1905 Journal of the American Medical Association (JAMA)  
It is generally recognized by those who have studied this subject that the prophylaxis of the class of diseases comprehended under the general term "venereal" is the most complex, difficult and baffling of all the problems of social hygiene which confront us at the present day. My object in this paper is simply to indicate the lines along which this prophylactic work should be undertaken and to recommend certain measures which are immediately available and which promise to be effective in
more » ... effective in limiting, at least, the evil we wish to prevent. In the first place, it is necessary to clear away certain misconceptions which evidently exist in the minds of many of the medical profession as to the purely sanitary character of this problem. Venereal diseases pos¬ sess certain peculiarities in their origin and mode of propagation which distinguish them from all other in¬ fectious diseases, and our methods of dealing with them must be differentiated from ordinary sanitary methods, and must be adapted with special reference to their mode of communication. Especially would I emphasize the view that these diseases are not merely diseases of the human body; in their essential causes they are dis¬ eases of the social organism ; their prophylaxis is pre¬ eminently a socio-sanitary problem, the only correct so¬ lution of which must be sought for in the co-operative effort of all the social forces, educational, moral and legislative, as well as sanitary. It is hardly necessary to pass in review the extent to which these diseases prevail, their pathologic importance and their dangers to the public health. I may, however, refer briefly to one phase of venereal morbidity of the utmost importance from a biologic standpoint, and which gives to these diseases their superior significance as a social danger. The distinctive feature of venereal diseases is that •they specifically affect the reproductive organs; they damage or destroy the functions through which life is perpetuated, and thus defeat the social aim of marriage -gonorrhea, by its inhibitory influence on the repro¬ ductive capacity, and syphilis by its blighting and de¬ structive effect on the product of conception. The im¬ portant relations of these diseases with marriage have never been sufficientlv appreciated, even by the medi¬ cal profession. Marriage constitutes a favorable culture bed for the germs of syphilis, and is the most prolific source of accidental innocent inoculations. The vast com plexus of morbid states, dystrophies and degenera¬ tions which make up the pathology of hereditary svnhilis, have their almost exclusive origin in marriage. The murderous influence of syphilis on the offspring, often extinguishing in germ the posterity of many families, is well known. Modern science has taught us that gon¬ orrhea is an even more potent factor of depopulation than syphilis. A large proportion of the involuntary or enforced childlessness of many couples is due to gon¬ orrhea. Through the process of parturition, gonorrheal inflammation becomes transformed into a dangerous and even deadly infection. A large percentage of blindness and vulvo-vaginitis of young girls results from the in¬ troduction of gonorrhea into marriage. The extent to which these diseases prevail in married life is much greater than is commonly supposed. Every motive leads to their concealment. I have elsewhere stated my conviction that there is more venereal infec¬ tion among virtuous wives than among professional pros¬ titutes in this country. I repeat, then, that the chief social danger of venereal diseases comes from their destructive effects on the health and the productive energy of the family. The office of social hygiene is not simply to protect the existing population from dis¬ ease; it embraces in its objects the welfare of the de¬ scendants, those who are destined to continue the race. This protective duty extends to the unborn children, who should not be deprived of their birthright of vi¬ tality and physical vigor. The term "prophylaxis" naturally suggests the inter¬ vention of the sanitary officials, who are the accredited representatives of the state in all matters relating to the care of the health of the people, and yet we have in this country the singular spectacle of a large and im¬ portant class of diseases, dangerous to the public health, a serious menace to the welfare of the family and of the race-diseases which are confessedly contagious, essentially evitable, and yet absolutely ignored by our sanitary officials. What is the explanation of this policy of inaction? Undoubtedly, one cause is the comparative failure of all methods hitherto employed to materially dimin¬ ish the spread of these diseases, and the hostility of public sentiment toward the legal recognition of pros¬ titution, which is the chief source of these d'seases. Without entering fully into the consideration of the system of réglementation employed in continental .coun¬ tries, it may be said that it has proved defective as a sanitary scheme and is condemned by its practical re¬ sults. Beside, it is found that the large' proportion of public prostitutes can not be subjected to sanitary sur¬ veillance, while the clandestine prostitutes, who are the most active spreaders of contagion, escape its operation altogether. The fatal defect of the system is that it ignores the masculine spreader of contagion. The sanitary authorities, in dealing with a typhoid epidemic, might as well attempt to sterilize the chief infected water supply while allowing a stream of con¬ tamination to be continually pouring in and, at the same time, ignoring thousands of infected private sources of supply constantly poisoning the consumers. As well might the health officer of a port attempt to prevent the importation of plague from an infected vessel by quar¬ antining the infected women and allowing the infected men to go free. It is the unilaterality. or "one-sidedness" of this surveillance, as if the women were the exclusive sources of contagion, which constitutes its es¬ sential weakness as a sanitary scheme. It may be positively affirmed that venereal diseases are not susceptible to the application of the sanitary methods ordinarily employed for the control of con¬ tagious diseases. The first essential to the success of any scheme of sanitary control is the co-operation of Downloaded From: by a UQ Library User on 06/17/2015
doi:10.1001/jama.1905.92500360001002 fatcat:lj4z32azerfh7ffl57vvckhndy