that segregation in this sense is a word that cannot be translated into German or French or -- so I am told -- into any other European tongue. There is no such thing as segregation of prostitution in Europe; there is no such thing as segregation of even that small fraction of prostitution which is regulated by the police. The forty-seven houses of prostitution in Paris, the six in Vienna, the thirteen in Budapest, the ten in Frankfort, the ninety-eight in Cologne, the seventeen in Geneva, the twenty-two in Rome, the thirty in Stockholm are scattered in various parts of the city. The Hamburg houses occupy more than eight different streets in widely separated sections of the town. The Dresden houses are found on thirty-two different streets. Moreover in all these cities registered prostitutes live in other streets as well. The situation then is this: the bulk of prostitution even in regulated cities is not regulated at all, it lives where and as it pleases. The minority may be registered but only a small proportion of this minority lives in houses and these houses are scattered. As far as Europe is concerned, segregation is a term which attempts to describe what has no existence whatsoever. I may go further. In the course of an inquiry that included all the great cities of Europe from Glasgow to Budapest and from Rome to Christiania I did not meet a single police official who favored the concentration of even registered prostitutes in a single neighborhood. Not only is such concentration or segregation impracticable; it is highly undesirable. Prostitution like crime is most dangerous and most offensive when it collects in nests. The segregation of prostitution, even if feasible, would be objectionable precisely as the segregation of criminals would be objectionable.

So much on the score of public order, in reference to which we may fairly say that regulation is useless or worse, and that on the ground that it is useless or worse, it is being rapidly discarded throughout the Continent.

Let us turn now to the sanitary side of regulation. The registered prostitute is medically inspected at intervals in the interest of her own health and that of her patrons. I will not discuss this point from the standpoint of morals; I will not even urge that by making itself responsible for the safety or supposed safety of promiscuous intercourse, the state incidentally incites to it. I prefer to meet regulation on its own ground. Medical inspection is said to minimize disease; it is said to be the common-sensible way to deal with a problem that cannot be got rid of; it makes the best of a bad bargain. Well, does it?

What are the facts? Medical inspection of prostitutes has been practised on the Continent off and on for perhaps a century. The largest venereal clinics in the world are found in regulated cities -- in Paris, in Berlin, and in Vienna. Students of medicine who desire to find a wealth of venereal disease repair, and have for years repaired, to cities in which for years prostitutes have been medically inspected in order that venereal disease might be diminished. It would appear therefore that medical inspection has not been potent enough to affect the total volume of venereal disease. Such statistics as are available amply confirm this statement.

There are several reasons why medical inspection is bound to be futile. In the first place, too few women are examined; for, if, as I have said, the police never apprehend more than an unimportant fraction, medical inspection never reaches at all the bulk of those diseased. In the next place, medical inspection does not continuously protect even the registered women. The woman pronounced diseased is forcibly confined to a prison hospital. Now the prostitute resents imprisonment, even in her own hygienic interest. She learns quite early the signs of infection; discovering herself infected she does one of two things -- covers them up, a trick at which she is expert, or, as the phrase is, "disappears" -- does not report for medical examination, meanwhile plying her trade in secret.

Again, the facilities provided at police headquarters and elsewhere for the purpose of medical inspection are absolutely inadequate. In Paris, Rome, Geneva, and Hamburg they are so bad that there is not the least doubt that medical inspection spreads more disease than it discovers. Conditions are better in Berlin, Dresden, Budapest, and Stockholm. But the diseases with which inspection deals laugh to scorn the feeble instruments which medical inspection employs. Syphilis is usually contracted early in the prostitute's career, often before she is old enough to be registered; it runs its course so capriciously that prolonged confinement in a hospital would have to be required, but no city has the requisite hospital facilities or can afford the expense. Syphilitic prostitutes therefore either escape detection or if detected are released before they are non-infectious. In the case of gonorrhea, the situation is even worse; for the prostitute well-nigh invariably suffers from chronic gonorrhea which is practically incurable. No professional prostitute is or can be made safe on this score. Medical inspection is therefore a farce. The police physicians know this perfectly well. And the small number of prostitutes confined to prison hospitals proves that no sincere effort is made to detain infected women. At the time of my visit to St. Lazare, 170 women were confined on the score of venereal infection -- 170 out of 6000 registered and 50,000 all told; at Brussels an average of thirteen annually received hospital treatment; in Rome I learned that the doctors find "very little disease," and the phrase is equally applicable to other continental towns. The truth is that medical inspection is only a pretext used to compel prostitutes suspected of criminal associations to report regularly to the police. There are physicians in Europe who believe that some form of medical inspection might be helpful; but none of rank who contend that it has ever yet been. When, therefore, medical inspection is urged on the ground that in Europe it is employed to reduce disease, you may confidently reply that regulation in Europe has most completely collapsed at precisely that point.

Let me then briefly resume. I have no opinion to express at this moment as to the best method of dealing with prostitution in America, but, whatever an American city undertakes to do, let it be careful how far it rests its proposed policy on what is popularly supposed to be European practice and experience. Regulation, tolerated houses, segregation, and medical examination cannot be advocated in America on the ground that they have succeeded or that they are even widely used in Europe. They are not widely used. Some of them are not used at all and none of them has succeeded anywhere.

The alternative policy is, as I have said, called abolition. Abolition involves simply a refusal to recognize prostitution as a legitimate means of earning a livelihood. It does not mean that prostitution is ignored. There is not an abolition city in Europe that ignores prostitution. Prostitution is not ignored in abolition England, abolition Holland, abolition Switzerland, abolition Denmark, or abolition Norway. It is in one way or another combated in all these countries and consistently combated because the law makes no exception of one prostitute at the expense of another. I cannot here discuss the abolition policy at length. I may briefly, however, summarize the situation regarding it. The disorderly house is non-existent in abolition countries. Clandestine brothels exist, it is true, but they lead an uneasy, transient, and unprofitable life. Street conditions vary with the vigor and purpose of the local police. In Amsterdam, for example, the street walker is unknown. In London she is prominent, though less so than in former years. Elsewhere she is more or less prominent according to the trend of public opinion.

In respect to venereal disease the most vigorous and enlightened measures that have been taken anywhere have been taken in abolition countries. Norway and Denmark endeavor to reduce venereal disease by providing at the public expense the largest possible facilities for its treatment and cure. Abolition, therefore, does not mean that venereal disease is to be allowed to rage rampant. It is on the contrary consistent with a determined and vigorous effort in the direction of hygiene and medication.

I should be glad if space permitted me to discuss certain other aspects of European experience with prostitution. There is, for example, the subject of sex education, regarding which extremely erroneous ideas prevail as to what is done in Europe and as to what can be wisely and effectually done either in Europe or anywhere else. The white slave traffic is another topic which we could profitably consider, for it is a topic regarding which no little nonsense has been circulated, some of it with a degree of artistic skill that could better have been expended on worthier objects. In the great cities of Europe, London, Berlin, Vienna, Budapest, there is no such thing as regular trafficking in innocent girls, though wherever houses of prostitution exist there is a sort of trade in already ruined women.

 I may fairly be asked to state in conclusion whether European experience points to any conclusion, valid for Europe, and perhaps to some extent for us. Perhaps the most significant expression I can utter is this: prostitution is a modifiable phenomenon. We will not at this moment theorize about suppressing it entirely. But, according as society prefers, there may be more or less of it. Nothing is more readily susceptible of artificial stimulation than prostitution and the recourse of men to prostitutes. For example, men can be led to believe immorality necessary and wholesome. Time was when European medical men favored this view, and practice conformed without opposition to this demoralizing theory. Now, for the most part, they take precisely the opposite view. They regard masculine continence as feasible and wholesome; sexual irregularity is in consequence less generally condoned and is probably beginning to diminish.

But there are more direct and obvious ways in which the volume of prostitution and the intensity of its operation can be affected for better or worse. The liquor traffic left to itself tends to utilize prostitution to increase its profits; the pimp directly increases the number of prostitutes and their activity, and the increased activity of one prostitute has the same effect as an increase in the number of prostitutes. And there are other ways in which demand and supply, reacting on each other, can both be whipped up. Now European administrators are practically of one mind in holding that every community can do something to check exploitation and artificial stimulation. How much can be done depends on public sentiment, on the vigor of municipal administrators, on the wording of the laws, on the tone and intelligence of the courts. Given a public sentiment that is determined to check the artificial manipulation of prostitution for the profit of third parties, so determined that good laws are passed and able administrators and judges put in office, and there is no question that the amount of prostitution can be perceptibly reduced, and the amount of damage perceptibly curtailed.

Of course, even after crude artificial manipulation has been abridged, a residual phenomenon, large and serious, will remain. I have no desire to minimize the problem which will then still confront us. There will be a large number of men with uncontrolled appetite; there will be a large number of women ready to gratify it on some terms or other. At no stage, indeed, is prostitution simply a matter of the existence and activity of dissolute women; for prostitution, like slavery, involves two parties and in the last analysis no measures will tell that do not apply equally to both parties involved, to the man as well as to the woman. When the situation has been stripped of sheer exploitation, we are face to face with the individual man seeking gratification and the individual woman willing to sell it. What is to be done about them? As far as direct action is concerned, this question must be deferred until the suppression of exploitation has been accomplished -- a humanly feasible even if difficult undertaking. But indirect action need not meanwhile be neglected. Whatever makes for social betterment is helpful; whatever makes for absolute equality between the sexes, whatever makes for absolutely equal responsibility between the sexes, whatever leads women to demand of men the same code of honor, decency, and self-respect that men demand of women, is a contribution toward the solution of the residual problem that the suppression of commercialized and exploited vice still leaves on our hands.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:23 am

EDUCATION AND THE SOCIAL HYGIENE MOVEMENT1 [1. Paper read at the meeting of The American Social Hygiene Association and The Society of Sanitary and Moral Prophylaxis, New York City, October 9, 1914.]
G. STANLEY HALL, PH.D.
President, Clark University, Worcester, Mass.


My topic on the program suggests that my twenty minutes will be given to a discussion of how to teach sex, just what of its many phases to stress, by whom, to whom, at what age to begin, how plainly to talk, especially of disease, etc. On all these topics, despite a Very slowly growing consensus, there is still the greatest diversity of opinion, and we have seen in recent years considerable vacillation of public opinion. Some psychologists and pedagogues and our Catholic brethren would teach almost nothing of it. Of pressing importance as all these problems are, I shall have nothing to say of any of them tonight but shall speak only of how to safeguard the rising generation against sex dangers without any allusion to sex, for here I think we have neglected a fundamental condition of prime importance.

The thesis is that whenever and however we excite genuine interest in any topic whatever, we set a back-fire to reduce sex stress and tension, and refine, sublimate, and spiritualize its crass energy, and that the degree in which we succeed in doing this is the best criterion of the value of all educational influences, secular or religious, during the critical decade between the dawn of puberty and full nubility, and that conversely, just in proportion as the school becomes dry and mechanical, and religious and aesthetic influences languish, sex dangers increase, so that a lifeless, formal, dead religion and a school devitalized and isolated from life, at the doors of which when children enter they leave their souls behind, constitute the most favorable condition for morbid over-activity of sexuality.

The adolescent decade, which has itself been a slow development, is the teacher's opportunity, for here education began among primitives and spread up and down the age scale from the kindergarten to the university with the progress of civilization. Youth hungers and thirsts for life more and fuller. Almost nothing is of value that does not touch its feelings and emotions. Youth must glow, tingle, crepitate, have excitement, and if this is not provided on a high it will be found on a low plane. The new light shed on sex, too, by psychoanalysis, shows how its derivatives and psychogenetic equivalents pervade every sphere of life, even those in which it was not suspected. Without the reinforcements of the sex nature in its large new meaning nearly all the forces of higher culture would languish. The problem of adolescence is how to short-circuit, transmute it, and turn it on to develop the higher powers of man. Now nature gives us our life capital and the problem is to invest it for our support through life. It is a problem like storing freshet water wrung from the clouds in the spring for irrigation to fertilize, through the summer and the harvest season, land otherwise dry and dead. The hundreds of biographies of great men that Yoder, Lancaster, Swift, and others have studied show that most of them at this stage were caught up by some consuming zest, that they saw, felt, intuited with amazing insight the deepest things of life, acquired their orientation and Einstellung and that, their subsequent life consisted in working out into clearness and for others the dim realization of this Wordsworthian period. Indeed, Julius Baumann has sought to show in detail that the life of Jesus from His advent in the temple was an enthusiastic and almost ecstatic absorption in what has variously been called the enthusiasm of humanity, the category of the ideal, the vision splendid, the great impulsion to love and serve God and man, that was so strong that in Him love took up the harp of life and smote the cord of sex which passed in music out of sight.

To Plato youth meant mild mental inebriation. The boy in the unique quadrennium from eight to twelve or more is most realistic. He is normally very active and always hard up against the world of things and other persons with little discrimination between them. But with the teens come not merely acquaintanceship but an inner circle of friends and sometimes spells of inclination to solitude, and he begins to unfold an inner world of ideas, feelings, wishes, insights of his own, which those who would influence him must appeal to; for as there is a new resistance to the suggestion of most adults, there is also a new docility and suggestibility toward those who can reach his inner life and who recognize that the stage of mere drill is now passing. Adolescence is the infancy and childhood of manhood and womanhood, the period in which the qualities that make maturity are born and sprouted. Youth is capable of intense admiration and true fellowship such as the lad can never know. Shoots of new instincts and interests are putting forth their first tender leaves. All the problems of the meaning, the worth, and work of life are dawning upon his horizon. The middle teens find these more or less defined, although by no means always consciously. The average normal girl in the later teens and the boy a few years later are both more keen, alertful, insightful, are growing faster in all their fundamental psychic powers than they will ever do later in life. Just these critical years are uniquely tense with personal, social, economic hopes and fears. These phrases are vague, but the burgeonings of the higher life now beginning are also nebulous and elemental.

Now how does sex error show itself? First of all in lessened developmental momentum in just this field. Many physical symptoms have been enumerated in medical literature but all these are unreliable and often misleading. But abated self-confidence and respect, of the desire to be, do, zest, curiosity, right ambition on the one hand, and the development of a nil admirari sense, of insufficiency to cope with the problem of life, is the surest if not the first sign and probably the greatest danger of errors in personal sex hygiene, although this rule is by no means without exception. We can often detect faint and flitting suggestions of sere and yellow age like a stray note of autumn in the flood of springtime. Is effort really worth while? There is a thin cloud of anxiety, which is the nebula out of which all fears, phobias, and obsessions are made, a sense of inadequacy or a dread of inferiority, so often and so well diagnosed by psychoanalysis, of border-line states which in psychopathic constitutions may darken into melancholia and even prompt juvenile suicide. A sex cause underlies at least half of these pathetic cases, where young people, who should have the pleroma of life, throw down its brimming cup from their lips, cases many of which have been carefully analyzed of late. We call youth golden because all possibilities are open to it, but we might call it leaden if all these buds of promise wilt.

Now a genetic psychologist might be misunderstood if he said boldly that every youth and maiden in the teens ought to express sex calentures, but always in the higher psychic spiritual region into which they are so easily transmuted at this age, and that the ideal should be to sublimate all physical experiences of this particular nature into their higher culture equivalents. The first stage of sublimation is, as all people who have any sagacity concerning youth know, on a high plane of physical culture, hygiene, athletics, and absorbing work. The boy or girl during these years, when the muscles respond by growth so exquisitely to every form of healthy exercise which makes this their nascent period, should use them up to the limit of wholesome fatigue, and this especially if in the open air and if he treats his stomach and bowels decently is probably on the whole the very best safeguard against lustful temptation. A little narcissism or a pleasing sense of one's physical perfection is not dangerous now unless there is hereditary predisposition to sex perversion. Most boys and girls can during the teens greatly enhance their physical attractiveness and get the most stimulating sense of being able to do things, and by arousing and training ideals in this direction the teacher can do very much. To appreciate and set a high valuation upon the body, to have a physical conscience, to be conscious of one's good points, and to seek to add to them -- this now makes directly for virtue. Everything we learn to do with the body, the purpose of keeping at the top of one's condition, helps to self-control. Tension repressed gives human nature much of all that is best in it and is basal for everything, so that we must make no degree of concession whatever from the ideals of chastity for boys at this stage any more than we do for girls. Apart from the social stigma, there is now some reason to think that lapses from chastity for boys at this age are physiologically and biologically worse in their effect on the last, highest, and always most precarious stages of the psychophysical development of the individual. Hence we must never let down our ideals of purity, innocence, modesty, which unfortunately we have to call virginal for male youth. This we are now well on the way to understand.

