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: