The Sexual Life of Our Time in Its Relations to Modern Civilization / Translated from the Sixth German Edition

by Iwan Bloch

CHAPTER XV

The motto which I have placed at the head of this chapter on the campaign against venereal diseases and on the attempt to suppress them is taken from an interesting academic essay by the former professor of medicine at Göttingen, K. F. H. Marx, who is well known to have been the physician of Heinrich Heine during the latter’s student life in Göttingen. The title of this essay is “The Diminution of Diseases in Consequence of Advancing Civilization,” p. 35 (Göttingen, 1844).

The hopeful view which is here expressed by the university professor regarding the ultimate eradication of venereal diseases was shared at that time by the eminently practical physician Parent-Duchatelet. He appeals, unfortunately, not to medical men and students of social hygiene, but to the police:

“Pursue without cessation the diseases which are diffused by means of prostitutes; take it as your goal to cause them to disappear from the list of human troubles; do not doubt that your labours will ultimately be crowned with success, although the task may be one that will occupy several generations.”[331]

Two complete generations had, however, to pass away before the campaign against venereal diseases and the attempt to suppress them became a burning question of the time, became a question of public health and social hygiene, like those which concern the fight with tuberculosis, with infant mortality, and with alcoholism. Once again I must repeat that the organized systematic campaign against venereal diseases is still in its very earliest stages. Strictly speaking, it dates only from seven years ago, when the first international congress for the prophylaxis of syphilis and other venereal diseases was held in Brussels, from September 4 to 8, 1899. Almost all the civilized countries, European and other, took part in this congress, and not only physicians and dermatologists, but also lawyers, clergymen, attachés of embassies, authors, and philanthropists, explained their views, and thereby showed that the question of the suppression of venereal diseases was one of equal interest to all classes of society, and one which must exercise the activity of the community at large. At the conclusion of this first international conference in 1899, there was founded the International Society for the Sanitary and Moral Prophylaxis of Syphilis and other Venereal Diseases, which has its seat in Brussels, and meets at periodical intervals for international conferences.

Especially in Germany has this organization aroused active interest, and it was soon decided to found a national German Society for the Suppression of Venereal Diseases, whose first meeting was held on October 19, 1903, in the hall of the Berlin Rathaus. The meeting was opened by a speech from Albert Neisser, after which Alfred Blaschko spoke on “The Diffusion of Venereal Diseases,” Edmund Lesser on “The Dangers of Venereal Diseases,” Martin Kirchner on “The Social Importance of Venereal Diseases,” and Albert Neisser on “The Aims of the German Society for the Suppression of Venereal Diseases.” The committee of the Society consists of Messrs. A. Neisser, president; E. Lesser, vice-president and treasurer; and A. Blaschko, general secretary. The organ of the Society is issued six times yearly, under the title, Reports of the German Society for the Suppression of Venereal Diseases, and has been published for the last four years; it is supplied gratis to members; to non-members the yearly subscription is only three marks. In the spring of the year 1903 there was founded a larger Journal for the Suppression of Venereal Diseases, of which five volumes have hitherto appeared; this serves for the publication of more comprehensive critical studies.

Still in the same year, 1902, there were formed the first branches and local groups of the German Society for the Suppression of Venereal Diseases in Hanover, Wiesbaden, Breslau, and Berlin. Subsequently other branches were formed in Mannheim, Munich, Cologne, Beuthen, Danzig, Stettin, Posen, Dortmund, Elberfeld, Frankfurt-on-the-Main, Görlitz, Hamburg, Königsberg, Nürnberg, Stuttgart, and Heidelberg.

During the last four years, by means of lectures, the circulation of pamphlets and leaflets, and by public discussions, information regarding the dangers of venereal diseases has been diffused among the widest circles of the population. Of the other activities and measures of the Society we shall have to speak later.

We pass on to the consideration of the principal elements of the modern campaign against venereal diseases. In view of the limits of this work our discussion of this question must necessarily be a brief one. The eradication of venereal diseases must be effected in a threefold manner:

1. By measures of personal prophylaxis against infection.

2. By the proper medical treatment of all cases of venereal disease.

3. By measures belonging to the province of public hygiene, to that of state action, and to that of education.

The personal prophylaxis of venereal diseases[332] has made great progress with the increasing scientific knowledge of the causes and modes of infection of these diseases. We know now precisely where and how we can lay down personal rules which give us at least a fairly secure guarantee that in an individual case venereal infection will not occur. Various points of view must then be taken into consideration, the combined influence of which will alone promise a successful result. No one single measure will suffice to gain this end.

Above all, in this department of the prophylaxis of venereal diseases, experienced physicians, alike of earlier and more recent times, will unanimously agree in this proposition, that the principal preliminary means for the avoidance of venereal infection, means which it is absolutely essential to employ in every instance, consist of perfect cleanliness on both sides. He who insists on the most scrupulous cleanliness of body, clothing, and underclothing, will be sure to get rid immediately of any uncleanliness acquired in sexual intercourse. Cleanliness and health are often (not always) identical. In any case, the greatest mistrust should be felt as regards a person evidently unclean, with a neglected exterior, for this is always a sign that such a person is not particular as regards choice in matters of sexual intercourse. “Germany, get into your bath!” Heinrich Laube once exclaimed. This would be a good device to adopt in the campaign against venereal diseases. Every uncleanliness is an irritant; it impairs the intactness of the skin; and especially is this true of any uncleanliness of the genital organs, and above all of the male genital organs, where, under the foreskin, the “smegma” (the sebaceous secretion of the preputial glands) often undergoes decomposition, and gives rise to an inflammation, the so-called balanitis, which greatly favours the probability of infection.[333]

If the foreskin has been removed by circumcision, this secretion entirely ceases, and the mucous membrane covering the glans penis is transformed into a thick skin, which is much less readily affected by the causes of infection. There is no doubt that circumcision is to a certain extent a protective measure against syphilitic infection, whilst it does not in any way protect against gonorrhœa. Neustätter has recently collected some very remarkable facts relating to this question.[334]

Breitenstein has contrasted 15,000 indigenous circumcised soldiers with 18,000 uncircumcised European soldiers of the army of the Dutch Indies, living under similar local and hygienic conditions. Thus, in the year 1895 there were infected with venereal diseases, of the circumcised 16 %, of the uncircumcised 41 %. As regards infections with syphilis, of the circumcised 0·8 % were infected; of the uncircumcised, on the other hand, 4·1 %—that is, five times as many. Similar observations were made by the celebrated English syphilologist Jonathan Hutchinson, one of the most ardent advocates of the general introduction of circumcision as a protective measure against venereal, and above all against syphilitic, infection. Moreover, with regard to the observations made in Java, the difference did not depend upon race, because similar differences have been observed as regards comparative immunity from infection in respect of circumcised Christians, circumcised on account of phimosis and other troubles, whose number is by no means insignificant.

Since, however, it is unlikely that circumcision will come into general use in Europe as a prophylactic measure, it only remains to recommend that, as a fundamental procedure, the greatest possible care should be employed in the daily and delicate cleansing of the preputial sac. By this means inflammation and laceration of these parts will be most effectually prevented, and even without circumcision a certain resisting power will be induced. For washing this region, lukewarm water which has been boiled and cooled may best be employed; then dry the part carefully, so as not to rub off the skin. In the case of women, frequent washings of the external genital organs, and vaginal douches, are also of great importance in regard to the prevention of venereal infection. Before and after the sexual act, these measures are of especial value, because often by simple mechanical means, infective material already deposited may be carried away. The same purpose is subserved by urination, a procedure certainly adapted for washing out gonorrhœal pus which has found its way into the urethra, before the gonococci have had time to establish themselves in the mucous membrane. I know a number of patients who use no other means of protection in sexual intercourse beyond the observation of extreme cleanliness, by washing and douching, in both sexes, before and after sexual intercourse, and by passing water immediately after intercourse, and thus have remained free from infection; but who promptly became infected as soon as they discontinued these simple measures.

For this reason, these measures, where possible with the assistance of soap, which certainly exercises some antiseptic influence, cannot be too warmly recommended, although they naturally do not offer any absolute security. They have, however, the advantage that, in the first place, they can always be employed, even when the true protective measures of which we speak below are not available, and that, in the second place, they can always be used in addition to these. It sounds, perhaps, somewhat absurd, and yet it is true, to say that washing and urination are the first and most important protective measures against sexual infection.

The second point, which must also be considered important in this connexion, is the exercise of self-command before and during the sexual act, as far as this is possible in view of the nature of sexual excitement, which always lessens the personal responsibility, and overcomes reason and understanding. Yet no one should have sexual intercourse when in a state of alcoholic intoxication, in which self-control is completely lost; as we have shown in an earlier passage ([pp. 292]-[296]), there are several reasons why intercourse is apt to be disastrous to a drunken man. Moreover, love prefers the dark, but precaution prefers the sunlight. Before having intercourse with a woman previously unknown to him, a man should inspect her in clear daylight, with a view to her state of health. Suspicious spots on the skin, especially on the forehead and on the trunk; white areas on the lips, the tongue, the throat, and the back of the neck; visible glandular swellings; a marked discharge from the genital organs; ulcerated areas in this region, etc., are of an extremely suspicious nature, and should cause abstinence from intercourse. French physicians go so far as to recommend examination of the inguinal and cervical glands under the harmless form of pretended caresses; but persons without medical education would seldom be sufficiently skilled to be able to detect glandular swellings unless these were unusually well developed. Especially enlargement of the cervical glands—this “pulse of syphilis,” as Alfred Fournier terms it—is a comparatively certain indication of syphilis.

It is dangerous also in many cases to repeat the sexual act several times in brief succession, because old experience has taught us that infective material may first make its appearance at the second or third act of coitus, and thus infect then only. This affords an explanation also of a fact often observed—that in intercourse with an infected woman on the part of two healthy men, with but a brief interval between the acts, the one who had intercourse first often remains healthy, whilst the second is infected.

I pass on to consider the special protective measures which have long been recommended for the prophylaxis of venereal infection.

1. The Condom.—This is the oldest and even to-day beyond question the best and most trustworthy artificial protective measure. Employed long ago in the days of antiquity, it was in the sixteenth century once more recommended by the Italian physician Fallopius, and therefore is not the invention of a physician “Conton,” after whom it is said to have been named (perhaps the name is connected with that of the French town “Condom”). Hans Ferdy (A. Meyerhof) suggests that the word is derived from “condus”—that is, one who preserves or protects—and that the article should properly be called “condus” instead of “condom.”[335]

The condom is a protective membrane, with which the penis is covered before intercourse. We distinguish as “rubber condoms” those made of rubber, gutta-percha, or caoutchouc; and as “cæcal condoms” those made out of the cæcal mucous membrane of the goat or sheep (incorrectly termed also “isinglass condoms”). The cæcal condom is thinner and more delicate, and blunts sensation less, than the rubber condom. The rubber condom, however, is more trustworthy, in respect of durability and its slighter liability to laceration, if the little precaution is not neglected to keep it in a cool place, and to protect it from the long-continued influence of warmth. The habit of carrying about a rubber condom in the pocket for a long time favours its rapidly becoming untrustworthy and easily torn. Cæcal condoms, on the other hand, very readily become fragile and pervious, although the contrary is the common opinion, and they are preferred to rubber condoms in the belief that the dearer article must be the better. Advertisement is exceedingly active in this direction, and every kind of speciality is widely recommended. In England condoms are sometimes sold bearing the portrait of some celebrated person!

The condom is a “general protective measure”—that is, it protects against both gonorrhœa and syphilis, in so far as the latter disease, as is usually the case, is transmitted from the genital organs. All the leading physicians engaged more especially in the treatment of venereal diseases are agreed that the condom, when of good quality, when properly applied, and when removed with care (for in the removal material adhering to the outer surface may very readily give rise to infection), constitutes the very best and most certain of all the protective measures hitherto advocated. It is true that it can be used by men only, but when used by the man it simultaneously protects the woman from gonorrhœal infection, and not rarely also from syphilitic infection.

2. The Instillation of Solutions of Silver Salts.[336]—These serve exclusively for the prophylaxis of gonorrhœa, and are not, therefore, general protective measures. We owe their introduction to Blokusewski, who recommended the use of a two % solution of nitrate of silver. More recently, the albuminates of silver have been preferred, such as protargol in a 10 to 20 % solution, albargin in a 4 to 10 % solution, or a solution of 20 % protargol-gelatine. These solutions can be carried about in small drop-bottles—for example, as the “Sanitas” (silver nitrate) of Blokusewski, the “Viro” or the “Phallokos” apparatus (these are trade names for proprietary preparations—solutions of protargol). All solutions of silver salts must be kept in the dark, and after the lapse of any considerable time, some freshly prepared solution must be introduced, for time and the influence of light destroy their efficacy. Immediately after intercourse and urination, one or two drops of the solution are instilled into the urethra, and a drop or two also allowed to run over the frænum præputii.[337]

The views regarding the value of these protective measures are conflicting. Beyond question, they are less trustworthy than the condom. Infection has been observed in spite of the use of instillations. Above all, however, the continued use of these methods gives rise to disagreeable irritative manifestations in the urethra and may even cause catarrhal inflammation, and thus artificially increase the liability to infection. Hence, these instillations should be reserved for occasional use; habitually, only the condom should be employed.

3. Inunction.—Whereas the instillation of chemical solutions serves to protect against gonorrhœa only, the practice recommended for a much longer time of anointing the penis with a simple fatty material, or with an antiseptic ointment, before or after sexual intercourse, protects against syphilis only. It is obvious that a layer of fatty material covering the penis exercises the purely mechanical function of preventing the passage of infective matters to the skin. It is, however, equally obvious that by the to-and-fro friction during sexual intercourse, especially when this occupies a considerable time, this fatty covering will be rubbed away, so that the virus can find a means of entrance. The protection is thus extremely relative. Still, such authors as Neisser, Max Joseph, Loeb, and Campagnolle, report favourable experiences regarding the prevention of syphilis by the inunction of the penis, for which purpose simple vaseline, or Schleich’s wax-soap cream, which is sold with the “Viro” apparatus, may be employed. In any case, this method is better than nothing at all. He who has no other protective measure available should remember that in every house there is always some fat or ointment obtainable which can be used for this purpose.

In order, whilst using this method, to protect simultaneously against gonorrhœa, it has been recommended that antiseptic ointment should be inserted into the urethra before intercourse, but this is a very unsatisfactory and untrustworthy method.

Well worth attention is the inunction recently recommended by Metchnikoff[338] of a specific mercurial ointment, after intercourse, for the destruction of any syphilitic virus which may have been deposited.[339] He used for this purpose, not the strongly irritant blue ointment, but the white precipitate ointment, an ointment of the salicyl-arseniate of mercury (enesol), and, above all, a 30 % calomel ointment. After any suspicious coitus, this ointment should be rubbed for four or five minutes into the area of possible infection; this should be done without delay; but even after the lapse of eighteen to twenty-four hours an effect has been traced. The experiments on apes inoculated with syphilis gave positive results; also in the case of a student of medicine who voluntarily offered himself for inoculation with the syphilitic virus, the inunction of calomel ointment appears to have prevented the outbreak of the disease.

In any case, these new methods for the prophylaxis of syphilis demand the most careful attention. Further experience is needed to determine whether they deserve general application.

4. Antiseptic Washes.—Washing of the penis and douching of the vagina with antiseptic lotions (sublimate, lysol, permanganate of potassium) after intercourse are among the most uncertain of protective measures, because the sublimate solution, or whatever may be used, does not find its way into any possible lacerations; and because, in consequence of the profuse secretion of the sebaceous glands of the male and female genital organs, these organs are covered with a layer of fatty material, which prevents the contact of watery fluids, but does not in the same degree prevent the entrance of the syphilitic poison. Antiseptic washes after the sexual act have as little value as the same used before the sexual act.

The knowledge of these protective measures—above all, of those named under the first, second, and third headings—ought to be very much more general than it is. Unfortunately, however, in public life such measures are still viewed largely from the standpoint of the moralist as “indecent” or “improper”; and the criminal law classifies them thus, so that their public recommendation and diffusion is still exposed to great hindrances.

At the second congress of the Society for the Suppression of Venereal Diseases, held in Munich in March, 1905, the question of the public recommendation of protective measures was opened to discussion, and was dealt with in two admirable addresses by O. Neustätter[340] and Georg Bernhard.[341] Bernhard proposed that to Section 184, paragraph 3, of the Criminal Code, which declares it to be a punishable offence to “expose for sale articles intended for an indecent use, or to recommend or sell such articles to the public,” should be added a legal definition in the following sense: articles which are used either to prevent venereal diseases or to prevent conception are not regarded as “intended for an indecent use”; and Neustätter pleaded for an alteration of the existing state of the law, in the sense that the public recommendation of means for the prevention and cure of venereal diseases should be legally permissible, being restricted merely by certain regulations against quackery, extortion, and other misuse. The regulation of the recommendation could best be associated with the necessary control of the recommendation of therapeutic and preventive measures in general. A supreme sanitary authority should be constituted, part of whose duties should be to examine the form and contents of recommendations of this character.

Another juristic relationship of the prophylaxis of venereal diseases concerns legal protection against venereal infection. Franz von Liszt,[342] von Bar,[343] and Schmölder,[344] opened the discussion on the biological and criminal aspects of the prophylaxis of venereal diseases at the first congress of the Society for the Suppression of Venereal Diseases, held at Frankfurt-on-the-Main in the year 1903.

Hitherto the heedless or deliberate transmission of venereal disease was punishable only as personal injury, since in the Criminal Code there was no paragraph directly relating to this matter. Only in the Criminal Code of Oldenburg of 1884 was such punishment expressly provided for (Article 387), and by this provision the intercourse of an infected person with a healthy one was punishable, without regard to the subsequent infection. In the legal regulations of other countries than Germany, we find several instances in which the witting transmission of venereal infection by means of sexual intercourse is punishable. In Germany a measure proposing this was rejected by the Reichstag in 1900. Von Liszt advocated the introduction of the following paragraph into the Criminal Code:

“One who, being aware that he is suffering from a contagious venereal disorder, performs coitus, or in any other way exposes another human being to the danger of infection, shall be punished with imprisonment for a term of two to three years, and in addition shall be deprived of civil rights.”

Schmölder enlarged this clause by an amendment relating to the punishment of prostitutes disseminating venereal diseases.

On the other hand, von Bar drew attention to the inconveniences and dangers which a punishment of this nature would involve, especially to the dangers of blackmail, and to the duty it would impose on physicians of breaking their obligations of professional secrecy. Moreover, a proof of the knowledge of venereal infection is difficult to obtain; the proof that infection is derived from a definite person is also far from easy. Von Bar opposed the addition of such a clause on this and other grounds. In the discussion upon the motion, this view was shared by C. Fränkel, Ries, Oppenheimer, and others; Neisser was in favour of a punishment of this kind, because then, at any rate, there would be a public recognition of the fact that such an action was open to severe punishment, and was a disgraceful one; thus, by the mere existence of the paragraph an educative influence would be exerted.

In any case, such a punishment would be a two-edged weapon, and as far as present necessity goes, we have sufficient powers in the application to such offences of the paragraphs of the Criminal Code relating to bodily injury.

The second great means for the limitation and entire suppression of venereal diseases is to deal with them by medical treatment, to cure as speedily as possible persons suffering from syphilis of gonorrhœa, and thus to prevent these persons from becoming sources of fresh infection. Systematic, methodical treatment on a large scale—that is the goal at which we have to aim. To the poor man or woman suffering from venereal infection the same advantages should be opened as to the wealthy voluptuary. The provision of means of treatment of venereal diseases cannot be too free. In public hospitals, private clinics, ambulatoria, and sanatoria, in convalescent homes, and polyclinics for prostitutes, everywhere must be provided means for an intelligent treatment of venereal diseases. Just as tuberculosis is now attacked systematically and vigorously, so must it be with venereal diseases.

Since syphilis constitutes only about 25 %—only one-fourth part, that is to say—of venereal diseases in general, since also during the last four centuries the disease has shown a natural tendency to decline in virulence, since a mitigation in the intensity of the virus is clearly recognizable, it is in the case of this disease that the hope of radical success is especially great.

Our forefathers carried out for us a great part of the campaign against syphilis. The comparatively mild course of syphilis in the majority of uncomplicated cases leads us to infer that there has been a relative immunization against syphilitic poison.

Albert Reibmayr remarks that “during the last 400 years, every human being now living in Europe has had about 4,000 ancestors; of these, however disagreeable the fact may seem, a considerable number must have had to contend with syphilis.”[345]

But this undoubted fact, that all of us have been to a certain extent “syphilized,”[346] plays its part to our advantage in the campaign against syphilis—that campaign which our own time has taken up with joyful hope of success.

Above all, let honour be paid to the ever youthful and fresh master and Nestor of European research into the subject of syphilis, Alfred Fournier, the evening of whose life is devoted to the campaign against syphilis as a “social danger.” To the great scientific works of his life he has now added the small, but not less valuable, explanatory writings, which are being sold at a low price all over France, and in part also have already been translated into German and English.[347] Their aim is to get the people on our side in the campaign against syphilis.

When, in April, 1906, I paid the master a visit, he gave me the last of these popular campaign writings. Its title was in the form of a question:

“En Guérit-on?” (“Is it Curable?”).

And the answer given on p. 4 runs: “Yes, it is curable, for of all diseases syphilis is the one which can best, most easily, and most certainly be cured.” And why? Because we have a wonderful specific against this disease, which, when given at the proper time and in the proper manner, works a miracle. This remedy is

Mercury.

I put this name clearly and visibly before the eyes of the reader, a name which for every physician to whose lot it falls to treat cases of syphilis has a truly miraculous sound, a name against which the unconscientious ignoramuses, the evil-disposed enemies of the human race have spoken their anathema, one which a great thinker and honourable man like Schopenhauer regarded as a “triumph of medicine,” a fact which he experienced personally in his own body. All honourable, critical, and scientific physicians agree in this opinion. In my work on “The Origin of Syphilis,” vol. i., p. 127, I have expressed the matter in the following words:

“Mercury is and remains—notwithstanding the ignorant and ill-considered hostility of quacks and their kindred—the divine means for the treatment of syphilis; mercury is to syphilis what water is to fire, in the hands of that physician who knows how to use the drug rightly, how to apply it at the right time and in the right form, who watches closely the course of the disease in his patient, and who supports the mercury cure (always of primary importance) by other therapeutic measures as indicated.”

Only the physician, the scientifically trained medical man, can cure syphilis; the quack certainly cannot; in his hands mercury is truly enough a dangerous “poison.” But he has no right to say, and he speaks deliberate untruths when he says, that we physicians “poison” the “unfortunate” syphilitics with mercury. To such preposterous accusations we can give a brief and incisive answer.

Therefore, during my lecturing journey, undertaken recently[348] under the auspices of the German Society for the Suppression of Venereal Diseases, I prepared the following brief account of the therapeutic employment of mercury in syphilis, which in my opinion suffices to throw the proper light upon the value and importance of the mercurial treatment of the disease; it is a sufficient answer to the “Nature-Healers,” who are opposed to the use of this “poison”:

1. In innumerable instances it has been observed by the most experienced and scientific physicians, that cases of syphilis treated without mercury run a very severe course, accompanied by the most dangerous symptoms, such as extensive destructive lesions of the skin, lesions of the internal organs, brain syphilis, eating away of the bones, loss of the nose, etc.

2. In cases which previously have been treated without mercury, the administration of the latter drug immediately arrests the destructive processes, and saves the patient from death, or from very severe illness, and from physical disfigurement.

3. No less an authority than Virchow, in his celebrated treatise “On the Nature of Constitutional Syphilitic Affections,” pp. 7-14 (Berlin, 1859), has shown that the hypothesis of Hermann[349] is entirely devoid of foundation in fact.

4. I should feel conscientiously compelled to denounce myself for the commission of grievous bodily harm if I ventured to-day, after the accumulated experience of four centuries, to treat a case of syphilis without mercury.

What use is it to continue to fight against the disbelief and superstition which clings to mercury? Why should we for ever be occupied in contradicting the false accusations brought against this drug? For four centuries the divine mercury has withstood all attacks, and will continue to withstand them, until a greatly desired and even better measure is discovered—prophylactic immunization against syphilitic infection.[350]

How mercury is to be given, whether in the form of the long-prized “schmierkur” (cure by inunction), or by hypodermic injection, or by ordinary internal use, must be left in individual cases to the decision of the medical man, for numerous considerations, which can only be properly weighed by the physician, have to be taken into account. A mercury cure is a serious matter, but always also one which repays all the trouble that we take. In “En Guérit-on?” Fournier has most admirably described the wonderful results of a critically considered and carefully conducted mercury cure. I do not, indeed, belong to the “doctors who build for themselves a house of pure quicksilver,” when they enter the field against the “French” (= syphilis), as the phrase runs in Schiller’s work “The Robbers.” I hold by a reasonable, measured use of mercury in the course of the treatment of syphilis, and I advise a good “after-treatment” in addition to the treatment with mercury.[351] Mercury, when given in moderate but sufficient doses, not only destroys the syphilitic virus, but also has a very favourable influence on the general condition, and sometimes even gives rise to an increase in the number of the red blood-corpuscles. Thus, mercury is not only not a poison: it is a most valuable restorative and vitalizing means. This is well illustrated by the following case, which came under my own observation, and which I recommend to the Nature-Healers, in the hope that it may lead them to revise their views regarding the action of mercury:

The case was that of an official, thirty years of age, who had been under my care several times before since the year 1898 for other troubles (gonorrhœa, etc.), and who was always pale and with hollow cheeks, in no way giving the impression of possessing a constitution with strong powers of resistance. Late in the summer he was infected with syphilis; the attack proved a severe one, running a serious course, complicated by an extremely painful suppurative inflammation of the lymphatic vessels of the penis, and accompanied by fever, lassitude, and a sense of exhaustion. An energetic inunction cure was immediately begun. Under this not only did the morbid symptoms rapidly disappear, but there occurred a remarkable change in the general condition, in the sense of an increase of strength, such as had not existed before the illness. Notwithstanding slight stomatitis, the patient during and after the cure felt stronger and more fit for work than he ever had before, and even now this favourable state continues unaltered, as is manifested above all by the increase in the body-weight, by the good appearance, etc. The patient, who now, one and a half years after the cure, has had no relapse, informed me repeatedly and spontaneously that this delightful improvement in his health could only be attributed to his syphilis (!) or to the mercury!

A single mercury cure will suffice, in some cases, to cure syphilis for ever! Regarding this, we have numerous trustworthy observations. In most cases, indeed, during the early years relapses occur, and then we need to use the indispensable mercury cure once more with care, and to employ all the other measures which make up the above-mentioned “after-treatment,” the supplementary means being, above all, iodide of potassium, sulphur (in the long-celebrated sulphur-baths of Aix, Nenndorf, etc.) and arsenic (first recommended by me); also the water cure, brine-baths, and iodide-baths, and a visit to the seaside or to the mountains, and massage, are good accessory means to the cure. Above all, however, the State of nutrition of the patient[352] must always be kept under consideration, and assisted where necessary, for which purpose preparations of iron, nutritive preparations like sanatogen, and milk cures, are of value. Strict abstinence from alcohol is always necessary in the treatment of syphilis. Alcohol has a very unfavourable influence on the syphilitic process, and is often the only cause of continually recurring relapses of this disease.

The thorough treatment of syphilis is a matter of several years, during which the patient must repeatedly present himself to the physician for examination, and should any relapse occur, he must be subjected to renewed treatment. Such thoroughness will invariably be rewarded. Attention to detail will always bear fruit. Syphilis is curable. It is purely fanciful to say that syphilis is never cured, that it pursues its victims up to the end of life, that it knows no pardon. That is not true. Treat your syphilitic patients, treat them properly and thoroughly, if necessary for years in succession, and they will be freed from the disease. “Syphilis,” says Fournier, “is a misfortune, but it is a misfortune from which complete recovery is possible.” From the day when the patient becomes aware that he is suffering from syphilis, he must face the situation “in a calm and manly fashion,” and must say to himself:

“Now there is to be a fight between syphilis and me. To work, therefore, and courage! Courage, because science assures me that with the aid of mercury, of hygiene, and of time, an end will come to the syphilis, and because science gives me an absolute assurance that some day I shall be as healthy as I was before, and that I shall again have the right to a family, that I shall attain the freedom and the happiness of being a father!”[353]

With these admirable words of the greatest living authority on syphilis, I close my account of the suppression of syphilis by medical treatment, and turn to the not less important question of the management of gonorrhœa.

Recent scientific researches, especially those of A. Neisser and E. Finger, have shown that the infective urethritis of the male produced by gonococci is by no means the “trifling and childish complaint” which it was formerly supposed to be, but, on the contrary, is a very serious and obstinate trouble, often resisting the very best means of treatment, so that it may persist for years, and remain for years infective. Still worse is it as regards gonorrhœa of the female genital organs, the cure of which is even more difficult, and the consequences of which are even more disastrous than in the case of the male. If the physician is needed for the cure of syphilis, still more is this the case as regards gonorrhœa. He only can command the scientific methods, and the very complicated technique of the treatment of gonorrhœa. He only can undertake the indispensable control of the treatment by means of microscopic and other methods of investigation. Every cobbler thinks he can cure gonorrhœa, and yet it is this disease which, even more than syphilis, demands the most precise knowledge of the local anatomical and pathological conditions. Blaschko rightly says:

“While no one gives a damaged watch to a baker to mend, or a torn coat to a tinsmith, every one seems to believe that in order to restore the most valuable gift of humanity, health, it is unnecessary to possess the profoundest knowledge of the human body, and to understand the nature and the causes of the disease. Anyone who has come to grief in his ordinary profession, but who understands how with a brazen voice to denounce the so-called ‘medicine of the schools,’ and to praise with sufficient confidence his own successes, is supposed to possess the wonderful power, without any exact knowledge at all, of charming all the illnesses of mankind out of the world.”

Gonorrhœa is also a curable disease, though curable often with great difficulty. We see this from the fact that, notwithstanding the extraordinarily wide diffusion of gonorrhœa (for a far greater number of infections with gonorrhœa occur than of infections with syphilis), still ultimately the majority of the men, and a large proportion of the women, infected with gonorrhœa are completely cured of their trouble.

The treatment of gonorrhœa is a complicated affair. Within the first two days, by the injection of powerful caustic agents, we are sometimes able to cut the matter short and to put an end completely to the gonococci. In every case the patient, as soon as he perceives a discharge, though not yet purulent, from the urethra, should immediately consult a physician, in order to determine the nature of his disease, which, in the majority of cases, will be found to be true gonorrhœa. If it is not possible to abort the gonorrhœa, then the disease will have to run its course. The best measure, whenever possible, is rest in bed for a week or two, in association with a mild, unstimulating diet, and the absolute prohibition of all alcoholic beverages—the last is indispensable throughout the duration of the gonorrhœa—the drinking of uva ursi tea, and, if the inflammatory symptoms are severe, the application of cold compresses to the penis. Only when the first more severe symptoms have passed away, by which time, owing to the reaction of the urethral mucous membrane, a large proportion of the exciters of the disease will already have been expelled, is it time to begin injections or irrigations of the urethra, containing medicaments the nature of which must be left to the decision of the experienced physician, who will regard each individual case on its own merits. If rest in bed is not possible, the patient must wear a so-called “suspensory” bandage, in order to give as much rest as possible to the testicles and the epididymis, which are gravely endangered in every attack of gonorrhœa. If, as often happens, gonorrhœa ascends to the posterior part of the urethra, or to the bladder, or to the prostate, or if, finally, it becomes chronic, then special methods of treatment, with internal medicines, with local cauterization, massage, distension, medicated bougies, baths, etc., are needful. The cure will ensue very gradually; relapses are frequent; even cessation of the discharge is no certain sign of cure, as the presence in the still turbid urine of “threads” containing gonococci sufficiently proves. Only when the urine has become perfectly clear, and any threads which it may contain are shown by repeated search to contain no more gonococci; when also the prostate, a favourite seat of the last remnants of gonorrhœa, is free from inflammation, can the cure be regarded as complete. Even more difficult is the determination of a cure in women. But persistency in the treatment, and frequently repeated examinations, will lead also in women to the desired goal, or, at any rate, will overcome the capacity for spreading the infection.

In the campaign against venereal diseases by the methods of medical treatment, the facilitation of treatment for the great masses of impecunious persons, for the proletariat, is of great value. For them, above all, the provision of Krankenkassen[354] is needed, and it is very satisfactory to note that during recent years the Krankenkassen have especially directed their attention to venereal diseases, since A. Blaschko,[355] A. Neisser,[356] R. Ledermann,[357] and Albert Kohn[358] drew attention to the duties of Krankenkassen in this relationship in a number of admirable works. Krankenkassen are in a position to obtain exact statistics regarding venereal diseases; to diffuse information, verbally and in writing, to the widest extent among their members; to facilitate hospital treatment, and treatment by specialists; to give medical aid as required to infected relatives of the insured; to carry out regularly every year, once or twice, a medical examination of all members, and to distribute among all these writings on the prophylaxis of venereal diseases. The question also of payment on the part of the patient requires new regulations as regards venereal diseases.[359]

Finally, it has been recommended that, in association with the Krankenkassen there should be founded “daily sanatoria” (Neisser), “work sanatoria” (Saalfeld), “ambulatory places for treatment” (Ledermann), and “convalescent homes” (Stern), for members of Krankenkassen suffering from venereal disease, and for insured persons similarly affected. All these institutions would, moreover, be valuable to the community at large.

What admirable results are obtainable by such a systematic treatment of as far as possible all the venereal patients throughout an entire country has been shown by the astonishing decline in the number of cases of venereal diseases in Sweden and Norway, and in Bosnia, where a gratuitous treatment of all such patients at the cost of the state has been introduced. Thus the organized campaign against venereal diseases, which during recent years has been initiated in all the civilized countries of Europe, has led more particularly to efforts in the direction of the sufficient treatment and speedy cure of recent syphilis and recent gonorrhœa.

We pass now to the consideration of the third factor in the campaign against venereal disease, which comprises the duty of the state, the task of social hygiene, and the task of public pedagogy.

The foundation for the suppression of venereal diseases by state effort consists in a knowledge of the extent of the diffusion of these diseases; we need, that is to say, accurate statistics regarding venereal diseases.

It is once more the great service of Blaschko to have been the first in Germany to work on these lines.[360]

Dismissing from consideration the distribution of venereal diseases in countries outside of Europe, regarding which he gives interesting reports, we find that the European conditions are of such a nature that the large towns, the centres of industry and manufacture, garrison towns, and university towns, are most severely affected; that the smaller provincial towns suffer less; that the agricultural population is comparatively free from this disease, with the exception of the uncultivated country districts of Russia and of the Balkan States, where the country people suffer from syphilis to a terrible extent. No exact statistical data are at present available regarding the diffusion of venereal diseases in the individual countries of Europe. The best measure of the prevalence of these diseases is afforded by the figures for the different armies. From these we learn that Denmark, Germany, German Austria, and Switzerland, show the most favourable conditions; next come Belgium, France, Spain, Portugal, North and Middle Italy. Worst of all are the conditions in Southern Italy, Greece, Turkey, Russia, and—England. These army statistics are, however, insufficient, for, as a matter of fact, England is most favourably placed in respect of the diffusion of venereal diseases. The most exact reports come from the Scandinavian countries, from Norway and Denmark, in which for several years all physicians have kept a list of all the infective diseases treated by them, as they are compelled every week to make a return to the Board of Public Health. According to these reports, it appears that venereal diseases in Copenhagen constitute the greater part of such diseases in the entire country; but in the period between 1876 and 1895 these diseases have notably declined in frequency in Copenhagen, and all venereal diseases have shared in this decline; gonorrhœa constitutes 70 % of all cases of venereal disease. With regard to the diffusion of infection, it appears from the Copenhagen statistics that one woman with venereal disease serves to transmit it to four men; on the other hand, of four men with venereal disease, one only will transmit that disease to a woman. On the average, there are infected with venereal disease every year 16 to 20 % of all young men between the ages of twenty and thirty years; with gonorrhœa 1 in 8 are infected; with syphilis 1 in 55 are infected. In these last ten years, for every 100 young men living, there have been 119 infections during ten years; that is to say, on the average every one has been infected once, and a great many have been infected more than once; in the same period of ten years, for every 100 young men, there have been 18 infected with syphilis—that is to say, 1 for every 5·5.

