It is possible to trace the beginning of a recognition that the transmission of a venereal disease is a matter of which legal cognizance may be taken in the English law courts. It is now well settled that the infection of a wife by her husband may be held to constitute the legal cruelty which, according to the present law, must be proved, in addition to adultery, before a wife can obtain divorce from her husband. In 1777 Restif de la Bretonne proposed in his Gynographes that the communication of a venereal disease should itself be an adequate ground for divorce; this, however, is not at present generally accepted.[[251]]
It is sometimes said that it is very well to make the individual legally responsible for the venereal disease he communicates, but that the difficulties of bringing that responsibility home would still remain. And those who admit these difficulties frequently reply that at the worst we should have in our hands a means of educating responsibility; the man who deliberately ran the risk of transmitting such infection would be made to feel that he was no longer fairly within his legal rights but had done a bad action. We are thus led on finally to what is now becoming generally recognized as the chief and central method of combating venereal disease, if we are to accept the principle of individual responsibility as ruling in this sphere of life. Organized sanitary and medical precautions, and proper legal protection for those who have been injured, are inoperative without the educative influence of elementary hygienic instruction placed in the possession of every young man and woman. In a sphere that is necessarily so intimate medical organization and legal resort can never be all-sufficing; knowledge is needed at every step in every individual to guide and even to awaken that sense of personal moral responsibility which must here always rule. Wherever the importance of these questions is becoming acutely realized—and notably at the Congresses of the German Society for Combating Venereal Disease—the problem is resolving itself mainly into one of education.[[252]] And although opinion and practice in this matter are to-day more advanced in Germany than elsewhere the conviction of this necessity is becoming scarcely less pronounced in all other civilized countries, in England and America as much as in France and the Scandinavian lands.
A knowledge of the risks of disease by sexual intercourse, both in and out of marriage,—and indeed, apart from sexual intercourse altogether,—is a further stage of that sexual education which, as we have already seen, must begin, so far as the elements are concerned, at a very early age. Youths and girls should be taught, as the distinguished Austrian economist, Anton von Menger wrote, shortly before his death, in his excellent little book, Neue Sittenlehre, that the production of children is a crime when the parents are syphilitic or otherwise incompetent through transmissible chronic diseases. Information about venereal disease should not indeed be given until after puberty is well established. It is unnecessary and undesirable to impart medical knowledge to young boys and girls and to warn them against risks they are yet little liable to be exposed to. It is when the age of strong sexual instinct, actual or potential, begins that the risks, under some circumstances, of yielding to it, need to be clearly present to the mind. No one who reflects on the actual facts of life ought to doubt that it is in the highest degree desirable that every adolescent youth and girl ought to receive some elementary instruction in the general facts of venereal disease, tuberculosis, and alcoholism. These three "plagues of civilization" are so widespread, so subtle and manifold in their operation, that everyone comes in contact with them during life, and that everyone is liable to suffer, even before he is aware, perhaps hopelessly and forever, from the results of that contact. Vague declamation about immorality and vaguer warnings against it have no effect and possess no meaning, while rhetorical exaggeration is unnecessary. A very simple and concise statement of the actual facts concerning the evils that beset life is quite sufficient and adequate, and quite essential. To ignore this need is only possible to those who take a dangerously frivolous view of life.
It is the young woman as much as the youth who needs this enlightenment. There are still some persons so ill-informed as to believe that though it may be necessary to instruct the youth it is best to leave his sister unsullied, as they consider it, by a knowledge of the facts of life. This is the very reverse of the truth. It is desirable indeed that all should be acquainted with facts so vital to humanity, even although not themselves personally concerned. But the girl is even more concerned than the youth. A man has the matter more within his own grasp, and if he so chooses he may avoid all the grosser risks of contact with venereal disease. But it is not so with the woman. Whatever her own purity, she cannot be sure that she may not have to guard against the possibility of disease in her future husband as well as in those to whom she may entrust her child. It is a possibility which the educated woman, so far from being dispensed from, is more liable to encounter than is the working-class woman, for venereal disease is less prevalent among the poor than the rich.[[253]] The careful physician, even when his patient is a minister of religion, considers it his duty to inquire if he has had syphilis, and the clergyman of most severely correct life recognizes the need of such inquiry and may perhaps smile, but seldom feels himself insulted. The relationship between husband and wife is even much more intimate and important than that between doctor and patient, and a woman is not dispensed from the necessity of such inquiry concerning her future husband by the conviction that the reply must surely be satisfactory. Moreover, it may well be in some cases that, if she is adequately enlightened, she may be the means of saving him, before it is too late, from the guilt of premature marriage and its fateful consequences, so deserving to earn his everlasting gratitude. Even if she fails in winning that, she still has her duty to herself and to the future race which her children will help to form.
