Venereal Diseases.—There is yet another very considerable class of maritally unfit who in any conscientious discussion of unfitness for marriage or of racial improvement must be considered. I refer to those who are afflicted with the diseases which are inseparably associated with the so-called “social evil.” To gonorrhea, one of the most prevalent of these diseases, more than one-fourth of our total one hundred and ten thousand blind in the United States are said to owe their affliction. Milder types of eye disease may also result from such infections. As much as eighty per cent., or some say practically all blindness in children born blind is caused by it, the infection occurring at the time of birth or within a few days thereafter. The terrible consequences of this disease to the innocent wife would alone make its discussion imperative.
The Seriousness of the Situation.—Unfortunately the insidious nature of gonorrheal infections is unknown to most persons. A cure is apparently effected, yet as a matter of fact the germs may live for years and, if in the male, later be transmitted to the wife, subjecting her to a future of invalidism and misery. Reliable statistics from various medical authorities reveal the appalling fact that seventy-five per cent. or more of the surgical operations for inflammatory pelvic disorders peculiar to women, such as pus tubes and peritonitis, are attributable to this disease, as is also the involuntary sterility of forty-five per cent. of childless women. Unwelcome as the fact is there is an abundance of evidence to show that a large percentage of men in particular have at some period of their life been infected with venereal disease. Of our fourteen million males in the United States under the age of thirty we find estimates by some specialists in venereal diseases to the effect that five million of them, that is, one out of three, suffer from some one of the social diseases or their consequences. Doctor Hugh Cabot, one of the chief surgeons of the Massachusetts General Hospital at Boston, a member of the faculty of the Harvard Medical School and president of the American Association of Genito-Urinary Surgeons, has this to say about the situation: “We have of late years heard much about the frequency and serious consequences of tuberculosis; it has been dubbed the ‘white plague,’ and so active has been the campaign that a wide-spread understanding of this serious disease has resulted. It may safely be averred that in the urban population at least there are two, and perhaps three, individuals with syphilis to every one with tuberculosis. The frequency of gonococcus infection is much higher.” He believes that over half the male population acquire a gonococcus infection at some period of their career. While as a layman, one can not but feel that a specialist’s estimate may run unduly high because of the fact that he is encountering an inordinate proportion of such maladies every day, still such specialists are in position to get at the truth as no other person can and their calculations are probably not grossly in error. In any event any one who has progressed in worldly knowledge beyond the naïveté of a child must recognize the appalling prevalence of these maladies.
Infantile Blindness.—So serious has the matter of infantile blindness become that some state boards of health and some city health departments supply all physicians and midwives with specially prepared packages containing cotton and nitrate of silver solution for preventive or curative treatment of the eyes of all new-born children. At the time of the first bath each eye is carefully washed with a separate pledget of cotton saturated with boric acid solution. Each then receives a drop of the silver solution, which is made just strong enough to kill any gonococci that might be present without itself inflaming the eye. Water used in bathing the baby’s body of course is not allowed to come in contact with its eyes. Such treatment should be given every child no matter how unsuspicious the circumstances may be. German authorities who have been following this method now for some years assure us that nineteen-twentieths of the blindness of infancy can thus be prevented.
Syphilis.—As to syphilis, another and even more terrible of these diseases, we have before us the absurd fact that while thousands upon thousands of dollars are being spent to establish a rigid inspection and preventive measures against the spread of a very similar disease in the horse, this malady in man is allowed to pass unchallenged and we are confronted by the gruesome certainty that there are hundreds of these diseased persons about us to-day who, on their mere affirmation that they are unmarried and of age, will be given the right to marry and thus produce families of infected children irrevocably doomed to early death or to lifelong misery.
While syphilis is most commonly spread through relations between the sexes, it may be acquired in various other ways, as for example, through a cut in shaving with the same razor an infected individual has used. It is commonly transmitted from parent to child. Practically every prostitute is a center of dissemination. Katherine Bement Davis has shown in her studies made at the New York State Reformatory for Women that while ordinary clinical tests show that apparently only twenty-one per cent. of these women are infected with venereal disease, more careful laboratory tests showed at least ninety per cent. to be infected.
Syphilis is caused by Treponema pallidum, a small unicellular animal parasite. Given access to the blood by any means whatever, possibly even through an abrasion in the lip by means of a kiss, it multiplies rapidly and any part or organ of the body may be attacked. Usually a small sore occurs at the point of entrance to the body, but often it heals up readily with little indication of the seriousness of the infection.
The development of the malady is insidious and long continued. As a matter of clinical convenience physicians divide its progress into successive stages although in reality the transitions are frequently variable and ill marked. The symptoms that arise within the first few months or even years are readily controlled by appropriate treatment, but to insure a cure prolonged and most thoroughgoing treatment is imperative. The symptoms disappear so completely after a short period of treatment that it is very difficult to persuade the average patient that he is not yet cured. Two years at least are none too short a period of treatment, yet the majority of patients, fully convinced that they are merely being exploited by the physician as a source of revenue, drift away at the end of a few months. As a matter of fact, however, the germs usually persist long after the obvious symptoms of the disease have disappeared, and in consequence many of the most serious results of syphilis may not manifest themselves for a period of perhaps ten, twenty or thirty years.
Some of the Effects.—It is now known that paresis, also termed general paralysis or softening of the brain, is probably invariably due to syphilis. The work of Flexner and Noguchi on paresis and tabes dorsalis show that always in such afflictions the tissues of the central nervous system have been invaded by the parasite. The original infection, however, may have occurred so long before as to have been almost forgotten by the patient. Thus many an apparently robust man is stricken down in the prime of life. Earlier and prolonged treatment would in all probability have eradicated the germs and thus prevented the mental breakdown, which can not be cured by any known treatment. Postmortem examination always shows that the Treponema has wrought wide-spread damage in the brain. The frequency of paresis may be realized when one learns that in some regions it is responsible for about one-fifth of all cases of insanity sent to hospitals for the insane. It ranks next to the highest as a cause of insanity. Statistics show that in the state of New York more deaths result annually from paresis than from smallpox, tetanus, malaria, dysentery and rabies all combined.
In some cases the disease attacks the membranes of the brain and the small blood vessels giving rise to a still different type of mental disorder. Practically all patients with locomotor ataxia owe their condition to an antecedent syphilis. Moreover it is one of the important causes of arterio-sclerosis, or hardening of the blood vessels, and is also a prominent factor in certain forms of heart-disease, as well as by no means an unimportant cause of blindness in children.
As to specific cases of the effects of this disease on descendants the literature of the subject is crowded full. While it is needless to conduct the reader through a chamber of horrors by reviewing clinical cases, it is desirable to point out in a general way some of the effects. Doctor George H. Kirby, director of Clinical Psychiatry, Manhattan State Hospital, says: