The Third Great Plague A Discussion of Syphilis for Everyday People online

reach. Physicians who work with large numbers of these patients realize
that privacy is one of the details which has an attraction that cannot
be ignored.

+Compulsory Treatment.+ - Compulsory provisions in the law form the
third debatable feature of a modern program against syphilis. The
Scandinavian countries have adopted it, and in them a patient who does
not take treatment can be made to do so. If he is in a contagious
condition, he can be committed to a hospital for treatment. If he
infects another, knowing himself to have a venereal disease, he is
subject, not to fine, but to a long term of imprisonment. The West
Australian law is even more efficient than the Scandinavian in the vigor
with which it supplies teeth for the bite. The penalties for violations
of its provisions are so heavy as to most effectually discourage
would-be irresponsibles. At the other end of the scale we find Great
Britain relying thus far solely upon the provision of adequate
treatment, and trusting to the enlightenment of patients and the
education of public sentiment to induce them to continue treatment until
cured. Italy has, in the same way, left the matter to the judgment of
the patient. The Medical Association of Munich, Germany, in a recent
study has subscribed to compulsory treatment along the same lines as the
West Australia act, although thus far enforcement has been confined to
military districts. The program for disbanding of the German army after
the war, however, includes, under Blaschko's proposals, compulsion and
surveillance carried to the finest details. A conservative summary of
the situation seems to justify the belief that measures of compulsion
will ultimately form an essential part of a fully developed legal code
for the control of syphilis. The reasons for this belief have been
extensively reviewed in the discussion of the nature of the disease
itself (pages 104-105). On the whole, however, the method of Great
Britain in looking first to the provision for adequate diagnosis and
treatment, and then to the question as to who will not avail himself of
it, is a logical mode of attacking the question, and as it develops
public sentiment in its favor, will also pave the way for a sentiment
which will stand back of compulsion if need be, and save it from being a
dead letter.

+Backwardness of the United States in the Movement.+ - It will be
apparent, from the foregoing review of the world movement against
syphilis, and the essentials of a public policy toward the disease, that
the majority of our efforts in this direction have been decidedly
indirect. We have no national program of which we as a people are
conscious. It is all we can do to arouse a sentiment to the effect that
something ought to be done. In these critical times we must mobilize for
action in this direction with as much speed at least as we show in
developing an army and navy, slow though we are in that. To limit our
efforts to the passing of freak state legislation regulating the price
of a Wassermann to determine the fitness of a person for marriage, when
both Wassermann test itself, and Wassermann test as evidence of fitness
for marriage, are likely, under the conditions, to be absolutely
worthless, is to play penny eugenics. The move to take the gag from the
mouth of the physician when an irresponsible with a venereal disease
aims to spread his infection by marriage is at least intelligent,
preventive, even if indirect, legislation, because it acts before and
not after the event. Although at the present time we cannot boast a
single example of a complete program of direct legislation, the example
of Michigan, which is providing free hospital treatment for adults and
children with syphilis, should be watched as the first radical step in
the right direction. If war and our mobilization for defense leave us
with every hospital and dispensary and public health resource and all
the expert judgment we have available within our borders enlisted
finally in a great campaign against gonorrhea and syphilis, it will have
accomplished a miracle, though it will have done no more than war has
done for Europe. If it leaves us even with our more progressive states
committed to an expanding program of universal efficient and accessible
diagnosis and treatment, it will have conferred a blessing.

+Relation of War to the Spread of Venereal Disease.+ - The frequent
reference to the relation of war to the problems of sexual disease seems
to justify a concluding paragraph on this aspect of the matter. Much of
the impetus which has carried European nations so far along the road
toward an organized attack on syphilis and gonorrhea, as has been said,
is undoubtedly due to the realization that war in the past has been the
ally of these diseases, and that a campaign against them is as essential
to national self-defense as the organization of a vast army. Conflicting
reports are coming from various sources as to the prevalence of syphilis
and gonorrhea among European troops, although hopeful indications seem
to be that troops in the field may have even a lower rate of disability
than in peace times (British figures). The most serious risks are
encountered in troops withdrawn from the front or sent home on leave,
often demoralized by the strain of the trenches. The steady rise in the
amount of syphilis in a civil population during war is evidenced, for
example, by the figures of Gaucher's clinic in Paris, in which, just
before the war, 10 per cent of patients were syphilitic; after the first
sixteen months of the war 16.6 per cent were syphilitic, and in the last
eight months, up to December, 1916, 25 per cent had the disease. There
can be no doubt that a campaign of publicity can do much to control the
wholesale spread of infection under war conditions, and we should bend
our efforts to it, and to the more substantial work of providing for
treatment and the prevention of infectiousness, with as much energy as
we devote to the other tasks which preparedness has forced upon us. The
rigorous provisions proposed for continental armies should be carefully
studied, and in no cases in which either syphilis or gonorrhea is active
should leave or discharge be granted until the infectious period is
over. Compelling infected men to remain in the army under military
discipline until cured might have a deterrent effect upon promiscuous
exposure. In addition we should create as rapidly as possible a
mechanism for keeping inactive cases under surveillance after discharge
until there can no longer be the slightest doubt as to their fitness to
reënter civil life. Observers of European conditions in the population
at large are emphatic in saying that home conditions must have as much
attention as the army, and that suppression of open prostitution, a
watchful eye on the conditions under which women are employed or left
unemployed, and the control of contributory factors, such as the liquor
traffic, must be rigorously carried out. Nation-wide prohibition will do
much to control venereal disease.[18] It is interesting and significant
that little reliance is being placed on the obsolete idea that
prostitution can be made a legitimate and safe part of army life solely
by personal prophylactic methods, or by any system of inspection of the
women concerned. It is a hopeful sign that this conception is at last
meeting with the discredit which has long been due it.

[18] Through the effect on prostitution. A well-known and very
intelligent prostitute, with whom this question was recently
discussed, rated the liquor traffic first among the influences
tending to promote prostitution.

The question has occurred to those interested in compulsory military
service as a measure of national defense as to whether the mobilization
of troops for training will favor the spread of sexual disease.
Unfortunately, there are no satisfactory figures for the civil
population showing how many persons per thousand per year acquire
syphilis or gonorrhea, to be compared with the known figures for the
onset of such infections in the army. Arguing from general
considerations, however, there seems to be no reason to suppose that the
army will show a higher proportion of infections than civilians. In
fact, there is every ground for believing that the percentage will be
lower, since the army is protected by a fairly efficient and enforceable
system of prophylaxis which is taught to the men, and they live,
moreover, under a general medical discipline which reduces the risk of
infection from other than genital sources to the lowest possible terms.
In opposition to the conception that the sexual ideals of the army are
low, it may be urged that they are no lower than those of corresponding
grades in civil life, and that hard work and rigid discipline have a
much better effect in stiffening moral backbone than the laxities of
present-day social life. In the last analysis, the making of the moral
tone of the army is in our own hands, and by putting into it good blood
and high ideals, we can do as much to raise from it a clean manhood as
by submitting that same manhood to the temptations and inducements to
sexual laxity that it meets on every street corner.

This chapter closes the discussion of syphilis as a problem for the
every-day man and woman. It represents essentially the cross-section of
a moving stream. Today's truth may be tomorrow's error in any field of
human activity, and medicine is no exception to this law of change. It
is impossible to speak gospel about many things connected with syphilis,
or to offer more than current opinion, based on the keenest
investigation of the facts which modern methods make possible. None the
less, the great landmarks in our progress stand out with fair prospect
of permanent place. The germ, the recognition of the disease by blood
test and dark field microscope, the treatment and prevention seem built
on a firm foundation. As they stand, without regard to further advances,
they offer a brilliant future to a campaign for control To that
campaign, each and every one of us can address himself with the
prospect of adding his mite of energy to a tremendous movement for human
betterment. For every man or woman to whom the word syphilis can be made
to mean, not a secret, private, shameful disease, but a great open
problem in public health, a recruit has been called to the colors. There
are no signs more hopeful of the highest destiny for humanity than those
of today which mark the transition of disease from a personal to a
social problem. Such a transition foreshadows the passing of syphilis.
In that transition, each one of us has his part. Toward that
consummation, a goal only to be won by united and stubborn assault, each
one of us can contribute the comprehension, the sympathetic support, the
indomitable determination, which make victory.




INDEX


ABORTION, syphilis as cause of, 95

Abortive cure and marriage, 127
of syphilis, 27, 86
salvarsan in, 73, 79, 89
time required for, 87

Accidents, late, 45. _See also late syphilis_

Advertising in regard to treatment for syphilis, 175, 176

Alcohol, effects of, in syphilis, 137

America, backwardness of, in movement against venereal diseases, 181
state control of venereal diseases in, 170

American Social Hygiene Association, 165
pamphlets, 161

Antibodies in disease, 54

Antiseptics, effect of, on germ of syphilis, 27

Appearance of chancre, time elapsing before, 29

Armpits, contagious patches in, 38

Army and navy, Metchnikoff prophylaxis in, 162
probable outlook for venereal diseases in, 184
proposed measures relative to venereal disease in, 183
syphilis in, 25

Arsenic in salvarsan, 71

Arteries, effect of syphilis on, 47

Australia. _See West Australia_


BABIES, hereditary syphilis in, 99

Baltimore Vice Commission, report of, 134

Baths in treatment of syphilis, 140

Bath-tubs not means of transmitting syphilis, 114

Berlin, syphilis in clerks and merchants of, 25

Birth, premature, 95

Blaschko and German sexual disease program, 177, 180
estimate of syphilis in Berlin, 25

Blindness in hereditary syphilis, 104

Blood, Spirochæta pallida in, during secondary stage of syphilis, 35
test for syphilis, 54. _See also Wassermann test_
vessels, late syphilis in, 46

Board of Health, activities of, against syphilis, 165
national, need for, 167

Body, invasion of, by germs in secondary stage of syphilis, 35

Bones in hereditary syphilis, 102
late syphilis (gumma) in, 46
Spirochæta pallida in, 39
supposed effect of mercury on, 63

Bordet and Wassermann, blood test for syphilis, 14

Brain, late syphilis of, 48
softening of, 48
Brawl chancre, 116

Breasts, contagious patches on, 38

Brooklyn Hospital Dispensary, 171
health exhibit by, 175


CABOT, Hugh, comment on reporting syphilis, 179

Cancer following smoker's patch, 138

Chafe, chancre resembling, 30
relation of, to infection with syphilis, 28

Chancre, 29
and cold sores, 30
appearance of, 30
brawl, 116
combined with chancroid, 30
concealment of, by gonorrhea, 30
contagiousness of, 109
contracted during engagement, 117
cure of syphilis in stage of, 85
developed from kissing game, 117
diagnosis of, prevented by improper treatment, 32
ease with which overlooked, 30
enlargement of glands near, 33
extra-genital, from lax relations, 134
importance of early recognition of, 31, 34
in women, 30
location of, 28
of the lip, 117, 119
on knuckle (brawl chancre), 116
painlessness of, 30
soft, 30. _See also chancroid_
tertiary symptoms following, 45
urethral, in men, 30
variations in, 30

Chancroid, 16
and syphilitic infection, 30
confusion of, with syphilitic chancre, 31

Child, death of, in syphilitic miscarriages or abortion, 95
early signs of hereditary syphilis in, 99
effect of syphilitic eye trouble on development of, 103
healthy, born of syphilitic mother, 94
infection of wet nurse by syphilitic, 100
necessity of teaching sexual self-control to, 160
older, effect of hereditary syphilis on, 102
transmission of syphilis from mother to, 92
treatment of syphilis in, before birth, 97
unborn, effect of syphilis on, 98

Child-bearing, effect of syphilis on, 95

Children, adopted, syphilis in, 106
syphilitic, mental condition of, 101

Clap, 16.
_See also gonorrhea_

Clinics for pay patients to secure better treatment, 173
inadequate, for venereal disease, 170
night, necessity for, 171

Cold sores and chancres, 30

College students, syphilis in, 25

Commission, Baltimore Vice, 134
Sydenham Royal, 164

Complications, serious, of syphilis, 45

Compulsory treatment, state provision for, 169

Conception, influence of syphilis on, 95
treatment of syphilis occurring in mother after, 97

Coney Island Health Exhibit, 175

Contagiousness of moist sores in syphilis, 27, 38, 110
of secondary relapses in syphilis, 42
syphilitic sores, 38
of syphilis, 109. _See also infectiousness, infection, and transmission_
and medical examination of prostitutes, 135
control of, by salvarsan, 73, 74, 122
detection of, by examination of patient, 123
disappearance of, in late syphilis, 110
duration of, in late syphilis, 112
under treatment, 123
effect of incomplete cure on, 83
of local irritation on, 43
of mercury on, 64
of moisture on, 27, 38, 110
of time on, 111
of tobacco on, 138
estimate of risk for wife, 125
factors tending to increase, 112
five-year rule in relation to, 124
hereditary, 100, 105
ignorance of, in women, 135
impracticability of quarantine in control of, 121
in wet nurses, 101
inability of mercury to control, 123
obstacles to control by treatment, 123

Continence as personal prophylaxis, 161
economic forces opposing, 157

Copenhagen, dispensaries for treatment in, 171

Cost, economic, of mental disease due to syphilis, 51
of living, effect of, on marriage and sexual life, 158
of treatment, effect of, 84, 149

Cups, drinking, transmission of syphilis by, 113

Curability of syphilis, critical estimate of, 90

Cure, importance of, for the wife, 128
incomplete or symptomatic, danger of, 82
of early syphilis, abortive, 27, 34, 86, 127
of hereditary syphilis, 107
of syphilis, 124, 126, 129. _See also five-year rule_
abortive, salvarsan in, 73, 79, 89
complete, responsibility of the physician in regard to, 84
effect of cost on, 84, 149
stage of disease on, 85
importance of, 90
in early stage, 27, 86
in primary stage, 85. _See also cure of syphilis, abortive_
in secondary stage, 86, 88
methods of determining, 90
obstacles to, 80
radical or complete, 80
Wassermann test in, 58
symptomatic, in late syphilis, 87
time required for, 87


DARK-field examination, use of, in recognizing contagious recurrences, 111
germ of syphilis in, 22
importance of using, 22
use of, in recognizing early syphilis, 33

Deafness and loss of speech due to hereditary syphilis, 104

Deaths due to hereditary syphilis, 98, 99
due to late syphilis, 48

Denmark, free treatment of syphilis in, 169

Disgrace, syphilis and, 142, 144

Disinfection of hands, dishes, etc., by washing and disinfectants, 114

Dispensaries for syphilis in large cities, 170

Drinking of alcoholic liquors, effect of, in syphilis, 137

"Drops," 69

Drug stores and drug clerks, evil influence of, 175
prescribing, suppression of, 168, 174

Drying, effect on germ of syphilis, 27

Dumbness (loss of speech) in hereditary syphilis, 104

Dyes, relation of, to salvarsan, 70


EARS, secondary recurrences affecting, 43

Ears, trouble in, in hereditary syphilis, 104

Eating utensils, transmission of syphilis by, 113, 115

Education and character in the control of syphilis, 160
as means of controlling contagiousness of syphilis, 122

Ehrlich, Paul, 70

Engagements, syphilis contracted during, 117
to marry in syphilitics, precautions in connection with, 129

England, action of, against drug stores prescribing for syphilis, 176
provision for treatment of venereal disease in, 169
treatment not compulsory in, 180

English-speaking countries, attitude on Metchnikoff prophylaxis in, 177

Eruptions, absence of, in serious syphilis, 46
effect of mercury on syphilitic, 64
in hereditary syphilis, 100
non-syphilitic, 37
recurrent, 42, 43
secondary syphilitic, 36
syphilitic, effect of salvarsan on, 74

Estimate of damage caused by syphilitic eye trouble, 103
of frequency of relapse and recurrence in secondary syphilis, 125
of increase of syphilis during war, in Paris, 183
of percentage of marital syphilis, 119
of percentage of non-genital syphilis, 119
of prevalence of gonorrhea, 26
of syphilis, 24, 25
of risk of infecting wife, 125
of syphilis in prostitutes, 134

Examination, medical, before marriage, 130
limitations of, in detecting contagiousness, 123

Excesses, effect of, on the syphilitic, 137

Expense of treatment, effect of, 77, 84, 149

Expert advice, importance of, 32
in secondary stage of syphilis, 86
in pay patient clinics, 174
services, value of, in control and
treatment of syphilis, 173

Eye trouble in hereditary syphilis, 103
in later life, 105
in secondary syphilis, 36

Eyes, secondary syphilitic recurrences affecting, 43


FAMILY, economic forces working against, 158
transmission of syphilis in, 116

Fathers of families, encouragement of early marriages by, 159
syphilis in, 93, 126

Fiancée, non-genital chancre in, 129

First sore, 29. _See also chancre_

Fist chancre, 116

Five-year rule, 124, 126, 129
in relation to marriage, 126

Founder's estimate of prevalence of syphilis, 24

France, increase of syphilis in, during war, 183


GAUCHER'S estimates of increase in syphilis during war in France, 183

Genital syphilis in lax individuals, 133

Genitals, contagious sores on, 38, 112
fitness of, for harboring germs of syphilis, 118

Germ of syphilis, 40. _See also Spirochæta pallida_

Germany, action of, against drug store prescribing for syphilis, 176
attitude on Metchnikoff prophylaxis in, 177
compulsory treatment of venereal disease in, 180
sentiment against reporting of venereal disease in, 179
society for preventing sexual disease in, 164
syphilis in, 25

Germs, behavior of, in various diseases, 40

Glands, enlargement of, in neighborhood of chancre, 33
in chancre of the lip, 33

Gonorrhea and syphilis, measures to prevent spread from army to general
population, 183
concealment of chancre by, 31
confusion of, with syphilis, 13, 16, 31
drug store treatment of, 175
estimated prevalence of, 26
in prostitutes in Baltimore, 134
Gonorrhea, transmission of, by toilet seats, 114

Great Britain. _See England_

Gumma, 46. _See also syphilis, late_
effect of treatment on, 47
nature of, 46

Gummatous infiltration in hereditary
syphilis, 102
in late syphilis, 46


HAITI, origin of syphilis in, 11

Hata, 70

Headaches in syphilis, 36

Health, effect of secondary syphilis on, 36
Exhibit, Brooklyn Hospital Dispensary, 175

Hearing, disturbances of, in hereditary syphilis, 104
in secondary syphilis, 36

Heart in hereditary syphilis, 102

Hereditary syphilis, apparently healthy children with, 101
as cause of abortions and miscarriages, 95
of death, 98
blindness in, 104
bones and teeth in, 102
contagiousness of, 100, 105
deafness in, 104
early signs of, 99, 100
effect of accident and injury in, 105
eye trouble in, 103
heart, blood-vessels and nervous system in, 102
Hutchinson's teeth in, 102
immunity in, 106
in adopted children, state provision for care of, 106
in infant, 99
in unborn child, 98
late, in older children and adults, 101
moral costs of, 99
non-transmission of, by marriage, 105
treatment of, 107
in school hospitals, 108

Hoffmann's rule for marriage of syphilitics, 124

Hospital beds, number of, needed for venereal disease, 171
treatment for hereditary syphilis, 108

Hospitals in treating venereal disease, 171
special venereal, 167, 171

Hot Springs in treatment of syphilis, 140

Hunter, John, 13

Husband, probability of infection of wife by, 125

Hutchinson's teeth in hereditary syphilitics, 102

Hygiene, personal, of the syphilitic, 136


IDIOCY in hereditary syphilis, 101

Immunity in syphilis, absence of, 139
hereditary, 106

Incubation period of syphilis, 28, 29

Infection, break in skin necessary to, 28
double, with gonorrhea and syphilis, 30
with syphilis and chancroid, 30
point of entry of, site of chancre, 29
risks of, 32
time elapsing after, before chancre appears, 29
unsuspected risk of, 161
with syphilis favored by moisture, 27

Infectiousness of syphilis. _See contagiousness_
of syphilitic discharges, 28

Infiltration, gummatous, in late syphilis, 46
in hereditary syphilis, 102

Injections, mercurial, 66

Innocence, question of, in transmission of syphilis, 118

Inoculation, favorable ground for, 114

Insane asylums, amount of syphilitic mental disease in, 50

Inunctions, advantages of, 66
disadvantages of, 65
mercurial, 65
number required for cure, 66

Iodid of potash, 69

Irresponsible mental attitude in syphilis, 150, 151

Irritation, effect of, on contagious recurrences, 43

Italy, non-compulsory treatment in, 180
provision for treatment of venereal disease in, 169


KERATITIS, interstitial, in hereditary syphilis, 103

Kernels. _See glands_

Keyes' estimate of risk of infection of wife by husband, 125

Kissing, rules governing, in syphilitics, 138
transmission of syphilis by, 116

Knuckle chancre, 116


LATE syphilis, non-contagious character of, 110
premature development of, 45
prospects for cure in, 86

Latent or concealed syphilis, 22

Law, Ohio, relative to physicians and marriage of syphilitics, 131
controlling professional confidence, 131
crippling physician in relation to marriage of syphilitics, 131
providing for compulsory treatment in various countries, 180

Legal control, necessity for, in irresponsible syphilitics, 153

Legislation, conservative, 167
indirect, against venereal disease, 169
undesirable and freak, 166

Legs in locomotor ataxia, 49

Lemberg, study of prostitutes in city of, 134

Lesion, primary. _See chancre; also sore_