In most countries there is a growing feeling in favor of the enlightenment of young women equally with young men as regards venereal diseases. Thus in Germany Max Flesch, in his Prostitution und Frauenkrankheiten, considers that at the end of their school days all girls should receive instruction concerning the grave physical and social dangers to which women are exposed in life. In France Duclaux (in his L'Hygiène Sociale) is emphatic that women must be taught. "Already," he states, "doctors who by custom have been made, in spite of themselves, the husband's accomplices, will tell you of the ironical gaze they sometimes encounter when they seek to lead a wife astray concerning the causes of her ills. The day is approaching of a revolt against the social lie which has made so many victims, and you will be obliged to teach women what they need to know in order to guard themselves against you." It is the same in America. Reform in this field, Isidore Dyer declares, must emblazon on its flag the motto, "Knowledge is Health," as well of mind as of body, for women as well as for men. In a discussion introduced by Denslow Lewis at the annual meeting of the American Medical Association in 1901 on the limitation of venereal diseases (Medico-Legal Journal, June and September, 1903), there was a fairly general agreement among all the speakers that almost or quite the chief method of prevention lay in education, the education of women as much as of men. "Education lies at the bottom of the whole thing," declared one speaker (Seneca Egbert, of Philadelphia), "and we will never gain much headway until every young man, and every young woman, even before she falls in love and becomes engaged, knows what these diseases are, and what it will mean if she marries a man who has contracted them." "Educate father and mother, and they will educate their sons and daughters," exclaims Egbert Grandin, more especially in regard to gonorrhœa (Medical Record, May 26, 1906); "I lay stress on the daughter because she becomes the chief sufferer from inoculation, and it is her right to know that she should protect herself against the gonorrhœic as well as against the alcoholic."
We must fully face the fact that it is the woman herself who must be accounted responsible, as much as a man, for securing the right conditions of a marriage she proposes to enter into. In practice, at the outset, that responsibility may no doubt be in part delegated to parents or guardians. It is unreasonable that any false delicacy should be felt about this matter on either side. Questions of money and of income are discussed before marriage, and as public opinion grows sounder none will question the necessity of discussing the still more serious question of health, alike that of the prospective bridegroom and of the bride. An incalculable amount of disease and marital unhappiness would be prevented if before an engagement was finally concluded each party placed himself or herself in the hands of a physician and authorized him to report to the other party. Such a report would extend far beyond venereal disease. If its necessity became generally recognized it would put an end to much fraud which now takes place when entering the marriage bond. It constantly happens at present that one party or the other conceals the existence of some serious disease or disability which is speedily discovered after marriage, sometimes with a painful and alarming shock—as when a man discovers his wife in an epileptic fit on the wedding night—and always with the bitter and abiding sense of having been duped. There can be no reasonable doubt that such concealment is an adequate cause of divorce. Sir Thomas More doubtless sought to guard against such frauds when he ordained in his Utopia that each party should before marriage be shown naked to the other. The quaint ceremony he describes was based on a reasonable idea, for it is ludicrous, if it were not often tragic in its results, that any person should be asked to undertake to embrace for life a person whom he or she has not so much as seen.
It may be necessary to point out that every movement in this direction must be the spontaneous action of individuals directing their own lives according to the rules of an enlightened conscience, and cannot be initiated by the dictation of the community as a whole enforcing its commands by law. In these matters law can only come in at the end, not at the beginning. In the essential matters of marriage and procreation laws are primarily made in the brains and consciences of individuals for their own guidance. Unless such laws are already embodied in the actual practice of the great majority of the community it is useless for parliaments to enact them by statute. They will be ineffective or else they will be worse than ineffective by producing undesigned mischiefs. We can only go to the root of the matter by insisting on education in moral responsibility and instruction, in matters of fact.
