IMPURE SEXUAL INTERCOURSE — THE — PRIMITIVE CAUSE — OF — Syphilis, Scrofula, and Phthisis. BY WILLIAM B. DeWEES, A.M., M.D., SAEINA, KAN. PHILADELPHIA: RECORDS, McMULLIN & CO., Limited. 1888. IMPURE SEXUAL INTERCOURSE THE PRIMITIVE CAUSE OF SYPHILIS, SCROFULA, AND 'J~ If, unhappily, I dream, And prove too weak for so divine a theme, Let charity forgive me a mistake Which zeal, not vanity, has chanced to make, And spare the speaker for the subject’s sake. —Cowper. AT this, the noon of microorganific and sanitary- light, it would be a breach of order in medical talks to touch any subject relative to preventing dis- eases without a temerarious parade of one’s knowl- edge of this “idea of the season.” But in these hal- cyon days of deliberate reviews, retrospects, weekly couriers, records, bulletins, indexes, registers, and budgets, almost universally distributing to members of the profession through the advertising and enter- prising ingenuity of medical publishers, few, if any, of us could come here other than replete with knowl- edge and opinion of these much-discussed subjects. To dispel the incubus of your apprehensions, I shall begin by promising not to subject you to the tedium of a bacteriologist, but shall confine myself more strictly under the banner of sanitation. Thus, I shall endeavor to call your attention to the subject which I have selected for this occasion. Although not a novel one, it is, nevertheless, demanding first and foremost consideration of the sanitarian. I allude to impure sexual intercourse. The subject is one which invites and, I hdpe, will provoke discussion. It is high time that it should be thoroughly ventilated and brought boldly and prom- inently before the medical profession, and through this medium secure proper legislation, and thus lay the foundation-stone of true sanitation, when we may hope to see that great evil eradicated which is imper- ceptibly sapping the very foundation of health and society. The subject with which I have chosen to deal is not a matter of mere speculative curiosity or intellec- tual amusement—to be taken up to-day and dis- missed, perhaps, with unconcern to-morrow—but it involves questions of life and death. These thoughts should fill our minds with an almost painful sense of the obligations imposed upon us; therefore it is that I feel myself to be engaged in a very serious under- taking. No one, I am sure, will question my sincerity when I confess that I approach this subject with doubt as to its fitness to be discussed upon such an occasion, but I feel, however, that I have a great duty to per- form, and it is difficult to conceive of a more favora- ble opportunity for presenting my views than the present, standing as I do in the midst of my profes- sional brethren, congregated from all sections of the State of States—Kansas—and representing, in no in- considerable degree, the character and interests of the medical profession. To develop and defend facts, to separate truth from error, and, if possible, to induce those who shall hear me to consider fully, patiently, and deliberately the magnitude and importance, nay, the appalling char- acter of the subject, is my sole ambition. I shall not be sorry if, in what I may say, I shall meet with opposition. When Charles James Fox was Prime Minister of England, he one morning rushed into the House of Parliament, exclaiming: “ I am ruined ! I am ruined! ’ ’ And when asked the rea- son, he answered: “Because the Government has no opposition. ’ ’ If, in the discussion of this subject, I should be so unfortunate as to give offence to some bf my associ- ates in this assemblage, or in any wise disturb the prejudice of the public, I can only say, let it be so. My only sorrow would be if this address should fall stillborn from my lips. All new discoveries or inno- 3 vations upon customs or thought of the times are liable to encounter an ungrateful and, often, perse- cuting spirit. The torture of Galileo, the imprison- ment of Columbus, the ridicule and misrepresentation with which the new discoveries of Harvey or .Jenner were received by even the scientific men of their day, are only illustrations of the fact. I am convinced that the subject under considera- tion is invested with such momentous importance that it cannot fail, if rightly understood and wisely interpreted, to enlist the sympathy and arouse the warmest feelings of the sense of duty of the sanita- rian ; who must acknowledge that this is a most im- portant field, loudly calling for his labors to quaran- tine the so far shamefully-neglected source of disease; which is a thousand times worse than the most deadly epidemic, doing its work slowly and, as it were, in disguise and darkness; ruining entire families, de- stroying many of our best men and women, and lay- ing the foundation of untold misery, wretchedness, and woe, not infrequently through several genera- tions, and literally poisoning the very fountains of life. In discussing this subject, I shall speak, in the first place, of the history and origin of pure and impure sexual intercourse. Secondly, of unclean sexual congress as the primitive source of syphilis, scrofula, and phthisis. Thirdly, of preventive measures. “By far the most interesting portions of history are the world’s crises in thought.” i. Sexual intercourse was originally designed by the Creator for the purpose of propagating the human race. Hence, being implanted in our nature, it is an impe- rious necessity to human life. There is nothing so conducive to the individual happiness or suffering of mankind as connubial or concubinal sexual congress. With normally clean connubial usages it is the chief preserver of virtue, health, and morality. Practised promiscuously and lustfully with unclean concubinal usages, it is the chief promoter of vice, disease, and sin; and the gratification of this cultured morbid passion, for which man will brave any danger, how- ever great to health and even life. Speaking under this branch of the subject, I can 4 probably do no better than by summing up the whole in the following: Connubial bliss is ordained by Di- vinity, sanctioned by the most sacred usages, and hallowed by love. Concubinage is conceived by Satan,, tolerated by the most ungodly usages, and gratified by lust. Sexual commerce between the two sexes must have been of constant occurrence from the earliest periods, and being followed, as it is in our day, by the saddest results. The earlier races of mankind were endowed with the same feelings and passions as the people of the present age, and that promiscuous sexual inter- course was common among them, is proved by the fact that concubinage was one of the peculiar prerogatives of the higher and more wealthy classes. What are the causes of these conditions ? Across the lapse of centuries the voice of Antigone answers: “No ordinance of man shall override the settled laws of Nature and of God. Not written these in the pages of a book, nor were they framed to-day nor yesterday. We know not whence they are; but this we know, that they from all eternity have been, and shall to all eternity endure.” This, together with a pagan sister’s words—the lament of a woman who suffered— Cut off from marriage bed and marriage song, Untasting wife’s true joy or mother’s bliss— contain the essence of the cause; for it is in violation of these unwritten laws that lie the most potent fac- tors in the production of impure sexual desires. Gonorrhoea prevailed and was duly recognized in the time of Moses, and men thus affected were pro- nounced as “unclean,” and, consequently, unfit to cohabit with their wives. No impartial and enlight- ened physician can read the accounts of the suffer- ings of Job and David—those two great and wonder- ful men—without being convinced that they were brought on by “unclean cohabitation,” or what are usually called ‘ ‘ early indiscretions. ’ ’ The symptoms they so graphically describe clearly point to what is now known as the tertiary form of syphilis. Job, in Chapter VII of the book bearing his name, says: “My flesh is covered with putrid sores.” And in 5 Chapter XXX, he adds: “My bones are pierced with pains in the night season, and my sinews take no rest. ’ ’ The royal Psalmist says: ‘ ‘ There is no soundness in my flesh because of thine anger; there is no rest for my bones on account of my transgres- sions. My sores stink and are corrupt because of my folly. For my loins are filled with a loathsome dis- ease, so that there is no soundness in my flesh.” (Psalm XXXVIII.) Josephus, in his account of the last illness of Herod, attributes the death of that monarch to the putrefac- tion of his genital organs. If we seek for information respecting the exist- ence or the origin of these maladies among the early Romans, it will not be difficult to find it. How de- praved the ancient Roman women were, is evinced by the fact that they openly wore breastpins and other ornaments representing the male genital or- gans. To suppose that such a people were free from venereal maladies, is an egregious absurdity, unworthy of serious refutation. Celsus, so celebrated for the purity and the ele- gance of his diction, describes buboes and ulcers of the groins as products of diseases of these organs, and distinguishes several forms of sores upon the genital organs corresponding with the hard, soft, and other varieties of chancre of the present day. Horace, in one of his odes, makes distinct mention of the disease; and Pliny states that a woman was drowned, as a punishment, in the lake of Como be- cause she gave her husband a disease in his genital organs from the effects of which he died. Passing by the writings of the “father of medicine,” who, in speaking of a disease peculiar to the Scythian women, mentions the occurrence of ulcers upon their genital organs, it is a well-known fact that Galen was acquainted with osteoscopic pains, so graphically described by Job and modern syphilographers, ascrib- ing their cause to unclean sexual intercourse. It may, perhaps, have been included under those plagues of Egypt, the “botch,” the “emerods,” and the “scab,” (Deut. XXVII, 27,) with which Moses threatened the Israelites as a punishment for disobedience to the Di- vine command. 6 Soft chancres must have been well known. I find proof of this in the account given, in i Samuel, V, of the plague of ‘ ‘ emerods ’ ’ which occurred among the Philistines of Samuel’s time after their capture of the sacred ark. These “emerods” affected the “ men of the city, both small and great, in their secret parts,” and caused great destruction of life. The account of the description bears full resemblance to the more modem species of some severe phagedenic chancre, like the famous “Swan Alley sore” of London, “black lion” of Portugal, or the “Chinese pox” familiar to the Pacific Ocean sailors. 