American Social Hygiene Association.

Journal of social hygiene (Volume 28) online

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(b) Sent to a quarantine hospital

(c) Or otherwise dealt with in the

best interests of themselves
and the community.

5. After recovery, or progress to a
condition in which they are no longer
a danger to the community, they
should be released from custodial con-
trol by the health officer. Treat-
ment, however, should be secured for
each patient for his own benefit
and the welfare of the community
until he is discharged by the physician.

6. Immediately after inquiry into a re-
port of a probable case of syphilis or
gonorrhea, the Health Department
should inform the proper police or
court officials of all pertinent infor-
mation relating to violation of laws
against prostitution and conditions
and activities favoring the practice of
prostitution. Throughout the Health
Department's activities, every effort
should be made to cooperate closely
with the law enforcement authorities
in their protection of the community
and individual men and women from
exploitation by promoters of prosti-
tution and all those who secure
profits therefrom.



If these steps in Police, Court, Probation and Custodial Service are
carried out with adequate facilities available, the health of the com-
munity will not be endangered during the entire period of the
arrest, trial and sentence; and the health department will not have
any problem in relation to the persons arrested. Adequate facili-
ties, however, imply custodial care in a house of detention until
trial ; guidance and community protection during probation after con-
viction ; and constructive follow-up after assignment to a correctional
institution. Each of these requires arrangements for medical advice
and treatment. The provision of adequate medical service is a prob-
lem common to all public institutions including the insane and



CONTROLLING VENEREAL DISEASES 421

dependents as well as delinquents and criminals. It is not a problem
which health departments are expected ordinarily to deal with. Where
the public supports such medical service, syphilis and gonorrhea
cases should be discovered and treated, just as all other conditions are
detected and cared for.

The steps indicated in the column for Health Department, Medical
Officers, Social Service Bureaus, and related institutions do not present
any problem for police or court action unless a person refuses to obey
isolation or quarantine requirements or fails to carry out other
instructions of the health officer. In such cases the health officer
prefers charges and the police and courts proceed as in all other
violations of law.

Theoretically there is no basis for conflict or overlapping of
authority between the legal and health divisions of government in
dealing with prostitution and the venereal diseases. In practical
application of the principles outlined in this diagram, many diffi-
culties and confusing situations arise. For example, instead of all
these steps being carried out the arrested person may be granted
bail until the case comes to trial; the judge may suspend sentence;
or a fine may be imposed. Under these circumstances unrestricted
freedom may result in exposing other persons in the community to
infection with venereal diseases before the date set for trial, or in
providing increased opportunities and incentives for soliciting and
practicing prostitution.

Even under these conditions, however, if the court officials always
notified the health authorities in advance of the action to be taken,
the latter could consider this information in connection with other
facts obtainable, and proceed with such measures as the case might
require without reference to the legal history unless conviction should
be followed by release on probation, in which case the protection of
the public should be provided for, or by incarceration in a correctional
institution, under which circumstances the convicted person ceases
to be a public danger, and therefore of no further concern to the
health officer, at least until the end of the sentence.

As in all other dangerous communicable diseases the health officer
should be concerned officially only with protection of the public
from the spread of disease and the proper treatment of those infected.
Such information as he may receive from court records is only
incidental and supplementary to other information he must have
to decide the degree and character of supervision required to protect
the public health. On the other hand, the judge or a jury does not
need a report on a medical examination for syphilis or gonorrhea
before conviction and sentence.

The serious and widespread confusion of the problems of repression
of prostitution and venereal disease control is not based on facts but
rather on fallacies. It is believed by the proponents of compulsory
registration and examination of prostitutes that because commercial-
ized prostitution is a chief source of disseminating syphilis and
gonorrhea, women suspected of being prostitutes should be taken into



422 JOURNAL OP SOCIAL HYGIENE

custody by the police and detained until the health officer pronounces
them infected or free from infection. Their male partners are seldom
arrested or examined. If the woman is not reported as showing evi-
dence of infection she may be released, or tried, fined, and released;
but if she is reported infected she is usually sent to a quarantine
hospital under specified sentence. This procedure ignores the fact
that the limited examination which it is practical to give under such
conditions neither discovers all those who are infected nor gives
adequate data regarding their infectiousness for others. Further-
more it tends to give both the public, and the men and women
engaged in prostitution, a false sense of security from disease. It
also tends to encourage judges to continue the system of fining prosti-
tutes who periodically appear before them and who are not found
infected.

The evidence clearly shows that while close cooperation is essential,
a sharp line needs to be drawn between the purposes and procedures
of police and courts on one side and health departments on the other.
Efficiency and economy are both served by such a course. Every
person accused of violating the laws against prostitution has a right
to fair and prompt trial and decision uninfluenced by any medical
reports of infection or non-infection. Furthermore the rights and
personal liberty of individual citizens concerned are best protected
by this course. This statement has been drawn up to indicate the
steps which should be taken by each of the two groups after informa-
tion reaches them. If both are continuously active as they should be
in the interests of prevention and of protection of the health, wel-
fare and efficiency of both girls and boys, the program becomes much
clearer and the danger of confusion disappears. While the health
authorities should not be required to enforce laws against prostitution,
as officials and citizens they can be of the greatest cooperative assist-
ance to the police and court authorities. Similarly the law-enforcing
agencies should not be required to control the venereal diseases, but
their officers and staff can be of very great assistance by close and
sympathetic cooperation with the Health Department.



The police officer . . . wants facts. When he has the facts and a really effective
grasp of the law and the police methods for dealing with the problem, you will
find no more cooperative group of officials in any profession.

. . . American police are on their way to a full working partnership with he
medical, public health, and welfare professions now working for venereal disease
control.

PAUL V. McNuTT
Federal Security Administrator
in The Federal Fight against Venereal Disease,
a Social Hygiene Day address, February 3, 1942.



NO CERTIFICATION OF PROSTITUTES

WALTER CLARKE, M.D.
Executive Director, American Social Hygiene Association

At its meeting on June 9th, 1942 at Atlantic City, the House of
Delegates of the American Medical Association passed a resolution
which will greatly aid in the fight against venereal diseases by placing
the medical profession on record against the medical inspection and
certification of prostitutes. The resolution was introduced by Doctor
George Kosmak, a leading physician of New York City, well-known to
the profession as the editor of the American Journal of Obstetrics and
Gynecology. The Reference Committee to which the resolution was
referred reported it favorably to the House of Delegates with the
following statement:

"Your reference committee is completely in accord with the pro-
visions of this resolution and recommends its adoption. It is incon-
ceivable that any reputable physician should so degrade his profession
and himself as to issue certificates to prostitutes, to the effect that
they are free from venereal disease. This is a baneful practice which
encourages the maintenance of vice and may do incalculable damage
by giving false assurance of safety and lead to an appreciable increase
in venereal disease. Moreover, it tends to nullify the efforts of the
duly constituted authorities, Federal, State and local, to deal with
the problems of prostitution by law enforcement and other accepted
methods.

' ' Your reference committee wishes only that it were gifted with the
power of expression to emphasize more strongly its approval of the
spirit and intent of the provisions of this resolution. ' '

The resolution as passed is as follows :

WHEREAS, Published reports indicate an increasing prevalence of venereal
disease in the armed forces and defense workers of this nation; and

WHEREAS, Commercialized prostitution constitutes an outstanding factor in
the dissemination of these diseases and requires an intensified campaign against
their elimination; therefore be it

RESOLVED, That the House of Delegates of the American Medical Association
takes the following stand: (1) that the control of venereal disease requires
elimination of commercialized prostitution, (2) that medical inspection of
prostitutes is untrustworthy and inefficient, gives a false sense of security and
fails to prevent the spread of infection, and (3) that prostitution is unlawful,
and physicians who knowingly examine prostitutes for the purpose of providing
them with medical certificates to be used in soliciting are participating in an
illegal activity and are violating the principles of accepted professional ethics.