But we do not realize the need or the power of more purely psychic sublimation or how every real interest in any culture topic whatever has moral and prophylactic power. The teacher of arithmetic, geography, history, drawing, music, literature, nature study, as well as the manual arts, if she or he can arouse intellectual zest even for the sake of better marks in the school, is doing a work of Aristotelian katharsis for sex, diverting some of its energy for better things. Nothing is so convertible or polymorphic. The lives of youths who have later become great which have lately been studied show that in the great majority of cases their lives have been marked by a series of fevers, commonly one after another, each for a time dominating all they did with will, understanding, and success. In one typical case a passion for hunting and trapping which led the boy to spend all his spare time roaming the hills and woods, to read and suck up from the environment all knowledge of petty game in his region, culminated about twelve. At fourteen music became a craze and he studied, practised in and out of season, until the family revolted at the noise. At sixteen he became very pietistic, read the Bible, prayed, and planned to be a clergyman. At eighteen oratory absorbed his soul and he declaimed, spouted, knew by heart half a dozen collections of the world's eloquence. At twenty he wrote, both novels and poetry, and at twenty-four settled down to philosophy as his final muse. These were in a sense so many sex therapies that nature offered. And this one case must serve here to illustrate the theory that youth means mild intoxication of soul, which is moving about in a world unrealized, trying to orient itself with a series of strong mental tropisms, always or often in a state of psychic second breath and exaltation or faint ecstasy, prone to give itself up to something with abandon. It wants to let itself go, be superlative, must have excitement, and will get it on a low if it is not provided on a high plane. Some youths feel their excelsior call early and never swerve, while in our complex life there are more often a series of these calentures, but one is accepted as a call to the work of life. But in these latter cases we often find a dominant genetic correlation in the series and the range of vacillation narrows with years. The point is that a goal is erected and is striven toward with might and main. Such experiences are surrogates or vicariates for or alternates of sex during the probationary period between its beginning and before it is ripe for its function of propagation. I believe that there is growing reason to think that, despite Weismann, not only are acquired qualities inherited but that those that crop out in these youthful fervors are the most inheritable of all traits, mental or moral, so that their deploying now is the blossoming of the flower which has its own function of seeding later. It is these qualities that have made youth so attractive to normal adulthood from the days of Platonic love of boys to the modern student of adolescence, and those who love to work for boys generally. These nascencies of the human soul are among the most attractive things in this world and are what inspire those who are intent on serving youth. They are far more patent in boys but so latent in girls that what takes place in the soul of the Backfisch or tendron is perhaps the most unknown thing in the domain of all psychology, for she does not understand herself and nobody has ever yet penetrated far into her soul, so that we know very little of what to do for her during the very first pubescent years. Our point here and now is that such calentures are also vents for the more sarcous manifestations of sex.

Religion has always been thought a regulative of sex and some are now saying that the value of every religion from the lowest up is measured by its effectiveness in normalizing this function. If love is the strongest passion in the soul it should be fixed on the object deemed to be of supreme value and most worthy of love, reverence, and sacrifice, whether it be a totem, personal God, or our fellow man. From our prophylactic point of view, then, the chief need of youth is religion, define it as you will, for any is better than none, and the need of all our work would be far less if religion had not lapsed to a subordinate place in the life of the average youth. If you say religion belongs only to a past age of the world, I reply, in youth all normally pass through this stage by way of recapitulation, as so many forms of arrest and inversion are regressive to it. Religions are good or bad, true or false for the most part according to their pragmatic value for youth.

Indoor and sedentary life is very hard and unnatural for young people, whose very nature is activity during this transition period. The chief need of the soul, then, is incentive to psychic activity, to bring and keep it in the state of slightly perfervid activity that belongs to it. If the school is uninteresting, monotonous, its methods mechanical, its atmosphere dull and lifeless, then its influence can be probably on the whole more pernicious than any other. Therefore at the very dawn of this age there should be a distinct change in subject-matter, methods, perhaps in the school, possibly in the sex of the teacher, and if sex segregation is desirable, this is the time when it should begin. But these are details. The great fact is that our youth are not inspired and without inspiration there is no genuine youth, and inspiration is the great regulator of sexuality during its developmental stages.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:24 am

PLAY LEADERSHIP IN SEX EDUCATION1 [1. Read before the Second Annual Conference of the Pacific Coast Social Hygiene Federation, June 30, 1914.]
CLARK W. HETHERINGTON, PH.D.
Professor of Physical Education, University of Wisconsin


In spite of the "conspiracy of silence" concerning sex matters, currents of sex information have flowed on in the past and children have drunk knowledge frequently from polluted sources. At last the conspiracy has been attacked and its power broken. With that power broken, it is now possible to organize and develop methods for the presentation of wholesome sex information -- a task to which many able and normal-minded students have set themselves, thus marking a distinct educational and social advance. There is, however, a side to the sex problem in childhood and youth, which is quite apart from the satisfaction of sex curiosity and which has changed decidedly for the worse in recent years. I refer to the child's or youth's own sexual activity or experience.

Groos says that the pleasure in certain reflexes and strong contacts in childhood is of sexual origin. This is certainly true in domestic animals. The love of dolls, and many personal attachments are in part sex phenomena and there are probably many other expressions of the immature sex powers which are normal, innocent, and in many cases, beautiful.

Frequently, however, even in tender childhood, accidental contacts or irritation and rubbing or association with innoculated children or ignorant or psychopathic adults sets up a vicious manipulation of the sex organs. Often these conditions or reflex irritations start morbid mental processes. Premature neurotic and erotic desires and associations are developed that produce abnormal responses and distinctly psychopathic tendencies. In any case where these activities occur, irritable organs, morbid mental associations, and heightened susceptibility to sexual suggestion are, in some degree, carried over to complicate the strain of later years. These cases become the difficult, even dangerous, cases in the adolescent period.

While many children escape the more serious consequences of early perversion or even mental pollution, youth at the opening of adolescence is subjected to the strain of an active sex hunger and the susceptibility to stimuli in sex situations. This strain our civilization makes doubly hard. It is enormously prolonged through the social sanction of a delayed marriageable age and the increasing number of unmarried individuals. It is intensified through the social toleration of a commercial exploitation of the sex feelings. Even though free from a polluted imagination and psychopathic complications, youth is subjected by our civilization to a social organization with aggressive sex stimuli and suggestiveness oozing from every pore. And youth is carrying the strain without adult sympathy or organized guidance.

The educational and social results are serious. Jane Addams and other social workers have emphasized the conditions and the dangers. Illegitimacy, according to the Juvenile Protective Association of Chicago, is much greater than public statistics indicate. County social workers have found that sex conditions in rural communities are worse from several standpoints than they are in the city. Social surveys in rural states disclose an indulgence in sex intercourse among young boys and girls so widespread that it is appalling.

Anyone with eyes open to the interests of youth can see the results both on youth and society. And the future, unless our educational attitude is changed, holds further dangers. Medicine is sure to conquer sex diseases and their dangers, until the public conscience is as careless concerning them as it is at present concerning smallpox. Familiarity with immorality and its blunting influence on the mind of youth will spread so long as the public supports a press that exploits scandal like a village gossip endowed with ten thousand tongues. Knowledge of popular methods of preventing conception is at present the possession of school children and disgrace is easily covered in our rapidly shifting population. Social checks of the traditional type are breaking down.

The difficulty with the situation is that the essential character of sex activities among children and youths is not generally recognized. The element necessary for the solution of the problem is the recognition that sexual perversion and sexual vice develop on the play side of life.

Play is identical with joyous living. It is the very soul of human nature. It is the enthusiasm of youth in the great quest, the expression of the developing hungers for activity, experience, self-expression, adventure, conquest, and romance! But these hungers are not their own guide in conduct. Without guidance they are as apt to go wrong, according to the world's judgment, as right. In a broad sense, the failure to give this guidance has caused the failure of present day education and a large part of our civilization. Sexual immorality and vice, like all the traditional vices of man, have developed in play; though their results, so far as the personal suffering and the ruined lives of innocent wives and babies are concerned, are anything but pleasurable.

Sexual immorality and vice arose out of acts not intended for reproduction, but for a sensuous indulgence of the sexual appetite, i.e., in play. On this playful indulgence have been built the pathological sex customs of all people, even the debauchery of the married relationship. It has caused the social evil with all its social consequences. The brothel is a play center, though a pathological one. Sexual vice is a most striking illustration of the pathology of play. Children and youths are polluted and initiated into sexual immorality at play. The ideas and acts are not learned in the home or in the schoolroom, but in the free quest for life. Before adolescence, reflex irritations, accidental experience, bad associations, or vicious instruction start the process and it is continued playfully for the temporary pleasure involved. The youth, without guidance, driven by powerful hungers, and stimulated by many sex situations, drifts through his own experience or through associations, into some playful form of mental or physical indulgence; most frequently, by late adolescence, into the traditional forms with all their individual and social complications and consequences.

It is all play gone wrong. And the pity of it is, that it is in proportion to the lack of real life-stimulating activities which supply an emotional content easily organized.

With this statement and analysis of the problem two points seem clear: first, whatever effort is organized must be started early in childhood and be continued through youth; and secondly, cold information given in any scheme of text-book or classroom or lecture organization will not alone meet the situation.

Information is essential to satisfy, in a wholesome manner, normal curiosity. But information will not remove reflex irritations or control them. The Jews recognized this centuries ago. Again the youth's sexual desire is not satisfied by biological information. The youth faces a problem of conduct, of difficult self-control, and there is no necessary relationship between knowing and doing. The translation of information about conduct into conduct has tested, to its chagrin, the moral genius of the race. Why expect nerve-hungry, passion-driven, undisciplined youth to do what the inspired, in so large a measure,, have failed to do; and this in an age when self-control is tested more severely than ever before!

A vastly deeper foundation for sexual morality must be found than information about the meaning of sex, or the fear of disease or conception or social disgrace. None of these work. The solution lies in the conscious educational organization of that force which has been the source of power in self-controlled men and women all through history -- leadership. Leadership is the conscious constructive force in any program of child engineering. It includes more than training, because it includes watchful companionship and participation in the child's or youth's play life. It means more than wise teaching.

The conscious leadership that watches the developing organism, removes reflex irritations, prevents contamination, checks bad responses, encourages normal responses, and organizes power-developing activities until character-fortifying habits are established, and in the process gives a friendship in experience that interprets and fertilizes ideals so that reason will later be satisfied -- all these are the laboratory processes in moral education. It is leadership of the great quest.

Now that the stable influence of public opinion is so largely neutralized by familiarity with immorality and vice, the problem of sex morality rests squarely on the shoulders of organized and conscious leadership. It must be direct and personal; not indirect and impersonal. Now that sex stimuli are so ever present, individual self-control of a firmer fibre than ever before is needed. The extent to which we secure this personal power is the test of the leadership of childhood and youth in our civilization. Leadership in play is exalted through educational and social necessity. It is essential to a general freedom from morbid sex tendencies.

The tremendous power of the sex feelings in the life of most youths will make them a source of playful enjoyment, under present social conditions, until adults set up a plan of action and volition which appeals to and holds the hardy practical sense of youth.

The double standard is breaking down. Are the women, in their new freedom, to descend to the traditional man's level or are they to pull the men's standards up to their own level? Personal ideals among the masses which are established only through leadership, will settle the issues and bring racial efficiency. Leadership must supply the essential ideals concerning domestic life if marriage is not to be used more and more as a convenience for indulging an undisciplined sensuality, and divorce as a device for a change of experience.

A distinction should be made, however, between leadership in the sex education of children and youths and the development of adult public opinion concerning sex problems. It is legitimate to i turn loose upon adult public opinion, with all the skill of modern propaganda, the results of sexual immorality and vice, -- the medical horrors, the economic loss, the social results in dependence, poverty, and crime, the moral results in wrecked innocent lives, distrust, and anguish, -- and to drive the argument close home by stinging the individual conscience. But children should know little of this; youth should find its meaning only as it gradually emerges into adult life. The development of public opinion is corrective, preventive, reconstructive; the leadership of children and youths should be conscious and educationally constructive.

Conscious leadership is developing. We see in the multitude of boys' and girls! clubs, the Boy Scouts, the Camp Fire Girls, and numerous other movements, the rising social feeling that play must be supervised. To say that such conscious leadership cannot be efficient is tantamount to saying that trained leaders with all the resources of racial experience and social organization cannot do under our complex social conditions what savages, careful parents, and interested teachers have always done. Leadership in play has already proved its effectiveness in securing the results desired. Its power in substituting a program of wholesome activities for vicious habits and customs is well known. It has lifted even reform school subjects out of their own subjective mire. It has given stimulating activities that fascinate, aroused enthusiasms, developed nervous energy, and established responses as habits, thus supplying the foundation for ideals and supplementary supporting information.

Among normal hero-worshipping youths the power of leadership is clear; the response striking. Youth wants to be clean, but it wants life. Leadership can give both. Even the crudest of youths respond to standards necessary for development and to continence for the sake of virility. Discipline in achievement that is hard and that absorbs the sex energies is accepted. Responsibility, service, and civic welfare become a part of the game. The love of doing, of adventure, of pride-satisfying conquest or achievement, of taking a hand in the world's work, all lead to individual and race-lifting conduct under the vision-controlled suggestion of the leader. Civic and eugenic patriotism are as easy to develop as political patriotism.

So clear is the power of leadership that, if it were recognized by educational and social engineers, we might set up a perfectly practical program of achievement for leadership, -- the ideal of developing habits in the rising generation that would defy the stimulus of social conditions.

Legislation is essential as a corrective and preventive measure, but we must go deeper than the correction of the sex environment and the removal of temptation. The essential point to attack is the attitude toward the use of the sex environment. The ideal is to so mould the interests, activities, and organized volitions of youth, that it will put the brothel out of business through lack of patronage. This is a perfectly practical ideal for the conscious and organized leadership of childhood and youth, the misanthrope and cynic to the contrary notwithstanding. Modern men must have the capacity to face evil and snap their fingers at it. That is the attitude of a vast number of men now; it is perfectly possible to make it the attitude of practically all normal men within a single generation, if the leaders of boys and girls put their heads to the task.

Efficient leadership of developing sex ideas and ideals may be given by parents in the home; but it is not necessarily the function of the home. A few parents can give it; the majority cannot. Parents themselves need leadership. A generation of leadership will, however, increase the number able to perform this high function for their children.

But deliberately to set up a program which insists that parents shall give the essentials in the sex engineering of children and youths, condemns the masses to immorality and vice. Leaving children to the accidents of birth or parental temperament and training is not only educationally undesirable, it is irreligious. It condemns the innocent. It blasts their lives before they get a chance. The attitude is the same that has opposed democratic education from the beginning. If the masses are to be lifted above the grip of custom, they must have leadership that can bridge the gap to higher standards. The task demands the best of leaders.

To say that this leadership cannot be supplied for all the boys and girls of the nation is fatalistic and a confession that neither human nature nor the temper of the leaders of the race is understood. It is an acknowledgment of the deep-worn and dust-filled rut into which our educational and religious practices have brought us.

The supply of potential leaders is endless. The attitude of the average school teacher in teaching is no criterion. Teaching in the routine of the school as organized does not inspire, though many noble men and women make their living that way. Participation in the life of children and youth with the ideal of moulding character appeals to all who have a right to teach. It inspires. Every casual presentation of the practical results of leadership and the opportunities for service through leadership, lifts the ethically disturbed and service-hungry young men and women of the land to a life of sacrifice. The leadership is at hand, when leadership is the means recognized by educational and social organizers.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:25 am

THE BIONOMICS OF WAR
RACE MODIFICATION BY MILITARY SELECTION
VERNON L. KELLOGG, M.S.
Professor of Entomology, Stanford University


I

At the bottom of the affairs of life, and in the long run, heredity plays the great part. And in many of these affairs the run is not so very long, nor the bottom too deep to be out of sight. By no virtue of social environment can a race be raised considerably or permanently above the level of its inheritance, nor can any disadvantage in such environment do more than hinder inherited capacity from revealing itself. It cannot prevent it.

If a treatment of that aspect of the war question which concerns heredity seems, therefore, at first thought, to be too academic to concern the practical philanthropist, let him consider that what any given man or family or nation or race of men is at the present time, is primarily a matter of heredity, and that the men who are coming after us will mostly be what they are by reason of that same potent factor. Variation, or differences; selection, or the choice among these differences; and heredity, or the inheritance of these chosen differences, are the chief factors in all organic evolution; and organic evolution means the evolution of man, as well as that of the plants and lower animals. If, therefore, the war question actually has an aspect which concerns heredity, that aspect is likely to be an important one.

Now the variation and the heredity factors in evolution are provided, and unescapably so, by nature. And for most living kinds she provides the selection also. But man, through his endowment of mind, has gained the great privilege of determining, in large measure, the character of the selection of his own kind and that of any other kind of animal or plant for which he pleases to exercise it. The animal and plant breeders do exercise this privilege constantly, and they direct heredity here and there as they please, to the effect of making very useful new kinds of cattle and fruit and very absurd pigeons and chrysanthemums. They do their selecting artificially and consciously, and by doing it drastically as well, they speed up evolution to a rate quite extraordinarily rapid compared with her more natural pace.

As it is to this category of artificial selection that man's selective modification of his own kind belongs it also can be effected very rapidly. So that the possible objection to the slowness of the workings of any form of human selection, based on an analogy with natural selection, is less valid than the objectors seem to think it is.

In sum, the discussion of the selective possibilities of such a race-modifying agent as militarism is by no means1 a purely academic one, but one which may be made very pertinent and practical. It is such a practical discussion of it that the writer wishes to present.

II

The theoretical consideration of the matter, however, should not be dismissed without a word. If we can accept the whole great theory of natural selection upon a basis of two logical conclusions derived from two premises of observed fact -- and we do exactly this -- then we should recognize the strength of the similar argument for military selection.

The observed facts of constant variation and constant overproduction warrant the logical conclusions of a struggle for existence and a consequent survival of the fittest. That is natural selection.

In times of war we see many or even most of the able-bodied men of a sorely pressed nation drafted for death or disablement by wounds or disease. And yet we note that little diminution occurs in the birth rate of the nation. On these observations we conclude that in such times the new generations are produced by inferior men, or that at least a larger proportion of them is so produced than would be the case were there no war. We breed our new generations not from the best but from less than the best; even, in severe cases, from the worst. We conclude, then, that war produces a deplorable artificial human selection, which may be called military selection.

But we can do better than make logical conclusions. We can do better than the natural selectionist. For we can see our deplorable artificial selection actually working and actually producing measurable results. And we can see further that this military selection is not dependent on actual war alone for its effects, but that the preparedness for war is also a condition which sets it agoing. We can see the specific results of military selection arising from the existence of militarism, even though war itself never or but rarely come.

III

France has kept, for over a century, an interesting set of official records which offers most valuable data for the scrutiny of the biologic student of war. They are the records of the physical examination of all the male youths of France as these youths reach their twentieth year of age, and offer themselves, compulsorily, for conscription. To determine who realize the condition of minimum height, weight, chest measurement, and the freedom from infirmity and disease necessary for actual service, all are examined and the results recorded. These records show, therefore, for each year very clearly and precisely the physical status of the new generation of Frenchmen.

The minimum physical condition for actual enlistment has varied much with the varying needs of the nation for men of war. In certain warring periods of her history France has had to drain to the very limit her resources in men able to bear arms. Most notably this condition obtained during the nearly continuous twenty-year period of the Napoleonic Wars.

Louis XIV in 1701 fixed the minimum height of soldiers at 1624 mm. But Napoleon reduced it in 1799 to 1598 mm. (an inch lower) and in 1804 he lowered it two inches further namely to 1544 mm. It remained at this figure until the Restoration, when (1818) it was raised by an inch and a quarter, that is, to 1570 mm. In 1830, at the time of the war with Spain, it was lowered again to 1540 mm., and finally, in 1832 again raised to 1560 mm. Napoleon had also to reduce the figure of minimum military age.

The death list, both in actual numbers and in percentage of all men called to the colors, during the long and terrible wars of the Revolution and Empire, was enormous. And the actual results in racial modification due to the removal from the breeding population of France of its able-bodied male youth, leaving its feeble-bodied youth and senescent maturity at home to be the fathers of the new generation, is plainly visible in the condition of the conscripts of later years.

From the recruiting statistics, as officially recorded, it may be stated with confidence that the average height of the men of France began notably to decrease with the coming of age in 1813 and on, of the young men born in the years of the Revolutionary Wars (1792-1802), and that it continued to decrease in the following years with the coming of age of youths born during the Wars of the Empire. Soon after the cessation of these terrible man-draining wars, for the maintenance of which a great part of the able-bodied male population of France had been withdrawn from their families and the duties of reproduction, and much of this part actually sacrificed, a new type of boys began to be born, boys that had in them an inheritance of stature that carried them by the time of their coming of age in the late 1830's and 40's to a height an inch greater than that of the earlier generations born in war time. The average height of the annual conscription contingent born during the Napoleonic Wars was about 1625 mm.; of those born after the war it was about 1655 mm.

The fluctuation of the height of the young men of France had as obvious result a steady increase and later decrease in the number of conscripts exempted in successive years from military service because of undersize. Immediately after the Restoration, when the minimum height standard was raised from 1544 mm. to 1570 mm., certain French departments were quite unable to complete the number of men which they ought to furnish as young soldiers of sufficient height and vigor according to proportion of their population.

Running nearly parallel with the fluctuation in number of exemptions for undersize is the fluctuation in number of exemptions for infirmities. These exemptions increased by one-third in twenty years. Exemptions for undersize and infirmities together nearly doubled in number. But the lessening again of the figure of exemptions for infirmities was not so easily accomplished as was that of the figure for undersize. The influence of the Napoleonic Wars was felt by the nation, and revealed by its recruiting statistics, for a far longer time in its aspect of producing a racial deterioration as to vigor than in its aspect of producing a lessening stature.

It is sometimes claimed that military selection is of biological advantage to the race as a purifier by fire. This might indeed be true if it were the whole population that was exposed. But it is only a certain part of it that is so exposed, a part chosen on a basis of conditions very pertinent to racial integrity. For in the first place it is composed exclusively of men, its removal thus tending to disturb the sex-equilibrium of the population, and to prevent normal and advantageous sexual selection. Next, these men are all of them of greatest sexual vigor and fecundity. Finally they are all men, none of whom fall below and most of whom exceed a certain desirable standard of physical vigor and freedom from infirmity and disease.

War's selection is exercised on an already selected part of the population. And every death in war means the death of a man physically superior to at least some other one man retained in the civil population. For the actual figures of present-day recruitment in the great European states show that of the men gathered by conscription, as in France and Germany, or by voluntary enlistment, as in Great Britain, from 40 to 50 per centum are rejected by the examining boards as unfit for service because of undersize, infirmities, or disease.

Nor is it necessary that these selected men be actually removed by death in order that militarism may effect its deplorable racial hurt. For this removal even for a comparatively short time of a considerable body of these men from the reproductive duties of the population, and their special exposure to injury and disease -- disease, we shall see, of a particularly dangerous character to the race -- is in itself a factor sufficient to make military selection a real and dangerous thing.

IV

Death in war comes not always nor even most often in battle. It comes more often from disease. And disease, until very recent years, and even now except in the armies of certain few countries, has stricken and still strikes soldiers not only in war time but in the pipingest time of peace. And, what is almost worse for the individual and decidedly so for the race, its stroke is less often death than permanent infirmity. The constant invaliding home of the broken-down men to join the civil population is one of the most serious dysgenic features of militarism.

In the French army in France, Algeria, and Tunis in the 13-year period 1872-1884, with a mean annual strength of 413,493 men, the mean annual cases of typhoid were 11,640, or one typhoid case to every 36 soldiers! In the middle of the last century the mortality among the armies on peace footing in France, Prussia, and England was almost exactly 50 per cent, greater than among the civil population. When parts of the armies were serving abroad, especially if in the tropics, the mortality was greatly increased. In 1877 the deaths from phthisis in the British army were two to one in the civil population. And how suggestive this is, when we recall that the examining boards reject all obviously phthisis-tainted men from the recruits. The proportion was still three to two as late as 1884. In the last war of our own scientifically enlightened country, the deaths from disease in camp were eight to one from the incidents of battle. But we could do better now. And so could France and England.

In fact, the modern humane war against disease has made life much safer for the soldier. That is to be admitted. But there has occurred so far but one conspicuous radical exception to the general rule of a much greater percentage of deaths from disease than from bullets and bayonet in war time. That, of course, is the record of the Japanese armies in the Russo-Japanese war. The records of the recent war in the Balkan States are like those of a century ago.

V

The actual dysgenic importance of the diseases fostered and diffused by militarism, though certainly real, is hard to get at in any quantitative way. The problem of the inheritance of disease, or better of the inheritance of the diathesis of disease, is one as yet only in the beginnings of scientific elucidation. But of the congenital transmission and racial importance of one terrible disease, of the venereal disease group, and one that more than any other is characteristic of military service, there is no shadow of doubt. It is a disease communicable by husband to wife, by mother to children, and by these children to their children. It is a disease that causes more suffering and disaster than phthisis or cancer. It is a disease accompanied by a dread cloud of other ills that it causes, such as paralysis, malformations, congenital blindness, idiocy, and insanity, all of them particularly dysgenic in character. It is a disease that renders marriage an abomination and child-bearing a social danger. And as a crowning misfortune this disease does not kill but only ruins its victims. While phthisis and cancer carry off their subjects at the rate, in England today, of 1000 per year to each 1,000,000 of population, syphilis kills but 50 persons a million. It is not a purifying but wholly a contaminating disease. It does not select by death. It is, then, a disease of great possibilities and importance in relation to racial deterioration.

Venereal disease1 [1. Syphilis and gonococcus infections.] is a scourge fostered especially by militarism. The statistics reveal this at once. It is the cause of more hospital admissions among soldiers than any other disease or group of related diseases. It caused 31.8 per cent, of the total military inefficiency in the British army in 1910. It was the cause of one-fifth of all the British military hospital admissions for that year, yet it caused but one one-hundredth of the total military deaths. It causes one-third of all the illness of the British navy, both at home and abroad. The admissions to the hospital for venereal disease in the British army in India reached in 1895 as terrible a figure as 537 per 1000 men. Conditions are bettered, but are still bad.

Nor is the British army by any means the greatest sufferer from the scourge. The army of the United States has twice as many hospital admissions for the same cause. Russia has about the same as Great Britain, Austria and France less, and Germany least of all. Germany, indeed, has done much more to control the disease than any other great nation, unless it be Japan, for which I have not been able to get data. The following figures from the British Army Medical Report for 1910 show the rates of prevalence of venereal disease in different armies:

Country / Year / Per 1000

Germany......................................... / 1905-06 / 19.8
France ........................................... / 1906 / 28.6
Austria........................................... / 1907 / 54.2
Russia ........................................... / 1906 / 62.7
United Kingdom.................................. / 1907 / 68.4
United States..................................... / 1907 / 167.8


A measure of the prevalence of syphilis and other venereal disease in the civil population is difficult to get at. But certain facts are most suggestive. Of the young men who offered themselves for enlistment in the British army in 1910, 1-1.2 per 10,000 were rejected because of syphilis, while for the same year in the army, 230 per 10,000 were admitted to hospital with syphilis. And for all venereal disease the proportion was 31-1/2 per 10,000 of those applying for enlistment rejected, and 1000 per 10,000 of those in the army admitted to hospital. In other words, while the army recruiting boards discover in the civil population, and reject back into it, but two or three syphilitic men per 1000, the army finds within itself a constant proportion of infected men of many times that number.

It is obvious from these figures that venereal disease finds in armies a veritable breeding ground. That such disease is highly dysgenic, i.e., race deteriorating in influence, is indisputable. The frightful effects of syphilis and its direct communication from parents to children are fairly well known popularly. But with regard to the serious effects of gonorrhea the popular mind is not equally as well impressed. Indeed it is too commonly regarded as a mild and not very shameful disease. But medical opinion is really doubtful whether it is not, in some of its effects, as bad as, or even worse than syphilis. About 50 per cent, of young women infected by young men are made sterile by it. Many are made chronic invalids. It is the commonest cause of infant blindness (opthalmia neonatorum). In Prussia 30,000 such blind persons are to be found.

The congenital transmission of venereal disease is what gives it its particularly dysgenic importance. Such transmission has all the force of actual inheritance. Indeed, if tainting the germ cells so that the fertilized egg is predetermined to develop into a syphilitic individual is heredity, then syphilis is literally an hereditary disease. But as between a taint at conception and one at birth, either of which can be handed on to successive generations, there is little choice from the point of view of the student of race deterioration. The effect is typically that of hereditary transmission. Indeed, as an authority has strongly put it, "Syphilis is the hereditary disease par excellence. Its hereditary effects are more inevitable, more multiple, more diverse, and more disastrous in their results on the progeny and the race than in the case of any other disease. Syphilis, in fact, has a more harmful influence on the species than on the individual."

VI

The facts speak for themselves. Serious war and the preparedness for serious war mean the temporary or permanent withdrawal from the population of a part of it selected for physical vigor and often for courage, patriotism, and idealism, and the exposure of this part to special danger from death and disease. This death and disease, under the circumstances, are not race-purifying or race-enhancing, but race-deteriorating, through the encouragement of poor breeding and the fostering of heritable, race-poisoning disease. Every race needs its best possible inheritance. Any institution that tends to give it less than that is a race-injuring institution. Militarism is such an institution.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:26 am

DIAGNOSIS AND ADVICE IN VENEREAL DISEASES AS FURNISHED BY THE DEPARTMENT OF HEALTH, NEW YORK CITY
ARCHIBALD McNEIL, M.D., AND B. S. BARRINGER, M.D.


The administrative control of the venereal diseases, as attempted by the Department of Health of New York City, centers mainly about the work of the laboratory and the work of the venereal diagnostic clinics. The latter were established on May 1, 1912, and had, at first, an average daily attendance of two or three patients a day. This has since increased to an average of 38 a day. These figures do not include patients attending the medical advisor's clinic. At the present time there are being made an average of 120 Wassermann tests a day, and 29 complement fixation tests for gonorrheal infection. So about 25 per cent, of the blood specimens examined for gonorrhea and syphilis are taken in the diagnostic clinics, while 75 per cent, are sent in by private physicians and institutions.

The department is making routine tests on all persons sent to the Bedford State Reformatory for Women and on the inmates of all the New York City penal institutions.

To give some idea how the diagnostic laboratory work is increasing, we may compare the records for 1913 with those of 1914, to date.1 [1. June 1914.] In 1913, a total of 18,750 Wassermann tests and 3526 complement fixation tests for gonorrhea, while from January 1, 1914, to date, a total of 15,793 Wassermann tests and 3806 complement fixation tests for gonorrhea have been made. The advisory work of the division of venereal diseases has necessarily extended over a fairly large field. Inasmuch as but two hours daily are allotted to this work, some phases are slow in development. Aside from the advisory work proper, a crusade, in a small way, has been waged against the advertising venereal quack, and attempts have been made by legislation and by diverting patients from quacks to limit their activity. Such diverted patients must be sent somewhere for treatment. This has meant additional work in the classification and listing of the venereal clinics in New York City.

ADVISORY WORK

A daily chart is kept of the cases seen; this chart serves to check up in a measure the advisory efficiency and indicates what class of patients are coming for advice. A glance at this chart gives some idea of the scope of the advisory work. For instance, in the month of May, in which 127 patients were seen, 122 were tabulated; 111 were male, and 11 female. This possibly indicates that the advertising methods do not reach women or that women are not yet educated to the point where they seek knowledge on venereal diseases. Eighty were single and 42 married; 106 patients had expert occupations (considering housewifery as expert work); among these, 21 were out of work; 16 were laborers or longshoremen and out of these, 5 were out of work.

A blood examination for gonorrhea or syphilis was made on 34 patients; the various diseases encountered were 92 cases of suspected or real syphilis, 27 cases of suspected or real gonorrhea, 7 cases of sexual neurosis, and 6 cases of various other diseases. This shows a very high percentage of syphilis as compared with 974 analyzed cases of the advisory department of the Oregon Social Hygiene Society and rather a small proportion of cases suffering from one form or another of sexual neurosis.

Fifteen of these cases had been previously treated by quack physicians. This, compared to other months, is a low proportion; in one month in which 85 patients were seen, 24 had been previously treated by one or more quacks; in another month when 88 patients were seen, 22 had been treated by quacks.

An attempt has been made to place the patients in two classes -- one above average intelligence and one below. No system has been used in this classification (the Binet-Simon has not been discarded), and 102 were conceived to be above average intelligence, and 20, below. This very well corresponds with the 106 who had expert occupations and the 16, who had non-expert occupations.

Forty-eight patients were referred to clinics, and 9 to doctors' lists, thus indicating that all patients of expert occupations cannot, or think they cannot afford to pay physicians. As a routine, those who wish to be referred to clinics are asked to state their weekly income and are asked how many people they have to support. Our analysis also indicates that about half of the patients seen do not need treatment, but advice or a blood test only.

Forty of the 122, have returned for various reports, advice, etc.

ADVERTISING

To date, there have been three methods of advertising the activities of this department:

First: A circular to the physicians of the city;

Second: Various notices in health, sex, and other journals;

Third: A small advertisement in one of the evening newspapers.

This advertisement started some time in October, 1913, and because of various changes in administration, ran irregularly. It has been a regular insert since February, 1914. The advertisement reads as follows:

"Free advice regarding venereal diseases can be obtained at the Department of Health, 149 Centre Street, Room No. 207, from 9 a.m. to 12 m. daily; Sundays and holidays excepted. Consultations strictly confidential."

The monthly increase of patients since February, 1914, shows the value of the advertisement.

In February, 68 were seen.

In March, 85 were seen.

In April, 88 were seen.

In May, 127 were seen.

This advertisement is but a four line insert and costs $2.10 a day. While the results from it have been good, much greater results are expected from the tin signs which are now being placed in toilets of saloons and various other places in the city. These signs read as follows:

"VENEREAL DISEASES. Confidential advice regarding gonorrhea, syphilis and sex diseases, can be obtained free at Room No. 207, the Department of Health, 149 Centre Street, daily from 9 a.m. to 12 m.., Sundays and holidays excepted. AVOID advertising specialists and patent medicines."

The opportunity to place these signs in the toilets of various saloons in New York City, came through Mr. Whitin, of the Committee of Fourteen, who enlisted the help of Messrs. M. J. Quinn, T. D. O'Connor, and James Coyle, of the Retail Liquor Dealers' Central Association. This Association passed resolutions allowing the Department of Health to take down any signs now in the toilets of their saloons and replace them by the Department of Health signs. As Mr. Quinn, the President of the Association, said: --

"We know the harm that these quacks do and we will back you in your fight against them."

The time may come when the various business men's associations and various newspaper publishers will take a like stand. Five hundred of these signs are at hand, and 5000 more have been ordered. Of these 5000, a certain number are to be in German, Yiddish, and Italian.

A single history will serve to illustrate the methods of the quacks. Mr. X, a self-respecting teacher of Hebrew, with a wife and two children, went to a well-known and long-established advertising venereal quack because of a swelling in the groin. This quack, it is alleged, pricked the finger of the patient, got a drop of blood and put it under a microscope and declared the patient to have syphilis (syphilis cannot be diagnosed in this way). Thereupon the doctor told him he must immediately get an injection of salvarsan which would cost him $25.00,and which would cure him. The patient had not as much money with him so the doctor asked if he had any rings or jewelry to leave as security for the $25.00. The patient had a watch worth $36.00; this he gave to the doctor with the understanding that if it were not redeemed within a short time, it would become the property of the doctor. The patient got his injection of No. 606. On leaving the doctor the patient said that he was on the verge of committing suicide. One month later, he was examined; he showed absolutely no signs of syphilis -- his Wassermann examination was negative. Two months later he was reexamined and he still showed absolutely no signs of syphilis and the Wassermann examination still was negative. He had never had syphilis.

LEGISLATION AGAINST THE QUACK

There is a law by which the Regents of the State of New York can revoke the license of practitioners if they are guilty of fraud, deceit, etc. Proof of fraud and deceit is difficult and presumably this is the reason why this law is totally ineffective in combating the venereal quack. The present Penal Code is apparently likewise inefficient. The "Chorash Bill" passed by the New York Board of Aldermen, makes persons whose advertisement contains "assertions, representations or statements which are untrue, deceptive or misleading" liable to a fine of from $25.00 to $200.00 for each offense. An attempt is being made to have this ordinance tested. As it does not directly involve a matter of public health, but rather one of fraud, the Department of Health cannot actively take up the work of proving the worth of this bill. It is the work of the county medical societies or possibly of the Society for the Prevention of Crime. Certainly many of the venereal advertisements which appear today in the New York newspapers are both deceptive and misleading.

CLASSIFICATION OF CLINICS

Inasmuch as the Department of Health has no venereal clinics in which treatment is given, it has been necessary to determine upon some standard for genito-urinary clinics and then list the clinics according to this standard. In New York such a standard has been set by the Associated Out-Patient Clinics. This standard is as follows:--

I. Syphilis

1. The treatment of syphilis, whatever its manifestation, should be conducted in one department, which shall be either a special department of syphilis or dermatological department.

2. Whenever the nature of the lesion, such as eye, throat, viscera, etc., has directed the patient to a department other than that of syphilitics, the treatment should be conducted jointly by the two departments, but the anti-syphilitic treatment be administered in the department of syphilis or the dermatological department.

3. Every department for the treatment of syphilis should be provided with a dark-field microscope.

4. Facilities for making the Wassermann reaction test should be provided, if possible, in every institution where syphilis is treated.

5. Wherever laboratory facilities for making the Wassermann reaction test are not available at the clinic, provisions should be made for the prompt conveyance of the specimens to the Department of Health or other places at which the examinations are made.

6. The principle of the limitation of the number of patients in each clinic should be adopted, such limitation to be based upon the estimated facilities in men and equipment of each clinic.

7. Intravenous medication may be administered to suitable ambulatory cases of syphilis.

8. In view of the fact that an obligation to render a patient with an infectious disease innocuous at the earliest possible moment rests on the institution to which the patient has applied for treatment, it is the duty of such an institution to provide suitable medication free to those who are unable to pay for it.

9. The Association recommends that a suitable uniform circular of instructions be given to every syphilitic patient at the dispensary.

10. The Association recommends that uniform forms of records be employed in all the clinics treating syphilis.

II. Gonorrhea and chancroid

1. Every department for the treatment of gonorrhea and chancroid should be provided with a microscope.

2. Every department for the treatment of gonorrhea and chancroid should be provided with proper facilities for sterilization.

3. Facilities for endoscopic and cystoscopic work should be provided.

4. Wherever laboratory facilities for making the complement deviation test for gonorrhea are not available at the clinic, provision should be made for the prompt conveyance of the specimens to the Department of Health or other places at which the examinations are made.

5. The principle of limitation of the number of patients in each clinic should be adopted, such limitation to be based upon the estimated facilities in men and equipment of each clinic.

6. In view of the fact that an obligation to render a patient with an infectious disease innocuous at the earliest possible moment rests on the institution to which the patient has applied for treatment, it is the duty of such an institution to provide suitable medication free to those who are unable to pay for it.

7. The Association recommends that a suitable uniform circular of instructions be given at the dispensary, to every patient suffering from gonorrhea.

8. The Association recommends that uniform forms of records be employed in all the clinics treating gonorrhea.

Inasmuch as the Associated Out-Patient Clinics has been in existence only about a year and as the adoption of this standard in various clinics has taken some time, there are to date but imperfect lists of those clinics which have come up to the standard. Within a month it is hoped to have a complete list. The clinics not on such a list will have their attention called to the fact either by the Department or the Associated Out-Patient Clinics, and this may serve to stimulate such clinics to come up to the standard.

The popular publications to date have been meagre. Two cards of instructions to those having gonorrhea and syphilis have been printed, and in the press at present is a circular on the dangers of gonorrhea and syphilis and on the advertising venereal quack. This circular is to be placed at the disposal of the hospitals and dispensaries that may wish them. There has been very little call for publications on various sex matters. When there is a call such patients are told where they can get the literature they wish, and the cost thereof.

A description of the methods of administrative control of venereal diseases by the Department of Health, has been published in the Reprint Series and is available for distribution to physicians, health officers, and others.
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Re: Journal of Social Hygiene, by The American Social Hygien

Postby admin » Thu Mar 05, 2020 11:27 am

THE INTEREST OF LIFE INSURANCE COMPANIES IN SOCIAL HYGIENE1 [1. Paper read at the meeting of The American Social Hygiene Association and The Society of Sanitary and Moral Prophylaxis, New York City, October 9, 1914.]
LEE K. FRANKEL, PH.D.
Sixth Vice-President, Metropolitan Life Insurance Company


The interest of life insurance companies in the social hygiene campaign is evident. Life insurance fundamentally is a cooperative proposition. Individuals have organized themselves collectively under any life insurance plan to safeguard each other against the hazard of premature death. It is to the interest of life insurance companies as representatives of masses of insured men and women to carefully study the causes which make men die earlier than they normally should.

 The statistics of life insurance companies have shown rather clearly that the death rate of individuals afflicted with venereal diseases, particularly syphilis, is higher than the average. The medico-actuarial mortality investigation, which gives the combined experience of a number of life insurance companies, shows that the ratio of actual to expected deaths of syphilitics, thoroughly treated for two years and who for one year were free from symptoms, was nevertheless 188 per cent. Florschutz has shown from the experience of the Gotha Life Insurance Company for the years 1893-1897, that the company had 164 deaths from progressive paralysis in that period. Of these 121 or exactly three-fourths of the total were less than 50 years old, and 96 cases or 53 per cent, had been insured less than ten years. The duration of insurance was as follows: --

Less than 1 year...................................................5
I to 5............................................................33
 6 to 10............................................................58
11 to 15............................................................39
16 to 20............................................................14
Over 20............................................................15


Other statistical data is available to demonstrate this point but it is not necessary to go further into the discussion at this time.

On the other hand, it seems quite clear from a study of the mortality statistics of insurance companies that at the present time the causes of death as given in the records of cities and as made by physicians are woefully lacking with respect to venereal disease as a cause of death. If the statistics regarding social diseases given by Morrow, Keyes, and others are at all correct, it is evident that in the compilation of vital statistics in the United States more stress must be laid upon registration or recording the so-called social diseases and other sequelae as primary causes of death. Following are tables giving the experience of the Metropolitan Life Insurance Company in its Industrial Department for the year 1913 with a comparison of the mortality from similar causes in the registration area of the United States in the year 1912. I think it is quite evident that the stated percentages of deaths due to certain diseases are altogether too low.

If we are to obtain an accurate record in the United States, it seems clear that we shall have to follow the same procedure with these diseases as has been followed with tuberculosis and other infectious diseases, namely: compulsory registration. The objections to such a procedure have been voiced time and again and some of them have merit. Nevertheless it is to be hoped that in our various states some practical plan can be devised which shall preserve professional secrecy, under which physicians will be able to notify their respective health departments of certain diseases which are venereal in origin.

Such a course will eventually lead up to a more thorough registration of mortality from social diseases and be of inestimable value to insurance companies in cooperating with other agencies for the prevention of such diseases.

The interest of insurance companies in the social hygiene program may be considered along two lines: (1) The utilitarian or practical, (2) The social. From the standpoint of the former, it has been necessary for insurance companies as a matter of self-preservation to reject in most cases applicants for insurance who are known to be suffering from certain diseases. The reason for this is obvious, if one considers the higher mortality in this group as shown by the statistics given above. It is the effort of every well-managed insurance company to offer its policies at the lowest possible cost. This has only been feasible in the past through a process of medical selection which excludes the unfit.

TABLE I

Mortality from Syphilis, Gonococcus Infection, and their Probable Sequelae

CAUSES OF DEATH / METROPOLITAN INDUSTRIAL, 1913 / REGISTRATION AREA, 1912

-- / Number of Deaths / Per cent, of Total / Number of Deaths / Per cent, of Total


Total Deaths -- all causes / 104,306 / 100.0 / 838,251 / 100.0
Syphilis / 520 / 0.5 / 3,941 / 0.5
Gonococcus infection / 28 / -- / 219 / --
Locomotor ataxia / 163 / 0.2 / 1,588 / 0.2
General paralysis of the insane / 510 / 0.5 / 4,053 / 0.5
Softening of the brain / 78 / 0.1 / 1,045 / 0.1
Salpingitis and other diseases of the female genital organs / 289 / 0.3 / 1,324 / 0.2


TABLE II

Mortality from Disease and Conditions of the Puerperal State

Causes of Death / Metropolitan Industria, 1912 / Registration Area, 1912

-- / Number of Deaths / Per cent, of Total / Number of Deaths / Per cent of Total


Total deaths -- Females / 53,407 / 100.0 / 379,139 / 100.0
Accidents of pregnancy / 149 / 0.1 / 863 / 0.1
Puerperal hemorrhage / 110 / 0.1 / 923 / 0.1
Other accidents of labor / 178 / 0.2 / 842 / 0.1
Puerperal septicemia* / 793 / 0.8 / 3,905 / 0.5
Puerperal albuminuria and convulsions / 458 / 0.4 / 2,174 / 0.3
Puerperal phlegmasia, alba dolens, embolus, and sudden death / 43 / -- / 276 / --
Following childbirth / 7 / -- / 44 / --
Puerperal diseases of the breast / -- / -- / 8 / --
Total diseases and conditions of the puerperal state / 1,738 / 1.7 / 9,035 / 1.1

* This cause is very generally queried by our Statistical Bureau and a number of cases of "peritonitis," etc., are thus transferred to this title. This explains the apparent difference in the per cent of total when compared with the registration area.


It may be opportune at this time to introduce a thought which as yet has not been given sufficient consideration by life insurance companies. It has not been the business of life insurance companies until now to consider the rejected applicant from the social standpoint. In fact, it has been a policy of insurance companies for reasons that are obviously practical to keep to themselves the medical facts obtained in the examination of an applicant. It would seem to me, therefore, highly desirable from the standpoint of the campaign for social hygiene as well as the various campaigns carried on in the United States at present for the prevention of disease, if insurance companies could place the valuable information regarding rejected applicants at the disposal of these unfortunates. It is more than probable that many such individuals knowing of their precarious condition would alter their methods of life and endeavor to lengthen its span. I can conceive of no more valuable service, which might be offered by life insurance companies, for the improvement of the welfare of many citizens, than if they were systematically to communicate with the family physician of the rejected applicant, giving him the diagnosis which has been made with the suggestion that he use his influence with his patient to enable him if possible to rid himself of his trouble. The Metropolitan has done this in a limited number of cases with a marked measure of success.

The records of life insurance companies show in many instances where applications, instead of being rejected, have been temporarily postponed, that the applicants in question have at a later date presented themselves for reexamination and have successfully passed it. Such excellent results as these could be obtained in much larger number of instances if the plan above outlined were systematically carried out.

Still another opportunity is offered by insurance companies to show their interest in the social hygiene movement, namely: through the offer which can be made to policy-holders entitling them to periodic reexaminations. Several of the larger insurance companies have realized the value not only to themselves but to their policy-holders of such an offer and are conducting such reexaminations, either directly or through the machinery of the Life Extension Institute, one of whose main functions is the conduct of such reexaminations. The statistics of insurance companies show quite clearly that the opportunity thus given to policy-holders is being availed of. The Metropolitan Life Insurance Company first offered this privilege to its ordinary policy-holders in the fall of 1913, a circular to this effect being enclosed in the renewal notices sent to such policy-holders. As requests for reexamination are received by the company, they are turned over to the Life Extension Institute. We are of the impression that year by year as policy-holders realize the value of this privilege and are free of any suspicion regarding the motive of the company in offering it, more and more will avail themselves of the opportunity which is offered.

Dr. Fisk, the medical director of the Life Extension Institute, who will discuss this paper, will probably tell you of the results which have been obtained by the Life Extension Institute as a result of reexaminations of this kind.

The particular value, however, which insurance companies may be in the campaign of social hygiene is along educational lines. The relation between an insurance company and a policy-holder is frequently an intimate one. This is particularly true of industrial insurance companies whose agents visit the policy-holders weekly and who as a result soon get to be on terms of friendship and companionship with the men, women, and children, who are subject to their weekly visits. I am convinced that the educational campaign which has been conducted by the Metropolitan Life Insurance Company for a number of years along health lines has very definitely established its value. This campaign has proven that it is possible to present the basic facts regarding health and disease and in particular the care and prevention of the latter in such a fashion that even the man on the street will become interested and will follow the instruction which is given to him.

The question at issue is this: Can the social hygiene program be similarly popularized; can pamphlets or literature of any kind be placed in the hands of the great masses of workingmen and women in the United States written in a popular way and yet not give offense? We have made several attempts to have pamphlets of this kind prepared for us to be used among our industrial policy-holders, but until now have not found anything in the literature of the subject that we have felt we could use with impunity. The opportunity for the Social Hygiene Association is at hand. The preparation of literature of the kind I have described is primarily not a function of an insurance company. It should, however, be part of the activities of an organization such as this. The Association may rest assured that whenever literature can be presented which will meet the requirements mentioned above, which can be distributed in the average American home without danger, and which in a dignified, ethical way will present the fundamental principles which this Association advocates, insurance companies generally will be only too glad to cooperate with them and utilize the machinery at their disposal for the distribution of such literature among the millions of men, women, and children in the United States who today are policy-holders in the life insurance companies.
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