2. It is no more a disputed fact that gonorrhoea and syphilis have for their primitive origin, impure sexual congress. The connection between syphilis, scrofula, and phthisis, and cause and effect, has attracted much attention within the past quarter of a century, and has been warmly advocated by a number of writers. In classing pulmonary phthisis with syphilis and scrofula, I no doubt shall meet the strongest opposi- tion in the discussion of this subject. But let us see if I am wholly in error. When Koch, the great apostle of bacterian pathol- ogy, made known the results of his investigation in Berlin, but a few years ago, in less than forty-eight hours the contents of his paper were telegraphed to the world, the important part of which—and that which defined his position—said: ‘ ‘ The active agent in the causation and propagation of tuberculosis is a distinct species of bacterium—a bacillus. Tubercu- losis does not occur without the presence of these organisms, and, conversely, no disease should be re- garded as tuberculosis without the presence and vital activity of this bacillus.” Out of one hundred and fifty tubercular specimens at various stages of development, Spina did not find bacilli in one. Dr. H. B. Formad (Journal of the American Medi- cal Association, February 9, 1884), with a view of proving or disproving the position of Koch, utilized tubercular material from the autopsy table of over four hundred cases, the result of which was the con- 7 elusion, on his part, that tuberculosis is not a con- tagious disease. Dr. William Porter, in a paper, entitled The Por- tagiousness of Phthisis, read before the Medical Press Association of St. Louis, January 30, 1888, says: “Before entering upon the discussion of the subject proposed, permit me brief reference to the terms employed. I have chosen the word portagious be- cause it conveys a more exact idea of the manner of transmission of phthisis, for reasons hereinafter mentioned, than either contagious or infectious. In this writing the term phthisis will be used to denote the class of slowly progressive pulmonary inflamma- tions—i. e., chronic tubercular phthisis. ‘ ‘ Pardon me if I decline to enter into a discussion of the relation ’of the bacillus to phthisis. After somewhat closely following the investigations of re- cent years, I cannot conclude whether the bacillus is the cause or product of tuberculosis. Certainly, no positive therapeutical gain has yet been made, based upon the hypothesis that the microbe is a factor of phthisis, per se, but rather is our advance continually upon the old lines of aiding assimilation, diminishing waste, and caring for the hygienic sur- roundings. So far as our present knowledge extends, the bacillus is to phthisis as smoke to fire: it may indicate its existence, but neither incites nor inten- sifies the combustion.” I cite these more than familiar examples and late opinion, and I am afraid you will be tempted to say with Josh Billings, “ A man had better not know so much, than to know so many things that aint so.” But no, the only way we have of formulating our ideas is through physical laws. Take from us the faculty of philosophical reasoning, and all research and progress will stop. I avow my belief, however, that Koch’s discovery has not assisted us in either remedying the disease, when it, comes before us, or diminishing the frequency of its occurrence. His theory of contagiousness is already waning. Upon the threshold of the decadence of its lustre we stand, however, much advanced, not in knowing its depen- dent cause, but in knowing at least one more thing that it is not caused by. 8 If these facts be admitted, they will substantially prove the fact that the bacillus tuberculosis does not occur in every case of phthisis; therefore, the tu- bercular diathesis is not necessarily produced by a dis- tinct species of bacterium—a bacillus; and hence it will follow, that if all cases of phthisis—tuberculosis— are not necessarily and inevitably produced by a ba- cillus, none are; but that phthisis, like scrofula and syphilis, must depend upon an adventitious cause. In proof of this, we find Prof. Furneaux Jordan, of Birmingham, Eng., very justly says: “We can man- ufacture strumous disease at pleasure, since all that is necessary is to bring into contact two persons af- fected with hereditary and they will be sure, especially if, in addition to this taint, they have a muddy complexion, to produce children, one of whom will have phthisis, another Pott’s disease of the spine, a third coxalgia, a fourth enlarged glands, or hydrocephalus.” “If acquired be added,” he further remarks, “to the inherited syphilis, the result will be still more certain.” Sir William Jenner says: “The frequency of so- called consumption, and of cases of so-called scrofu- lous diseases in the child, that are also due to in- herited syphilis, becomes daily more apparent.” ‘ ‘ Strumosis and tuberculosis have no place in the Registrar-General’s Returns; and yet to the pre- existence of these diseased states, in a large pro- portion of cases, is due the death in scarlet fever, in measles, hoopingcough; and but for these states how large a number of cases of Bright’s disease, hepatic disease, and puerperal mischief would never have occurred !” (“ Practical Medicine of To-day,’ p. 42, London, 1869.) ‘ * Scrofula, ’ ’ says Mr. Richard Barwell (‘ ‘ Guide in the Sick-room,” p. 3, London, 1864), “a name well known in America, is so common in the United Kingdom of Great Britain, that it would be below the truth to affirm that at least three-fourths of the people have the seeds of that malady in their consti- tutions. The Registrar-General’s Returns show facts which prove that there is a blight upon the children, transmitted from the parents, rendering their lives sickly, their death premature.” 9 Prof. Samuel D. Gross, of Philadelphia, Pa., a warm advocate of this theory (no one can read the productions of this distinguished author without rising to the conviction that he was a most accu- rate and patient observer, a truthful recorder of facts, and a man of the highest analytical genius and powers of generalization), says: “What is called scrofula, struma, or tuberculosis, is, I have long been satisfied from careful observation of the sick, and in profound study of the literature of the subject, in the great majority of cases, if not invariably, merely syphilis in its more remote stages. It is, in short, a protei- form malady, capable of assuming a great variety of forms, often as difficult to distinguish as it is to treat them. It must necessarily follow that a disease, the specific principle of which remains so long in the system, must have, so to speak, many outgrowths hanging, like jypthe, upon its outskirts, and exhibit- ing theinselveiFin a great variety of forms, often de- scribed as so many separate and independent affec- tions under different names. In its original sense, the word struma had a very limited signification. Hypocrates, Galen, Celsus, Oribasius, Aetius, and other early authors restricted it to glandular enlarge- ments of the neck, axilla, and groin.” “ The doctrine that scrofula and phthisis are gener- ally, if not uniformly, merely a transformation, a de- generation, or a remote effect of the syphilitic virus, was entertained for ages by some of the ablest writers, such as Astruc, Rosenstein, Camper, Stoll, Selle, Por- tal, Alibert, Richerand, and Rugol.” ‘ ‘ At the present day, the affections included under this denomination amount to upwards of twenty. Among the more common are chronic enlargements of the lymphatic glands, various eruptions and ulcer- ations of the skin, embracing the milder forms of lu- pus, chronic abscesses, especially psoas and lumbar, Pott’s disease of the spine, psorophthalmia, chronic amygdalitis, caries and necrosis, ozaena, and certain inflammations of the eye, known as strumous, cox- algia, and white swelling, as it was formerly called, onychia maligna, otorrhcea, rickets, arachnitis, hy- drocephalus, pemphigus, sycosis, keratitis, and the notched and irregular condition of the teeth of in- 10 fants and ftiildren, so abl)' described by Mr. Hutch- inson, of London.” ‘ ‘ The affinity of scrofula and phthisis is now well established. The powerful minds that have been directed to these investigations have cleared away a vast amount of rubbish and firmly established the fact, now universally recognized, that the syphilitic virus is capable of infecting every particle of living matter, and, consequently, of producing changes in the organs and tissues of the most diverse character not even dreamed of forty years ago. ’ ’ “It has been argued that, because scrofula is not like syphilis, a contagious or inoculable disease, it cannot, therefore, be of a syphilitic origin. Such an assertion simply proves nothing; it is, in fact, a mere begging of the question. The force of the vaccine virus is much diminished, and in many instances en- tirely lost, after several vaccination, and the same is true of all infectious or contagious matter whatever. Its natural tendency is, in time, to lose its virulence, and eventually to die out, or to part with its specific properties. Scrofula and phthisis, however, are generally, like syphilis, hereditary affec- tions. In how many generations they may retain their specific powers before they are finally deprived of them, we have no means of determining. It must be confessed that it is often difficult, and sometimes impossible, to obtain the links necessary to construct the chain which connects these three diseases. The two great obstacles are: i. In obtaining satisfactory information concerning cases extending back a number of generations to persons long since dead. 2. The par- ticular proneness of women to conceal everything af- fecting the character of their offspring, especially when it relates to so delicate a matter, however closely they may be interrogated. It may be assumed, as an in- controvertible fact, that scrofula and phthisis are most prevalent wherever syphilis has the firmest hold upon the people. The children of phthisical parents are almost invariably strumous, and the taint engen- dered often runs through several generations, up- rooting, not infrequently, entire families. On the other hand, it sometimes skips a generation and ap- pears in the next succeeding one, just as family like- 11 nesses sometimes do.” If these statement now pre- sented be true, it is difficult to conceive a conclusion other than that these three diseases are akin, with but one primitive cause—impure sexual intercourse. I have myself long been a firm believer in this doctrine, and I cannot see how any one who has much experience in this class of diseases, or who has made himself familiar with the literature upon the subject, could come to a different conclusion. A passing notice with regard to the prevalence of these diseases must close this branch of the subject. But here, again, we have to lament the want of reli- able information so desirable in the settlement of a question of such magnitude and importance. That these diseases are widespread, that they have a deep and abiding hold upon the human race, and that they are annually causing a frightful mortality—it not being an overestimate, that three-fourths of all deaths can truly be ascribed to either direct or indirect in- fluence of these three diseases — no one at all ac- quainted with these maladies will for a moment doubt. I assume that upon this subject all enlight- ened practitioners are agreed. Dr. Lawrence F. Flick, in a paper read before the Philadelphia County Medical Society, January n, 1888, says: “For twenty-four hundred years, and probably during all preceding ages, some of the best minds the world has ever produced have studied and coped with phthisis, and, in spite of the accumula- tive knowledge of all these years, about one-fifteenth of the human family falls a victim to it yearly. There is not a clime in which it does not exist, nor a period of life in which it does not occur. Since it cannot be cured, it is but reasonable to try to prevent it, and much has been done in this direction during the last century. What percentage of deaths was due to con- sumption in the days of Hypocrites cannot be known, but that it was large would appear from his words : ‘ Consumption was the most considerable of the dis- eases which prevailed, and the only one which proved fatal to many persons. ’ Statistics are equally barren until about the seventeenth century, the first being given by Dr. Heberden in ‘Dr. Bateman’s Diseases of London’; in 1669, the deaths from consumption were 12 to the whole as about one to six and two-tenths ; in 1749, one to about five and five-tenths ; in 1799, one to about three and eight-tenths ; in 1808, one to about three and six-tenths; and in 1880, one to about ten. This improvement is not due to a larger number of cures, but to a more successful prevention that follows in the wake of civilization.” Prof. Kobner, of Berlin, Chairman of the Com- mittee on Collective Investigation of Syphilis of the Deutscher Naturforscher und Aerzta, has issued a circular, in March, 1888, asking for information re- garding syphilis and the method of treating it. The circular states : “ On account of the one-sided method of making and recording observations, there still re- main many points in the pathology, and especially the treatment of syphilis, as regarding the relations of syphilis to other diseases, for which thousands of cases might be utilized. Furthermore, it is important, for purposes of comparison, to know how other dis- eases, such as scrofulosis, tuberculosis, etc., are affected by the complication of syphilis and the method of treating it. Such an investigation, well carried out, can scarcely prove otherwise than valuable. ’ ’ (Journal American Medical Association, April 21, 1888 ) So much for the etiology and history of these three grave maladies. Their consideration has been neces- sary in order to study intelligibly the means for their prevention. The earnest seeker after truth should be both progressive and conservative. This is an age of brilliant scientific investigations and dazzling theories, and while we should not be captivated by this bril- liancy, we should give them an unprejudicial exami- nation and an impartial judgment. The advanced thought of to-day is the conservatism of to-morrow. The winnowing sieve of experience separates the grains of truth from the chaff of error—the former is eternal ; the latter is the rubbish of the past. The world is full of books, but not a very large volume would contain all well-proven facts. Against all the innovations of new theories stands conservatism, de- fending the theories of the past as a patriot defends home and country. ‘ ‘ How far what we now regard as ' necessary truths ’ may require modification in the future, it is impossible 13 for us to judge, simply because we can no more con- ceive of anything beyond the range of mental develop- ment we have ourselves obtained, than a man born blind can picture visual objects.” (W. B. Carpenter.) Scientific thought is ever progressive, and new theories are evolved from the old. “The originals,” says Emerson, ‘‘are not ori- ginals.” ‘‘And there is no new thing under the sun.” (Ecclesiastes, 1--9.) While Solomon says “ there is a time for all things under the sun.” The law of inertia has been and remains to be the chief weakness and danger of the medical profession. While many former objections now rest with other agencies, there are new lines of action which to neglect is a reproach. Humanity requires that we change our front to meet its enemies and dangers, however new or old. The rapid changes and de- mands of the condition of modern life imply high requirements of a calling whose relations thereto are so various and intimate as are those of our profes- sion. Insanity, intemperance, marriage laws, foeti- cide, food adulteration, sanitation relative to con- tagious diseases, are some of the subjects and interests which from questions of mere speculative interests, have but recently grown to great practical realities and issues. But the subject under discussion, whose relations are more urgent than any other for the health and life of our people, still remains for solution. Viewed from this standpoint, a standpoint of a purely hygienic character, the question assumes momentous importance, and it becomes our solemn duty, as the representatives of a great and learned profession, to look it squarely and boldly in the face, and rise en masse, marching to the front, and discharge our duty, which is metaphorically, but aptly, set forth in the following passage from Eord Bacon: ‘‘Be not like the empiric ant, who collects from every side indiscriminately for present wants ; nor speculative, like the spider, who, seeking no mate- rials from abroad, spins his web of sophistry from the recesses of his inner being ; but imitate rather the praiseworthy bee, who, gathering crude honey from various flowers, stores it up within, and, by his own operation, matures and perfects it for future use.” “ It is held in law that whosoever accelerates death, causes it.” (Taylor’s “Medical Jurisprudence,” American edition, 1861, p. 470.) Progress in measures for the protection of human life consists in exposing the consequences of their neglect. When Rome was the mistress of the world, her men and women were noble specimens of humanity; and it was not until after the introduction of all kinds of luxury, immorality, debauchery, and crime, that her glory fairly began to decline, and eventually culmi- nated in utter debasement and ruin. In proportion as the people of a country deteriorate in physical and mental powers, are its degradation and the danger of its ultimate downfall. We, as a people, of the State of Kansas, boast of the rapid increase of our popula- tion, and of the general diffusion of knowledge, but we seem to forget that the glory and prosperity of our State consists, not in the number, but in the character of our people. If these statements be true, and no one, I am sure, will gainsay them, it necessarily follows that the prevention of these diseases is a matter of far greater import than the attempt to cure them after they have been developed. How far the syphilitic virus, combined with the degrading arts of the shopkeeper, affects the present standard of the people of this country—which stands, as it does, without a precedent—is an interesting ques- tion for the solution of the physiologist, the philoso- pher, and the statesman. In view of the fact that no preventive measures hitherto devised are at all trust- worthy, and in view of the further fact that the sexual passion must and will seek indulgence, and inasmuch as the greatest risk of infection occurs at brothels or in houses of ill-fame, the question arises, How, or in what way, may these risks be reduced to their lowest minimum ? ' A wide field for useful exertion is here opened for the sanitarian. All must acknowledge that the prac- tice which has grown out of the germ theory so ably 15 taught by Lister and his zealous disciples, and which has laid the foundation of late advancements in sani- tation, has proved beyond doubt or cavil, that scrupu- lous cleanliness is the essential factor to success in all surgical operations, as well as in all sanitary regula- tions. If proper precautions were observed in unclean sexual congress, much of the danger of inoculation might be effectually avoided. In support of this view, we have the opinion of Lawson Tait, who says : “I am well satisfied that venereal diseases might be stamped out if more scrupulous attention were given to the toilet of the genitals.” Cold water, simple or medicated, with some astrin- gent substance as alum, common salt, chlorinated soda, etc., used judiciously, immediately after the commission of the act, generally completely neutral- izes or washes away the infectious matter, and thus insures immunity from further mischief. Few per- sons, however, are aware of the importance of such precautions, or, if they are, they neglect their employ- ment until it is too late to reap any benefit from them. Cleanliness of the genitals, certainly may be truly expected to strengthen the general, and especially the nervous, system by removing those sources of irrita- tion which by sympathy and reflex action so often act unfavorably upon it, and thus promote continence by diminishing the pruriency of the sexual appetite. That it really does produce these effects is a matter of no conjecture, when we have the most experienced and ablest writers ascribe to uncleanliness of the genitals a cause of pruritus vulva, follicular vulvitis, purulent vulvitis, periuterine cellulitis, pelvic peri- tonitis, acute endometritis, chronic cervical endome- tritis, chronic corporeal endometritis, chronic metritis, granular and cystic degeneration of the cervix uteri, vaginismus, etc., in the female; and in the male phymosis, paraphymosis, balanitis, etc., with their train of evils ; while in both sexes epilepsy, insanity, and nervous diseases can largely be attributed to this cause. “Cleanliness is next to godliness”—the oldest sanitary law on record, which, being duly observed, man will have no reason to criticize the ordinance of 16 God, “ It is not well for man to be alone,” and thus we have the loveliest part of his creation—woman, who in her pure and virtuous state is the delight of all mankind, both young and old ; of her, man can truly exclaim as did Goldsmith of his muse : Thou source of all my bliss, and all my woe, That found’st me poor at first and keep’st me so. My object in this address is to call attention to methods and materials, if there is not another field, of far greater import, for the labors of the sanitarian, than the prevention of cholera, yellow fever, small- pox, scarlet fever, etc., which is altogether neglected within the borders of our State, as well as in our whole country. And if another Finds tongues in trees, books in running brooks, Sermons in stones, and good in everything, may I not hope to see these remarks serve as a means to make our standard as sanitarians productive of much good to the State of Kansas. I am fully cog- nizant of the law that “A stream cannot rise higher than its source,” but we must feel responsible of great neglect of duty, so long as we do not manifest by our labors the principle that the greatness of a State de- pends upon the greatness of its people. The idea of a sound mind in a sound body, the value of physical health to the State and individual, is not new, for it was well known to Moses—the creator of preventive medicine, the greatest and wisest legislator the world has ever produced, who laid down the first definite sanitary regulations in regard to persons infected with venereal diseases, by whom if was fully recognized that a sexual sin committed to-day may prove a curse to our offspring generations hence. ‘ ‘ Of all arts, ’ ’ as has been happily observed by an ingenious writer and thinker, “the grandest is the art of forming noble specimens of humanity.” This was all profoundly felt as early as the time of Moses by the Jews, whose idea of promoting health by pre- venting themselves from becoming sick was the foun- dation of their sanitary regulation. The foremost subject of their code was dietetics. The Jews were good feeders. They were rich in sheep and cattle, and partook liberally of fresh meat. It has been said 17 that the greatness of England is founded on beef and beer. Undoubtedly, that of the Jews was partly due to a plentiful supply of meat. The flesh of reptiles, of all carnivorous animals, and of swine was, how- ever, condemned as unclean (Lev. X, i.) So also the flesh of diseased animals, or those which died a natural death. The prohibition against pork, con- sidering the heat of the climate, and its liability to be diseased, must be considered as a safe, if not abso- lutely necessary provision. It was left for the youngest of the sciences—histology—through the discovery of the trichina, to fully expose to the modern world the transcendent wisdom of the Hebrew law giver on sanitation. The laws concerning ‘ ‘ issues ’ ’ or discharges from the genital organs, both of men and women, display a similar wisdom. The word “issue” seems to be used indifferently for discharges of blood, pus, or mucus. The dangerous character of all such dis- charges was fully understood, and but little attempt was made to discriminate between them. All per- sons so affected were declared ‘ ‘ unclean. ’ ’ (Lev. XV.) They were obliged to live apart, and abstain from sexual intercourse. Their clothes, bedding, and cooking utensils were also declared “unclean.” Any person even touching them was obliged to wash care- fully his body and his clothes. This regime was contin- ued for seven days after the cessation of all discharges, after which a thorough ablution of both person and clothing was necessary before the affected individual could resume his place in society. With women, after childbirth, from one to two months of isolation was required. It is easy to see that these rules, if faith- fully carried out, would be an efficient preventive of gonorrhoea, syphilis, and all other venereal diseases. What better law was ever conceived by man, or what can we, as sanitarians, do better to-day than to abide by this code ? Yet, we, in our enlightened age and country, dare not legislate on the subject of venereal diseases, blindly refusing the protection of the law not only to the guilty victims of illicit pleasure, but to great numbers of innocent men, women, and children, who have to suffer, and often die, for the faults of others. 18 Appalling as these facts are, they have attracted little or no attention by our sanitarians, boards of health, and legislators. A great pestilence—like cholera, small-pox, scarlet fever, etc.—startles a whole com- munity, and every one asks for a remedy; the church offers up her vows to God; and the physician is en- treated for his aid and counsel; but when a pesti- lence like syphilis, scrofula, or phthisis stalks about in our midst, poisoning the very fountains of health and life, people fold their arms and look on in blind unconcern. Leaving wholly out of view the human aspect of the question, the mere pecuniary loss to the State from such defective, nay, want of, legislation is incalculable. Let us no longer be among those who entertain the flattering unction that the profession wields ‘ ‘ a potent influence and commands high honor of the public,” for, should we attempt its verification upon the floor of our State capitol, the conclusion would not be slowly rendered that the ‘ ‘ glorious call- ing ’ ’ business is a fact of the faculty address, a mere dress-parade tinsel, to be brushed aside by the wave of the hand, whose “honor” represents the preju- dices of the ignorant and the foolish, as well as “a guilty conscience doth make cowards of us all.” ‘ ‘ Positive action must be organized to check positive evil, to promote the public good, and to heal the fes- tering sore under which the country has so long groaned.” All must lend a helping hand in this great enterprise—the physician, the legislator, the philosopher, the philanthropist, the churchman, and the politician, nay, woman herself, too, should give her influence. Conjuncte stamus divisi catimus. Nor is it safe for us to enter into any disputes on this subject, for, as Denham so beautifully reminds us, The tree of knowledge, blasted by disputes, Produces sapless leaves instead of fruits. Thus, united in purpose of action, there is little to be feared from sweeping away prejudices surround- ing it, and of overcoming the ravages of the wolves, who have not been idle while the proper shepherds or scientific guardians of public health and welfare have slept. The remarkable exemption of the Jews from syph- ilis, insanity, and nervous diseases—even their gen- eral good health and longevity—may, in no small degree, be attributed to—not the rite of circum- cision, as has been alleged, for this is practised only in the male—the scrupulous attention given to the toilet of their genitals as well as their obedience to their rigid laws regarding sexual intercourse. It is this, and this alone, that has made the Jews the healthiest race in existence. Thus, they have pro- duced the greatest men and contributed more to the advancement of civilization than any people known to history. However degenerate, morally speaking, some of their modern descendants may be, they certainly have not degenerated physically; thus prov- ing the falsity of the often-repeated assertion that civili- zation tends to physical weakness, for the Jews have been longer civilized than any other highly-cultured people. May we not, then, venture the inference that, so far as the Jewish law relates to this subject, in the production of these wonderful results, we might profitably imitate similar legislation. Proud as we are of the great discoveries of modern science, we cannot repress a feeling of wonder at the astonishing wisdom of these old laws. Does not this remind us that we are far too apt to forget the great- ness of former ages in our boastful praises of the times in which we live ? It is good for us to turn back now and then to cull a lesson from the past, where we can find much that we ourselves might advantageously copy and do good to our fellow crea- tures as well as do reverence to the memory of the mighty dead ; for we should ever be mindful that ‘ ‘ our light shines none the less by shining for others.” Prof. S. D. Gross, from whom I have so largely quoted, observes very justly : ‘‘Sexual intercourse is an imperious necessity, implanted in our nature, for the gratification of which man will brave any dan- ger, however great to health and even life. Man, whether descended from the ape, or whether created in the image of his Maker, is still an animal, who, but for the humanizing influence of civilization and Christianity, would be more savage and degraded than the wildest beast of the forest. If this postulate be