Especially valuable also are the figures which Blaschko obtained in 1898 from the carefully kept books of a large mercantile Krankenkasse whose operations were diffused throughout Germany; these figures also give the result of an inquiry regarding venereal diseases amongst workmen, waiting-maids, secret prostitutes, and students. The result of these statistics, as regards Berlin, are given briefly in the following table:

Secret Prostitutes, 30 %.
Students, 25 %.
Shop Employees, 16 %.
Workmen, 9 %.
Soldiers, 4 %.

Venereal Diseases Affecting Various Classes of the Population of Berlin (after Blaschko).

According to these statistics, the diffusion of venereal diseases among shop employees, students, and secret prostitutes (chiefly barmaids and waitresses), is the greatest; it is much less among workmen and soldiers. It further appears, from Blaschko’s inquiry, that of the men who entered on marriage for the first time when above the age of thirty years, each one had, on the average, had gonorrhœa twice, and about one in four or five had been infected with syphilis. Wilhelm Erb, in Heidelberg, obtained similar results.

Still more remarkable were the results of the statistical investigation which was carried out for the entire Kingdom of Prussia by the Prussian Ministry of Ecclesiastical Affairs and Public Instruction on April 30, 1900.[361]

According to this investigation, it appeared that on this day, in Prussia, there were 41,000 persons suffering from venereal disease, among whom 11,000 were infected with recent syphilis; in Berlin, on the same day, there were 11,600 cases of venereal disease, among whom 3,000 were infected with recent syphilis. The general relations are shown in the following table:

The whole of Prussia, 0·28 %.
Berlin, 1·42 %.
Towns over 100,000 inhabitants, 1 %.
Towns over 30,000 inhabitants, 0·58 %.
Towns below 30,000 inhabitants, 0·45 %.
The Army, 0·15 %.

Venereal Diseases Affecting the Male Population of Prussia, April 30, 1900 (after Blaschko).

Thus, for every 10,000 adult men there were on this day persons suffering from venereal diseases to the following numbers: in Berlin, 142; in the remaining large towns, 100; in the smaller towns, 50; and in the whole of Prussia, on the average, 28. Naturally the figures should in reality be larger, for of the physicians to whom inquiries were sent, only 63 % returned an answer. Moreover, the annual figure of cases is a very much larger one. Kirchner[362] assumes that every day in Prussia more than 100,000 individuals—that is to say, about 3 per mille—are suffering from a transmissible venereal disease, and he estimates the damage to the national property by typhoid fever as about 8 million marks annually, but that from venereal diseases as not less than ninety million marks annually. In these reports of April 30, 1900, the ratio of men to women suffering from recent syphilis was as 3 : 1.

In order to obtain more exact information regarding the diffusion of venereal diseases, and the actual number of those affected by them, it is of very great importance that there should be a revision of the duty of medical men in respect of the notification of diseases, and also in respect of the duty of professional secrecy.[363]

This latter question is also of importance in respect of the prevention of venereal infection in married life. (The question of syphilitic infection of married women by their husbands has recently been considered by Alfred Fournier: “Syphilis in Honourable Women.”)

In addition to the question of the diffusion and frequency of venereal diseases, the greatest interest attaches to the sources of dangerous infections—that is to say, the question where men and women most frequently contract venereal disease.

Here also Blaschko has obtained interesting information; he states:

Of 487 syphilitic men, the disease was acquired by 395 (81·1 %) from professional prostitutes (officially inscribed or secret); 23 (4·7 %) from waitresses and barmaids; 23 (4·9 %) from their “intimate”; 45 (9·2 %) from casual acquaintances, shop-girls, or workwomen.

According to this report, it appears that prostitution, public and secret (under which heading the waitresses and “casual acquaintances” must be numbered), forms the principal focus of venereal infection.

And that wild sexual intercourse is here almost exclusively to blame is shown by the following statistics, given by Blaschko:

Of 67 syphilitic wives, almost all the wives of workmen, 64 were infected by their husbands; whereas, on the contrary, of 106 husbands, 7 only acquired the disease from their wives; the remaining 99 acquired it by extra-conjugal sexual intercourse, either before or after marriage.

Another very valuable set of statistics dealing with the sources of infection has been published by Heinrich Loeb.[364]

These relate to the conditions in Mannheim. It appears that the sources of infection were as follows:

Waitresses and barmaids	155	instances.
Maidservants, cooks	67	„
Shop-girls	65	„
Middle-class girls	29	„
Seamstresses and embroidery workers	27	„
Chambermaids	20	„
Factory workwomen	17	„
Artistes, singers, and ballet-girls	16	„
Wife or betrothed	12	„
Tailoresses and modistes	11	„
Ironers	9	„
Book-keepers	4	„
Widows	4	„
Country girls	3	„
Mistresses	3	„
Total	442

Here, as we see, the chief types of secret prostitution, the waitresses and barmaids, play the principal part; next, but a long way after, come maidservants and shop-girls. This, however, does not amount to saying that public prostitution is less dangerous. We know that a prostitute who has never been infected with venereal disease is something very rarely seen; that prostitutes under regulation are almost all, especially when still quite young, in an infective state, and that they serve just as much as secret prostitutes for the diffusion of venereal disease. It is a well-known fact that youthful prostitutes are more dangerous than women who have long practised prostitution, because the former are all suffering from more or less recent infection, and both gonorrhœa and syphilis are present in them in the stages in which they are still strongly infective. H. Berger bases upon statistical investigations[365] his belief that red-haired girls have the most delicate epithelium, fall sick most rapidly and in the greatest numbers; dark haired women at first suffer less. After they have been prostitutes for some time, there is no important difference between blonde, brown, and black-haired women; but black-haired prostitutes are, in fact, more inclined to infection later in their career, because they are more in request.

Now that we have learned that at the present day prostitution remains the principal source of venereal infection, the following question immediately demands an answer: What can the state do in order to remove these sources of infection? and have the measures which the state has hitherto put into operation been of any use in this direction? To put it shortly, what part has been played by the state regulation of prostitution, as hitherto practised, in the campaign against venereal diseases?

With Schmölder,[366] we understand by “regulation” the following practice, which is what obtains in the majority of civilized countries: The police keep a list in which the girls and women regarded by them as prostitutes have their names entered. The “inscribed” (inscrites) receive a “licentia stupri”—that is to say, the permission to practise professional fornication under continual observation on the part of the police (the renowned “moral control”[367]), which is associated with a number of commands, prohibitions, and regulations—above all, with the necessity of submitting to medical examination at definitely stated intervals, and, where necessary, to compulsory medical treatment. At the same time, public prostitution on the part of those who are not inscribed is suppressed as much as possible. Berger has admirably described (“Prostitution in Hanover,” pp. 1-19) the methods of regulation and their consequences. Above all, however, have Blaschko, Schmölder, and Neisser considered the modes of regulation customary at the present day from the moral, legal, and medical points of view, and have in part entirely condemned them (Blaschko and Schmölder), in part declared them to be gravely in need of reform (Neisser).[368]

Among those who have recently discussed the question of the regulation of prostitution, we may mention Anna Pappritz,[369] who condemns the practice; Clausmann, who is in favour of it;[370] Friedrich Hammer, also in favour of it;[371] and, finally, S. Bettmann, who leaves the question open.[372]

In our consideration of the coercive system of regulation, we take a single standpoint—namely, that of its possible value for the suppression of venereal diseases. Some demand the abolition of regulation on ethical and humanitarian grounds, and we do not wish in any way to make light of these grounds. But they could not be decisive, if, as an actual fact, regulation had an effect either in diminishing the prevalence of venereal diseases or in checking prostitution; but, in truth, the reverse is the case!

Schmölder[373] has shown beyond dispute that the compulsory inscription of prostitutes, introduced from France, is in our country an utterly illegal measure, arbitrarily enforced by the police. It has been amply proved that this illegal compulsory inscription has actually made prostitutes of many girls who had no inclination to permanent professional prostitution; that this method produces artificial prostitutes. What errors of judgment, what abuses of power, occur on the part of the police, in connexion with this compulsory inscription! How often does the inscription result from a denunciation made on grounds of private spite! The “Committee of Fifteen,” constituted for the study of prostitution in New York, declares in its report:

“Men with political insight are of opinion that every limitation of the freedom of the individual is in itself an evil, and that such a limitation can only be justified in cases in which the good derived from the infringement can really be estimated at a very high valuation. A system which permits the police, simply on grounds of suspicion, to arrest a citizen, to submit him to an injurious examination, only with the aim of discovering a disease he is suspected to have, and then to put him into prison, on the suspicion that he might have indulged in immoral intercourse if he had been left at liberty, cannot possibly be regarded as harmonizing with the principles of personal freedom.”[374]

Blaschko and Fiaux have proved that regulation concerns only a small fraction of prostitutes, usually the older ones; whereas the beginners, who are precisely those most dangerous in respect of venereal infection, and, further, the army of secret prostitutes, half prostitutes, occasional prostitutes, and the half-world, remain free from regulation—are probably left free deliberately—and anyhow could not possibly be supervised, on account of the enormous cost of supervision. In Berlin, speaking generally, only one-fifth part of the girls arrested are subjected to regulation, four-fifths are simply “warned and discharged”; and even of this fifth part, in reality a large percentage does not come under control because “escape from the lists” renders permanent observation impossible. Fiaux proves that more than 50 % of the medical examinations which ought to have been made on the 4,000 women under regulation in Berlin during the years 1888 to 1901, were in fact neglected.[375]

It is certain that regulated prostitution is more dangerous from the point of view of public health than free prostitution. The prostitute remaining under surveillance is in constant fear of compulsory treatment in the lock hospital, and therefore endeavours to conceal her illness as long as possible, or temporarily to avoid medical examination altogether. The free prostitute has a personal interest in becoming well again as soon as possible, and generally goes voluntarily and at once to seek treatment from a physician. Thus it happens that, among the regulated prostitutes, the number of those infected appears surprisingly small. In addition, we have to consider the inadequacy of the medical examination, because the number of the physicians and the time assigned to them are too small. And whilst it appears to be a fact that every third prostitute is infected with gonorrhœa, in Berlin, during the year 1889, as the result of official examination under regulation, only one prostitute in 200 was declared infected, and in 1884 only 1 in 1,873. Moreover, very many infected prostitutes under compulsory medical treatment are, as Blaschko proves, allowed to resume their professional occupation in an uncured state, and to diffuse their illness freely once more. The figures given by Blaschko speak very clearly on this point:

Place.	Date.	Annual Percentage of Prostitutes attacked by Syphilis.
		Regulated.	Free.
Paris	1878-1887	12·2	7·0
Brussels	1887-1889	25·0	9·0
St. Petersburg	1890	33·5	12·0
Antwerp	1882-1884	51·3	7·7

From this it is clear that the abolition of the regulation of prostitutes will not have an unfavourable, but, on the contrary, will have a thoroughly favourable, influence in respect of the frequency of venereal diseases. The conditions in England and Norway show this very clearly. In Christiania, after the abolition of regulation in the year 1888, syphilis declined in frequency—in the first place, because the number of girls who applied for treatment increased, whilst prior to the abolition of regulation they had concealed their illness in order to avoid falling into the hands of the police; and in the second place, because now the fear of venereal infection kept many young men from having intercourse with prostitutes, whereas previously they had erroneously believed that the “control” would free them from the danger of venereal infection. The same was the case in London, where there is no regulation; the frequency of venereal disease has decreased because young men now avoid intercourse with prostitutes as much as possible. In France, the country in which regulation was first introduced, the commission formed for the study of prostitution came to the conclusion that “regulation of prostitutes should be abolished.” The principal reason for which the police continue to advocate the preservation of the system of regulation—namely, that they have an interest in the matter on account of the intimate connexion between many prostitutes and criminality—will not bear examination. It is true enough that soutenage[376] is inseparable from prostitution. Moreover, the world of criminals is very near to prostitution, in the first place, because the prostitute also has need of a man on whom she can lean, who can be something to her from the personal point of view, to whom she is not simply a chattel;[377] and, in the second place, because the prostitute is, like the criminal, despised and defamed—she shares with the criminal the pariah nature. Lombroso’s doctrine that prostitution is throughout equivalent to criminality is certainly not justified. It is only by the outward circumstances of their life that the bulk of prostitutes are driven into intimate relations with criminality. And among these outward circumstances, regulation, and the expulsion of prostitutes from honourable society (which is a necessary part of regulation) play the principal rôle! For this reason, if for this reason alone, regulation must be abolished, because then a strong supplement to criminality from the circles of prostitution would be cut off.

Even before investigators had become convinced of the uselessness and danger of regulation the cry arose: “Away with the brothels!” We have already alluded to the continuous decline in the number of brothels in all large towns. In 1841 there were in Paris still 235 brothels (to 1,200,000 inhabitants); in 1900 there were only 48 brothels (to 3,600,000 inhabitants); and for St. Petersburg and other large towns a similar decline in the number of brothels can be established, notwithstanding the fact that everywhere the population has markedly increased. This proves that the brothels no longer correspond to any real need.[378] At the present day, owing to the great development of intercourse in modern times, brothels are a public calamity; they bring the quarter of the town in which they exist into disrepute, and deprive the neighbourhood of its proper monetary value. Moreover, the time is past for slave-holding on the part of the brothel-owner. The existence of brothels favours the traffic in girls (the “White Slave Trade”), encourages sexual perversities, and increases the diffusion of venereal diseases. The prostitute living in a brothel is sometimes compelled to have intercourse with ten or twelve men in a single day, and is thus pre-eminently exposed to venereal infection, all the more because she must admit the embraces of every man who pays the brothel-keeper money; whilst the prostitute living freely can at least refuse to have anything to do with a man who appears to her to be ill. According to Lecour, Mireur, Diday, and Sperk, prostitutes in brothels suffer from syphilis about three times as often as free prostitutes.[379]

Other modifications of brothel life, such as the so-called “controlled streets,”[380] the best known of which are in Bremen[381]—that is to say, streets closed to ordinary traffic, the houses of which are inhabited only by prostitutes under control, but the girls being in other respects free and not living under the domination of a brothel-keeper; also the “Kasernierung”[382] of prostitutes, their confinement to particular streets, or special “quarters” of the town (“Dirnenquartiere”)[383]—are all to be rejected on the same grounds.

The whole nature of brothel life, and the very serious dangers it involves, have been discussed in excellent works by E. von Düring,[384] Henriette Fürth,[385] Karl Nötzel,[386] and Martin Bruck.[387] They illumine the whole question, and provide sufficient grounds for the condemnation of brothels.

A few authors, however, continue to advocate the preservation of brothels, and some of these wish to enforce medical examination, not only of prostitutes, but also of their masculine clients. This proposition is made, for example, by Ernst Kromayer in his work, which, notwithstanding many Utopian ideas, is nevertheless very stimulating, “The Eradication of Syphilis,” pp. 67, 68 (Berlin, 1898). Von Düring, in his criticism of these ideas, rightly points out that this recommendation would be quite useless in practice, because, in the first place, only a small proportion of men visit brothels at all. In the second place, in the hurry in these resorts no proper examination could be undertaken. In the third place, the doctors who were to be appointed as a kind of medical porters to brothels, would not easily be found to accept such situations. Lassar, who answers this last criticism, is of opinion that the brothel-master, or anybody with a little experience, could easily undertake this examination in the case of men.[388]

But these men would probably also decline the office; and even if they were willing, it is very doubtful if they would be in a position to make the suggested examinations, which, after all, require real medical skill; and, finally, the only result would be—to increase the number of quacks. Therefore, this idea of the examination of the male visitors to brothels is Utopian.

No, the true hope lies in absolute freedom; in relieving prostitution from the oppression of the police; in its gradual separation from criminality; in—I am not afraid of the word—in an “ennoblement” of prostitution.[389] The “prostitute” (German Dirne = drab) must disappear, and the “human being” must reawaken. The prostituted woman must be readmitted into the social community. No more coercion! Free and voluntary treatment, in polyclinics[390] and hospitals; the “rescue” of youthful prostitutes,[391] not in the prison-like “Magdalen Homes,” but by means of ethically instructive influence from human being to human being, of the value of which the “Letters to Prostitutes” of the noble philanthropist Frau Eggers-Smidt,[392] and also the experiences of the Salvation Army,[393] give such admirable evidence.

Very aptly, also, Kromayer has shown to what an extent a change in our present attitude towards sexual intercourse outside the conditions of coercive marriage, the removal of the stamp of infamy from such intercourse, would limit prostitution, and therewith also limit venereal diseases.[394] This is as clear as daylight. But, unfortunately, those very persons who declare the existing conditions in respect of prostitution to be absolutely intolerable will not admit its truth.

The misery of the life of these unhappy creatures must be relieved, but we must do it ourselves, and soon; for they are not in a position to do so. The last, the highest goal of the campaign against venereal disease is the humanization of the prostitute.[395]

Supplementary Note.—In the essay on “The Woman’s Question” in the sociological section of his work, “The Ethic of Free-Thought,” Karl Pearson discusses the question of Prostitution in relation to the Woman’s Question at large. His remarks have especial interest in view of what is said above about “the ennoblement of prostitution” and “the humanization of the prostitute,” and it seems expedient to quote the passage at length (op. cit., 1888, pp. 379-382).—Translator.

“The emancipation of woman, while placing her in a position of social responsibility, will make it her duty to investigate many matters of which she is at present frequently assumed to be ignorant. It may be doubted whether the identification of purity and ignorance has had wholly good effects in the past; indeed, it has frequently been the false cry with which men have sought to hide their own anti-social conduct. It is certain, however, that it cannot last in the future, and man will have to face the fact that woman’s views and social action with regard to many sex-problems may widely differ from his own. It is of the utmost importance that woman, not only on account of the part she already plays in the education of the young, but also because of the social responsibilities her emancipation must bring, should have a full knowledge of the laws of sex. Every attempt hitherto to grapple with prostitution has been a failure. What will women do when they thoroughly grasp the problem, and have a voice in the attitude the state should assume in regard to it? At present hundreds do not know of its existence; thousands only know of it to despise those who earn their living by it; one in ten thousand has examined the causes which lead to it, has felt that degradation, if there be any, lies not in the prostitute, but in the society where it exists; not in the women of the streets, but in the thousands of women in society, who are ignorant of the problem, ignore it, or fear to face it. What will be the result of woman’s action in the matter? Can it possibly be effectual, or will it merely tend to embitter the relations of men and women? Possibly an expression of woman’s opinion on this point in society and the press would do much, but then it must be an educated opinion, one which recognizes facts and knows the difficulties of the problem. An appeal to chivalry, to a Christian dogma, to a Biblical text, will hardly avail. The description we have of Calvin’s Geneva shows that puritanic suppression is wholly idle. What form will be taken by the reasoned action of women, cognizant of historical and sexualogical fact?