Other authoritative medical opinions on this subject have been
expressed recently. The Public Health Council of the State of New
York on November 28, 1941, expressed its views in part as follows:
"In the opinion of the Public Health Council, so-called 'regulated'

423



424 JOURNAL OP SOCIAL HYGIENE

prostitution including a medical examination of prostitutes is as dan-
gerous now as it has been in the past and will wherever practiced lead
to increased exposures and increased venereal infection. ' ' On Decem-
ber 1, 1941, the New York Academy of Medicine Committee on Public
Health Relations stated that it "wishes to record its opinion that
commercialized prostitution still constitutes a most serious health
hazard and that so-called regulation of prostitution is thoroughly
untrustworthy as a method of venereal disease control. ' ' A statement
issued by the Council of the Medical Society of the State of New York
was dated December 11, 1941, and was similar to the resolution later
passed by the American Medical Association.

It will be noted that the American Medical Association declares
that "physicians who knowingly examine prostitutes to give them
medical certificates to be used in soliciting were participating in an
illegal activity and violating the principles of accepted professional
ethics." In some states such practices are not only unethical but
illegal. Thus, the laws of the State of New Jersey (Section 89-273i,
Compiled Statutes 1910 with 1924 Cumulative Supplement: provide
that no certificate of freedom from venereal disease shall be issued by
any health officer or physician to any prostitute under any circum-
stances whatever. Similarly, laws of the State of Oregon (Chapter
320, Section 7, Oregon Code of 1930 with Laws of 1935) state that no
certificate of freedom from venereal disease shall be issued by any
health officer or physician or laboratory operator or other persons to
any prostitute.

Unfortunately, the type of physician who makes a practice of
examining and certifying prostitutes is unlikely to be restrained, by
ethical considerations, from aiding the prostitution racket by issuing
certificates of one sort or another to help prostitutes lure customers.
For the restraint of these unethical doctors laws similar to those of
New Jersey and Oregon, mentioned above, are designed to be a
deterrent to flagrant practices such as the issuance of certificates
over a doctor's signature stating that an individual has been examined
by the signator on such and such a date and was found free from
"venereal disease" or from "any infectious diseases." Such certifi-
cates formerly were common and they were sometimes issued by quack
doctors without even the formality of any examination whatever.

Nowadays this same type of doctor, sometimes guided by an equally
unscrupulous lawyer, attempts to avoid legal obstacles by giving
prostitutes a card or slip of paper stating that their blood was tested
for syphilis on such and such a date and found "negative." Prosti-
tutes assure prospective patrons that this means certain freedom from
venereal disease and the popular over-emphasis on the alleged infalli-
bility of the blood test for syphilis often leads to acceptance of a
negative serological report as a guarantee of freedom from syphilis
and maybe gonorrhea as well.

Prostitutes are quick to take advantage of anything which they
may use to indicate that they are healthy. They often call themselves



NO CERTIFICATION OF PROSTITUTES 425

waitresses and so obtain food handlers' health cards. They use
venereal disease clinic registration cards to support a claim that they
are examined regularly by health department doctors. A prostitute-
inmate of a brothel, in a city near which a great camp is situated,
showed an investigator how she convinces skeptics who fear infection.
She offered what she claimed was a ' ' health card ' ' as proof of freedom
from venereal disease. The card she had in her possession apparently
was a treatment record which had been issued by the local health
department. It bore the rubber stamped signature of the city health
officer, and in chronological order listed the bismuth treatments she
had received to date. These she palmed off on customers as "shots"
of a serum used to immunize one against syphilis. Rather cleverly
she stated:

' ' Just like boys in the Army are innoculated against smallpox . . . this stuff
is given to us to prevent syphilis. ..."

Even in recent years local authorities in various cities have com-
pelled prostitutes to be photographed and fingerprinted and examined
periodically for venereal diseases. In some communities the authori-
ties insisted that the prostitute visit certain physicians ; in others the
girls have been permitted to choose their own doctors. In either case
the police required prostitutes to have "health certificates." Thus
in a large measure the authorities created a condition which led some
ethical as well as many unethical practitioners to issue venereal disease
certificates. With the better enforcement of state laws and local
ordinances, especially since the declaration of war, these practices
have greatly diminished.

Numerous devices are employed by prostitutes to deceive gullible
men and boys with regard to the state of the prostitutes' health. This
was shown by the American Social Hygiene Association in its investi-
gation of prostitution conditions in 461 communities in 48 states
during 1941. These studies show that some ethical private physicians,
clinic directors and health officers are, unknown to themselves, being
used to aid the prostitution racket. A few physicians are know-
ingly and for profit helping the racket by examining and certifying
prostitutes.

The records of clinic directors and health officers are sometimes filed
in such a manner that these women find it possible to gain posses-
sion of negative serological reports, clinic registration cards and food
handlers' cards which they then use in promotion of their illegal
business. While the issuance of such a report or card to an individual
may not be in itself unethical or illegal, it is usually unwise and
unnecessary in good medical and public health practices. It is but
rarely desirable to give a patient a serological report, either positive or
negative. The venereal disease clinic registration card should, for
several good reasons, be a plain card bearing only the patient's clinic
number, name and address. Food handlers' cards wherever used
should be issued only to bona fide employees of food handling estab-
lishments and should bear only the name, address and date of exami-



426



JOURNAL OF SOCIAL HYGIENE



nation of the food handler with no indication of freedom from
infectious diseases.

It is desirable in every state that physicians, pharmacists, health
officers, legal authorities and other groups should cooperate closely to
discourage, and so far as possible, to prevent all of these practices,
which are harmful alike to the persons exploited and the general
public.



COMMERCIALIZED PROSTITUTION AND DISEASE
TRANSMISSION IN NEW YORK CITY

WALTEB CLARKE, M.D.
Executive Director, American Social Hygiene Association



The law and public health principles
should guide authorities in dealing with
the knotty problems of prostitution.
In the state of New York the law
provides that every person arrested
for a sex offense shall be reported,
within twenty-four hours, by the court
or magistrate before whom such person
is arraigned, to the health officer, and
shall be examined to ascertain whether
such person has syphilis or gonorrhea
in a communicable form. For the pur-
pose of such examination the person
may be detained until the result of such
examination is known, and no such per-
son, if convicted, shall be released until
examination has been completed in
accordance with this law (Section 343 N
of Article 17 B, of the Public Health
Law). In New York City all persons
arrested and arraigned on charges of
prostitution are examined and held
until the results of the examinations
are known. If the person has syphilis
or gonorrhea in a communicable form
hospital care until non-infectious is
recommended but the magistrate does
not see the health department's medical
report until the question of guilt or
innocence has been settled.

If the person is guilty of a sex
offense the court takes the medical
facts into consideration, and in dis-
posing of the case always makes sure
that treatment is given. The guilty
person may be sent to the Workhouse,
which provides medical care or, if a
first offender, may be allowed to go
to a hospital to remain under treat-
ment until non-infectious, or she may
be placed on probation.

If the person found infectious is
placed on probation, or if she is found



infectious, and "not guilty," the De-
partment of Health removes her to a
hospital for care until non- infectious,
unless her home and certain other con-
ditions permit her to be placed under
private care. That is to say, if the per-
son is infectious and if the disposition
of the case by the court permits her to
be at large, the Department of Health
undertakes to maintain her under medi-
cal control this means hospitalization
until non-infectious.

Section 88 of the Sanitary Code
requires that every person examined
by the Department of Health in accord
with the Public Health Law and found
to have syphilis and gonorrhea in a
communicable form, shall be removed
to a designated hospital, unless the
person is under the care of a physician
approved by the Director of the Bureau
of Social Hygiene and has home con-
ditions that permit suitable isolation.
Therefore, if a person can show that
he or she is under the care of an ap-
proved physician and has suitable home
conditions, he or she may be released
by the Director of the Bureau of Social
Hygiene from isolation in the hospital.
Cases released, however, usually disap-
pear long before the completion of
treatment, and there is reason to be-
lieve that they often engage in the
practice of prostitution even while
under medical care. Experience has
been that the interest of the public
health is best served by keeping such
individuals in a hospital until non-
infectious. For this reason the Health
Department insists upon the fullest
compliance with the requirements of
the Sanitary Code before releasing any
case from the isolation hospital. The



COMMERCIALIZED PROSTITUTION AND DISEASE TRANSMISSION 427



cases released are now carefully fol-
lowed up by a specially trained public
health nurse and the physicians treat-
ing them must report to the Health
Department each week. If a person
so released fails to comply with the
requirements there is no hesitation in
returning them to the hospital.

Persons examined in accordance with
the above procedures and found to have
syphilis or gonorrhea, but not in an
infectious stage, are referred to ap-
propriate sources of treatment. If they
are convicted and incarcerated, this
treatment, of course, is given in the
correctional institution ; if probated or
not guilty, they are referred to clinics
or private practitioners for medical care.

It will be noted that the State law
requires "That every person arrested
for a sex offense shall be reported
within twenty-four hours, by the court
or magistrate before whom such per-
son is arraigned, to the health officer. ' '
Whenever magistrates report male sex
offenders to the Department of Health
they are examined in exactly the same
way as female offenders and are dis-
posed of in accordance with the same
rules and principles. The number of
male sex offenders is small, compared
with the number of female sex of-
fenders. Some difficulty has been en-
countered because of lack of facili-
ties for holding male sex offenders
pending examination. It is expected
that these difficulties will shortly be
removed.



Patients in the clinics frequently
name prostitutes as sources of infec-
tion. The Health Department can deal
with such cases in one of two ways.
First they can be followed up by the
usual epidemiological procedures and
the prostitute invited to come to the
clinic for an examination. Second the
information given by the patient con-
cerning a prostitute can be regarded as
a citizen's complaint regarding illegal
practices, namely, prostitution, and can
be brought to the attention of the
appropriate branch of the city govern-
ment, namely, the Police Department.

Experience indicates that visits by
nurses or social workers to prostitutes
named as sources of infection, for the
purpose of persuading them to visit
a clinic for diagnosis, almost invariably
result in the prostitutes being lost to
the Health Department. They dis-
appear without leaving a trace. Usu-
ally, therefore, when the evidence is
sufficiently impressive, information ob-
tained from patients regarding the
practice of prostitution is referred to
the Police Department. The Police
Department investigates, and, if the
findings warrant, brings the persons
complained of to the Magistrates'
Court where they are arraigned. As
soon as they are arraigned, the De-
partment of Health examines them,
in accordance with the above men-
tioned plan. This procedure has given
quite satisfactory results in the num-
ber of persons examined, found in-
fected and consequently placed under
public health control.



TAKE YOUR BATTLE STATIONS

sounds the call to
Social Hygiene Day on February 3, 1943

For help in planning your meetings, radio broadcasts, newspaper publicity,
film showings and exhibits, write for these leaflets:

Social Hygiene Takes Battle Stations

Your Guide to Social Hygiene Day Materials



EDITORIAL

WAR AND THE COMING WINTER ON THE SOCIAL HYGIENE FRONT

Three years ago when the President proclaimed a limited
National Emergency, the people of the United States were
concerned with adjusting themselves and their business and
community affairs to the calling out of the National Guard for
training with the regular Army in war maneuvers. Neither
the states from which these men were drawn nor the states
to which they were sent were prepared for the new and



Online LibraryAmerican Social Hygiene AssociationJournal of social hygiene (Volume 28) → online text (page 55 of 71)