The question arises as to the best person to impart this instruction. As we have seen there can be little doubt that before puberty the parents, and especially the mother, are the proper instructors of their children in esoteric knowledge. But after puberty the case is altered. The boy and the girl are becoming less amenable to parental influence, there is greater shyness on both sides, and the parents rarely possess the more technical knowledge that is now required. At this stage it seems that the assistance of the physician, of the family doctor if he has the proper qualities for the task, should be called in. The plan usually adopted, and now widely carried out, is that of lectures setting forth the main facts concerning venereal diseases, their dangers, and allied topics.[[254]] This method is quite excellent. Such lectures should be delivered at intervals by medical lecturers at all urban, educational, manufacturing, military, and naval centres, wherever indeed a large number of young persons are gathered together. It should be the business of the central educational authority either to carry them out or to enforce on those controlling or employing young persons the duty of providing such lectures. The lectures should be free to all who have attained the age of sixteen.
In Germany the principle of instruction by lectures concerning venereal diseases seems to have become established, at all events so far as young men are concerned, and such lectures are constantly becoming more usual. In 1907 the Minister of Education established courses of lectures by doctors on sexual hygiene and venereal diseases for higher schools and educational institutions, though attendance was not made compulsory. The courses now frequently given by medical men to the higher classes in German secondary schools on the general principles of sexual anatomy and physiology nearly always include sexual hygiene with special reference to venereal diseases (see, e.g., Sexualpädagogik, pp. 131-153). In Austria, also, lectures on personal hygiene and the dangers of venereal disease are delivered to students about to leave the gymnasium for the university; and the working men's clubs have instituted regular courses of lectures on the same subjects delivered by physicians. In France many distinguished men, both inside and outside the medical profession, are working for the cause of the instruction of the young in sexual hygiene, though they have to contend against a more obstinate degree of prejudice and prudery on the part of the middle class than is to be found in the Germanic lands. The Commission Extraparlementaire du Régime des Mœurs, with the conjunction of Augagneur, Alfred Fournier, Yves Guyot, Gide, and other distinguished professors, teachers, etc., has lately pronounced in favor of the official establishment of instruction in sexual hygiene, to be given in the highest classes at the lycées, or in the earliest class at higher educational colleges; such instruction, it is argued, would not only furnish needed enlightenment, but also educate the sense of moral responsibility. There is in France, also, an active and distinguished though unofficial Société Française de Prophylaxie Sanitaire et Morale, which delivers public lectures on sexual hygiene. Fournier, Pinard, Burlureaux and other eminent physicians have written pamphlets on this subject for popular distribution (see, e.g., Le Progrès Médical of September, 1907). In England and the United States very little has yet been done in this direction, but in the United States, at all events, opinion in favor of action is rapidly growing (see, e.g., W. A. Funk, "The Venereal Peril," Medical Record, April 13, 1907). The American Society of Sanitary and Moral Prophylaxis (based on the parent society founded in Paris in 1900 by Fournier) was established in New York in 1905. There are similar societies in Chicago and Philadelphia. The main object is to study venereal diseases and to work toward their social control. Doctors, laymen, and women are members. Lectures and short talks are now given under the auspices of these societies to small groups of young women in social settlements, and in other ways, with encouraging success; it is found to be an excellent method of reaching the young women of the working classes. Both men and women physicians take part in the lectures (Clement Cleveland, Presidential Address on "Prophylaxis of Venereal Diseases," Transactions American Gynecological Society, Philadelphia, vol. xxxii, 1907).
An important auxiliary method of carrying out the task of sexual hygiene, and at the same time of spreading useful enlightenment, is furnished by the method of giving to every syphilitic patient in clinics where such cases are treated a card of instruction for his guidance in hygienic matters, together with a warning of the risks of marriage within four or five years after infection, and in no case without medical advice. Such printed instruction, in clear, simple, and incisive language, should be put into the hands of every syphilitic patient as a matter of routine, and it might be as well to have a corresponding card for gonorrhœal patients. This plan has already been introduced at some hospitals, and it is so simple and unobjectionable a precaution that it will, no doubt, be generally adopted. In some countries this measure is carried out on a wider scale. Thus in Austria, as the result of a movement in which several university professors have taken an active part, leaflets and circulars, explaining briefly the chief symptoms of venereal diseases and warning against quacks and secret remedies, are circulated among young laborers and factory hands, matriculating students, and scholars who are leaving trade schools.