“Perhaps it may be that women, when they fully grasp the problem, will despair, as many men do, of its solution. They may remark that prostitution has existed in nearly all historic times, and among nearly all races of men. It has existed as an institution as long as monogamic marriage has existed; it may be itself the outcome of that marriage. I do not know whether any trace of a like promiscuity has been found in the animals nearest allied to man—I believe not. The periodic instinct has probably preserved them from it. How mankind came to lose the periodic instinct, and how that loss may possibly be related to the solely human institution of marriage, are problems not without interest. On the one hand, it has been asserted that prostitution is a logical outcome of our present social relations, while, on the other hand, it is held to be a survival of matriarchal licence, and not a sine qua non of all forms of human society. There is very considerable evidence to show that a large percentage of women are driven to prostitution by absolute want, or by the extremities to which a seduced woman is forced by the society which casts her out. This point is important. It may, perhaps, be that our social system, quite as much as man’s supposed needs, keeps prostitution alive. The frequency with which prostitutes, for the sake of their own living, seduce comparative boys, may be as much a cause of the evil as male passion itself. The socialists hold the sale of a woman’s person to be directly associated with the monopoly of surplus labour. Is the emancipated woman likely to adopt this view? and if so shall we not have a wide-reaching social reconstruction forced upon us? That emancipated woman would strive for a vast economic reorganization, as the only means of preserving the self-respect and independence of her sex, is a possibility with the gravest and most wide-reaching consequences. We cannot emancipate woman without placing her in a position of political and social influence equal to man’s. It may well be that she will regard economic and sexual problems from a very different standpoint, and the result will infallibly lead to the formation of a woman’s party, and to a more or less conscious struggle between the sexes. Would this end in an increased social stability or another subjection of sex?

“Woman may, however, conclude that the alternative is true—that prostitution is not the outcome of our present social organisation, but a feature of all forms of human society. She must, then, treat it as a necessary evil or as a necessary good. In the former case she will at least insist on an equal social stigma attaching to both sexes if she does not demand, as in the instance of any other form of anti-social conduct, so far as practicable its legal repression. In the latter case—that is, if its existence really tends in some way to the welfare or stability of society—women will have to admit that prostitution is an honourable profession; they cannot shirk that conclusion, bitter as it may appear to some. The ‘social outcast’ would then have to be recognized as filling a social function, and the problem would reduce to the amelioration of her life, and to her elevation in the social scale. Either there is a means of abolishing prostitution, or all participators must be treated alike as anti-social, or the prostitute is an honourable woman—no other possibility suggests itself. Society has hitherto failed to find a remedy, perhaps because only man has sought for one; woman, when she for the time fully grasps the problem, must be prepared for one, or must recognize the alternatives. There cannot be a doubt, however, that in a matter so closely concerning her personal dignity she will take action, and that, if only in this one matter, her freedom will raise questions, which many would prefer to ignore, and which, when raised, will undoubtedly touch principles apparently fundamental to our existing social organization.”

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[330] See [note] to [p. 390].

[331] Parent-Duchatelet, “The Moral Corruption of the Female Sex in Paris,” vol. ii., p. 234 (Leipzig, 1837). Similarly, Julius Donarth remarks (“The Beginnings of the Human Spirit,” p. 19; Stuttgart, 1898): “Syphilis and alcoholism can by social arrangement and carefully adapted measures be suppressed just as much as plague and cholera.”

[332] The literature of this subject is very extensive. In addition to a comprehensive work dealing with the older literature, by J. K. Proksch, “The Prevention of Venereal Diseases” (Vienna, 1872), I must mention the following: E. Lang, “The Prevention of Venereal Diseases” (Vienna, 1894); M. Joseph, “Prophylaxis of Cutaneous and Venereal Diseases” (Munich, 1900); Neuberger, “The Prophylaxis of Venereal Diseases,” pp. 35-37 (Munich and Berlin, 1904); Felix Block, “How shall We protect Ourselves against Venereal Diseases and their Evil Consequences?” second edition (Leipzig, 1905); E. Boureau, “Conseils Pratiques à la Jeunesse pour Éviter les Avaries” (Paris, 1905); Suarez de Mendoza, “Conseils de Prophylaxie Sanitaire et Morale” (Paris, 1906); same author, “ABC à l’Usage des Mères de Famille pour la Défense de Leurs Foyers contre les Grands Fléaux du XXe Siècle: Tuberculose, Avariose [= Syphilis], Neissérose [= Gonorrhœa], Alcoolisme, Mortalité Infantile” (Paris, 1905); same author, “Avariose des Innocents” (Paris, 1905).

[333] Cf. also the valuable remarks of Robert Hessen, “Cleanliness or Morality?” published in Die Zukunft, June 9, 1906, pp. 367-377 (also separately printed in Munich, 1906).

[334] Otto Neustätter, “The Public Recommendation of Protective Measures,” published in The Journal for the Suppression of Venereal Diseases, vol. v., No. 3, pp. 225-227 (Leipzig, 1905).

[335] H. Ferdy, “The History of the Cæcal Condom,” published in The Journal for the Suppression of Venereal Diseases, 1905, vol. iii., No. 4, pp. 144-147.

[336] Cf. in this connexion the admirable essay, distinguished by a critical spirit, of R. de Campagnolle, “The Value of the Modern Prophylaxis of Gonorrhœa by Means of Instillations,” published in The Journal for the Suppression of Venereal Diseases, 1904, vol. iii., Nos. 1-4, pp. 1-31, 51-115, 148 (with a complete bibliography).

[337] In place of these solutions, Cronquist (“Contributions to the Personal Prophylaxis against Gonorrhœa,” published in Medizinische Klinik, No. 10, 1906) recommends the use of little rods or bougies containing 2 per cent. of albargin, which melt from the body-heat when introduced into the urethra (these are sold under the trade name of “antigon-rods”); they are used, like the solutions, immediately after coitus. The advantage they possess is their greater durability.

[338] The same idea had already been advanced in Germany by Eduard Richter and S. Behrmann.

[339] E. Metchnikoff, “The Prophylaxis of Syphilis,” published in Medizinische Klinik, 1906, No. 15, pp. 372, 373. Cf. also Paul Maisonneuve, “Experimentation sur la Prophylaxie de la Syphilis” (Paris, 1906); and A. Neisser. “Experimental Research regarding Syphilis,” pp. 81-83 (Berlin, 1906).

[340] O. Neustätter, “The Public Recommendation of Protective Measures,” published in The Journal for the Suppression of Venereal Diseases, 1905, vol. iv., pp. 203-252.

[341] G. Bernhard, “The Criminal Law and Protective Measures against Venereal Diseases,” ibid., pp. 253-273.

[342] F. von Liszt, “Legal Protection against Dangers to Health from Venereal Diseases,” published in The Journal for the Suppression of Venereal Diseases, 1903, vol. i., pp. 1-25.

[343] Von Bar, “The Need for a Special Law against Blameworthy Venereal Infection,” ibid., pp. 64-72.

[344] R. Schmölder, “Criminal and Civil Juridicial Significance of Venereal Diseases,” ibid., pp. 73-106.

[345] Albert Reibmayr, “The Immunization of Families by Inheritable Diseases (Tuberculosis, Lues, Mental Disorders),” p. 17 (Leipzig and Vienna, 1899).

[346] This conception of “partial syphilization” of our race appears somewhat vague. If we take care to think clearly, and in terms of exact biological knowledge, we shall see that—apart from a spontaneous loss of intensity on the part of the syphilitic virus (of which we have no precise knowledge whatever)—the only known way of accounting for syphilis having become milder is by natural selection, by the death of those who suffered most severely from the disease. Now, in 400 years, ten or twelve human generations, there has hardly been time for the development of immunity to a disease to which at most a small fraction only of the population has ever been exposed. It appears to me, however, that we may reasonably doubt the alleged decline in the severity of syphilis. It must be remembered that the entire absence of mercurial treatment at first, and the misuse of that specific for many years after its value had been proved, will account for much in respect of the apparent greater virulence of medieval as compared with modern syphilis. (See also [p. 356], and [footnote] to that page referring to the writings of Archdall Reid).—Translator.

[347] Alfred Fournier, “The Treatment and Prophylaxis of Syphilis.” One vol. Rebman, London.

[348] Cf. Iwan Bloch, “Personal Reminiscences of my Lecturing Journey this Year,” published in Medizinische Klinik, 1906, No. 10.

[349] Hermann is a fanatical medical opponent of mercury. There are, in fact, such oddities. They are very rare birds in the medical world.

[350] Recently R. Kaufmann has collected in a small readable essay the scientific views of the present day, “The Therapeutic Use of Mercury” (Leipzig, 1906). I warmly recommend this book to all who are interested in the question.

[351] Cf. Iwan Bloch, “The After-Treatment of Syphilis,” published in Medizinische Klinik, 1905, No. 4, pp. 88-91.

[352] Cf. Iwan Bloch, “Nutritive Therapeutics in Cases of Syphilis,” published in Medizinische Klinik, 1905, No. 18, pp. 442-446.

[353] Alfred Fournier, “En Guérit-on?” pp. 95, 96 (Paris, 1906).

[354] “Krankenkassen.”—I have to employ the German term, since in England we do not possess the institution, nor even the name. In Germany there is a general system of insurance against illness, to which workmen have to contribute a proportion of their wages, the fund being supplemented by contributions from the employers of labour. When ill the workman applies to the Krankenkasse for the necessary medical advice and treatment.—Translator.

[355] A. Blaschko, “The Treatment of Venereal Diseases in Krankenkassen” (Berlin, 1890).

[356] A. Neisser, “Krankenkassen and the Campaign against Venereal Diseases,” published in The Journal for the Suppression of Venereal Diseases, 1904, vol. ii., pp. 161-169, 181-194, 221-247.

[357] R. Ledermann, “Do the Provisions of the Law for Insurance against Sickness Provide for the Cure of Venereal Disease?” ibid., 1905, vol. iii., pp. 449-463.

[358] Albert Kohn, “Should Krankenkassen send Delegates to Hygienic Congresses?” ibid., 1906, vol. v., pp. 121-130.

[359] Rudolf Lennhoff, in an address on February 8, 1907, to the local group of Berlin of the German Society for the Suppression of Venereal Diseases on “Venereal Diseases and Social Legislation,” drew especial attention to the necessity of enrolling in the scheme of insurance against illness wider circles of the impecunious population, especially the class of domestic servants. Servants suffering from venereal disease, since at the present day they usually preserve secrecy as to their trouble, in order that they may not lose their place, constitute a dangerous source of infection for their employers and the latters’ children. Therefore, a particularly thorough and speedy treatment of servants suffering from venereal diseases is necessary. It is further necessary to insist that all the employees of the Krankenkassen should observe the duty of professional secrecy. Recently the Landesversicherungsanstalt (an insurance institution) of Berlin started a dispensary of its own in Lichtenberg for patients suffering from venereal disease, in which every year more than 400 patients undergo treatment.

[360] A. Blaschko, “The Diffusion of Venereal Diseases,” published in The Hygiene of Prostitution and of Venereal Diseases, pp. 19-36 (Jena, 1900).

[361] “Diffusion of Venereal Diseases in Prussia, as well as the Measures Necessary in the Campaign against these Diseases,” edited by A. Guttstadt; Berlin, 1901 (Journal of the Royal Prussian Statistical Bureau).

[362] M. Kirchner, “The Social Importance of Venereal Diseases.”

[363] Cf. Chotzen and Simonson, “The Duty of Notification and the Obligation of Professional Secrecy on the Part of Physicians in the Case of Venereal Diseases,” published in The Journal for the Suppression of Venereal Diseases, 1904, vol. ii., pp. 433-474; A. Neisser, “Amendment of § 300 of the Criminal Code, and the Medical Duty of Notification, in Relation to the Suppression of Venereal Diseases,” op. cit., 1905, vol. iv., pp. 1-28; Bernstein, “Medical Professional Secrecy and Venereal Diseases,” ibid., pp. 29-31; M. Flesch, “Medical Professional Secrecy and the Suppression of Venereal Diseases,” ibid., pp. 32-51; Magnus Möller, “The Duty of Professional Secrecy on the Part of Physicians, the Notification of Diseases, and the Ascertainment of the Sources of Infection in the Case of Venereal Diseases,” ibid., 1906, vol. vi., pp. 241-258, 283-301; Ludwig Bendix, “Professional Secrecy on the Part of Physicians,” ibid., 1906, pp. 372-376.

[364] H. Loeb, “Statistics Relating to Venereal Diseases in Mannheim,” published in The Journal for the Suppression of Venereal Diseases, vol. ii., pp. 97, 98 (1904).

[365] H. Berger, “Prostitution in Hanover,” pp. 37, 38 (Berlin, 1902).

[366] Schmölder, “The State and Prostitution,” p. 1 (Berlin, 1900).

[367] Cf. J. Fabry, “The Question of Inscription under Police Surveillance, with especial Regard to the Conditions in Dortmund,” published in The Journal for the Suppression of Venereal Diseases, 1906, vol. v., pp. 325-342.

[368] A. Neisser, “In what Direction can the Regulation of Prostitution be Reformed?” published in The Journal for the Suppression of Venereal Diseases, 1903, vol. i., pp. 163-356.

[369] Anna Pappritz, “Is the Present Method of the Regulation of Prostitution Capable of Reform, and in What Manner?” published in The Journal for the Suppression of Venereal Diseases, 1903, vol. i., pp. 367-372.

[370] Clausmann, “Prostitution, Police, and Justice,” op. cit., 1906, vol. v., pp. 219-225.

[371] Friedrich Hammer, “The Regulation of Prostitution,” published in The Journal for the Suppression of Venereal Diseases, 1904, 1905, vol. iii., pp. 373-385, 426-435.

[372] S. Bettmann, “The Medical Treatment of Prostitutes” (Jena, 1905)—a thorough study of all the available material.

[373] Schmölder, “Professional Fornication and Compulsory Inscription on the List of Prostitutes” (Berlin, 1894).

[374] “The Social Evil, with Especial Reference to Conditions existing in the City of New York. A Report prepared under the Direction of the ‘Committee of Fifteen,’” pp. 91, 92 (New York and London, 1902).

[375] A severe criticism of regulation and its consequences is to be found in the excellent dissertation of Paul Emile Morhardt, “Les Maladies Vénériennes et la Réglementation de la Prostitution au Point de Vue de l’Hygiène Sociale” (Paris, 1906).

[376] Cf. the admirable description of soutenage given by Hans Ostwald, “Soutenage in Berlin” (Berlin and Leipzig, 1905).

[377] “The human being awakens in the prostitute. That is the whole secret and the cause of soutenage.”—H. Ostwald.

[378] The dislike to the brothels of Paris is confirmed by Lassar (“Prostitution in Paris,” Berliner klinische Wochenschrift, 1892, No. 5).

[379] J. Rutgers (“Sketches from Holland,” published in The Journal for the Suppression of Venereal Diseases, 1906, vol. v., p. 345) has admirably expressed this fact in the following words: “The danger of infection is directly proportionable to centralization.”

[380] Anna Pappritz, “What Protection can Brothel Streets Offer?” published in The Journal for the Suppression of Venereal Diseases, 1904, 1905, vol. iii., pp. 417-424.

[381] Stachow, “The Controlled Streets of Bremen,” ibid., 1905, vol. iv., pp. 77-87.

[382] Fabry, “Brothels and Brothel Streets,” ibid., 1905, pp. 167-169 (in favour of “Kasernierung”); Wolff, “The Question of Kasernierung,” ibid., 1905, vol. iv., pp. 73-76 (in favour of “Kasernierung”); F. Block, “The Kasernierung of Prostitution in Hanover” (Hanover, 1907).

[383] F. Zinsser, “The Conditions of Prostitution in the Town of Cologne,” ibid., 1906, vol. v., pp. 201-218.

[384] E. von Düring, “The Brothel Question,” ibid., 1905, pp. 111-128.

[385] H. Fürth, “The Suppression of Venereal Diseases and the Brothel Question,” ibid., pp. 129-156.

[386] K. Nötzel, “Brothels in Russia,” ibid., 1906, pp. 41-66, 81-106.

[387] M. Bruck, “Good Morals and the Brothel Trade,” ibid., pp. 57-62.

[388] O. Lassar, “Prostitution and Venereal Diseases,” published in Hygienische Rundschau, 1891, No. 23.

[389] See [note] at end of chapter.

[390] B. Marcuse, “Treatment of Prostitutes,” published in The Journal for the Suppression of Venereal Diseases, 1906, pp. 1-8.

[391] F. Schiller, “Rescue-Work and the Suppression of Prostitution,” ibid., 1903, 1904, vol. ii., pp. 294-313, 341-349.

[392] Ibid., 1906, vol. iii., pp. 336-350.

[393] P. Kampffmeyer, “Educational Work in Connexion with Prostitutes,” ibid., pp. 351, 352.

[394] E. Kromayer, “The Physician and the Protection of Motherhood,” published in Mutterschutz, 1905, vol. iii., pp. 351-352.

[395] Quite recently—October, 1906—the first step in this direction has been taken. The Chief Commissioner of the Berlin Police addressed to the medical specialists in venereal diseases an inquiry whether they were prepared to treat gratuitously impecunious prostitutes who were not under police control. The girls would then be given a register of these doctors. If they presented themselves for treatment, no particulars about them would be demanded from the physician. The presentation by the patients to the police of a certificate from a medical man would suffice to exempt them from police control, and from compulsory examination and treatment at the police department of the section of the town to which they belonged. Further details will be arranged later in co-operation with the Committee of the Society for the Suppression of Venereal Diseases.

In his valuable study, “The Future of Prostitution,” published in the monthly magazine Mutterschutz, July, 1907, pp. 274-288, Havelook Ellis also takes an extremely optimistic view regarding the gradual and inevitable diminution of prostitution by indirect means—that is to say, in this way we are elevating ourselves socially and economically to a higher stage of humanity.

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CHAPTER XVI
STATES OF SEXUAL IRRITABILITY AND SEXUAL WEAKNESS
(Auto-erotism, Masturbation, Sexual Hyperæsthesia and Sexual Anæsthesia, Seminal Emissions, Impotence, and Sexual Neurasthenia).

“The conditions of modern civilization render auto-erotism a phenomenon of increasing social importance.”—Havelock Ellis.

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