admitted, it requires no argument to prove that pros- 19 20 titution is an essential necessity to society. If pros- titution were abolished, crimes of the most heinous and revolting character would be of incessant occur- rence, and no virtuous woman would be secure from the assaults of the libertine. ’ ’ “ Regarding prostitution as a necessary evil, an evil which has existed from the earliest periods of society, and which must endure to the end of time, until the angel Gabriel shall sound the last blast of his trumpet to summon together a fallen world, it should be the duty of every right-thinking, rational, progressive man to do all he can towards the suppres- sion of an evil far more pernicious in its influences and effects upon mankind than any of which we have any knowledge, drunkenness not excepted. In reflecting upon this subject, I am sometimes in- clined to believe that prostitution is the normal con- dition of the human race. Or, if we reject this proposition, so offensive to good taste, it must be admitted, the possibility of doubt or cavil, that the practice is so intimately interwoven with our social system as to form an essential part of it. In either event, the evil is a most sad one.” Prof. S. D. Gross, of Philadelphia, Pa., wrote: ‘ ‘ The only remedy for this evil is the licensing of prostitution, a remedy which has worked so well on the continent of Europe and in England as to deserve to be introduced into this country, where, as abroad, under proper restrictions, it could not fail to be pro- ductive of vast good in promoting the national health and lessening the mortality from numberless diseases. To legalize crime, as prostitution has always been considered to be, is to arouse at once the worst preju- dices of the public, and to excite the bitterest opposi- tion, on the ground that such a measure would tend to encourage vice and immorality. But would the licensing of brothels, or houses of ill-fame, really have such an effect? I answer unhesitatingly, no. The greatest opposition to the enactment and the efficient enforcement of a law licensing prostitution would necessarily come from the clergy and other religious people, who, without understanding the nature of these diseases and their extensive preva- lence, too often regard them as visitations of Provi- 21 dence, and every measure of this kind as an unholy attempt to “license shame,” “legalize vice,” and ‘ ‘ encourage crime, ’ ’ and other twaddle, as unmean- ing, when applied to such a serious matter, as it is unbecoming a Christian people.” “A large portion of the male population,” says Sir William Jenner, “are, at the age when the pas- sions are strongest, precluded by the necessity of their position from marriage. Under such conditions, either prostitution, seduction, or masturbation will be the prevailing vice. If by law public prostitution could be put down, the two latter of these three vices would undermine the health and lower the moral nature of the masses far more than does the present prevalence of the social evil. This inverse relation in the prevalence of masturbation, illegitimate chil- dren, and prostitution cannot be too strongly im- pressed on the public mind. All men have a repug- nance to referring to these matters, but it is our duty to do it. On the attention of the so-called religious this duty should be especially enforced. But prosti- tution is necessarily accompanied by syphilis. Syph- ilis more often than has been commonly believed means death—death to the primarily syphilized, and death to his offspring. The spread of this knowl- edge may have a little effect; but my experience has never yet made me acquainted with the case of a youth made continent by the fears of syphilis, but it has taught me that, where a youth is deterred from promiscuous sexual intercourse by the mere fear of contracting disease, he, as a rule, gratifies his desire in even a more discreditable manner. The vicious gratification of a natural desire is the cause of syphilis. If every young man curbed his pas- sions, syphilis might die out.” ‘ ‘ Let teachers of morality and religion endeavor to impress on young men and lads, above all the latter, the necessity of exercising this restraint. But until they have succeeded in their teaching, it is the duty of authority to prevent, as it could to a great extent, the spread of this terrible disease. Moral teaching may do something; the spread of knowledge and society can do almost nothing; but law could do much to diminish the mortality from syphilis. It 22 could prevent the prostitute from plying her trade in the public thoroughfares, and thus keep temp- tation to some extent out of the way of the merely irresolute and thoughtless. It is a disgrace to au- thority that it does not frame and enforce such a law. Again, law could check, to a great extent, the wide diffusion of syphilis. A little has been done in this direction; more is being attempted; but something more than the ‘ Contagious Disease Act ’ is necessary if the community at large, and not only our troops, are to be benefited.” (‘‘Practical Medicine of To- day,” p. 46.) This latter remark of Jenner’s regarding England is equally true of this country to-day. For it is to be seriously regretted that the bill (H. R. 1526) to prevent the introduction of contagious and infectious diseases, and to establish a Bureau of Health, now before Congress, does not, as a careful examination of its provisions will show, contain, or cover, any- thing relative to the terrible diseases and important measures now under consideration. One of the most serious questions which yet re- mains for solution, by Congress, is, what disposition to make of the millions of dollars of surplus remain- ing in the United States Treasury to-day. It is diffi- cult to conceive if a more honorable and more bene- ficial—alike to Congress and the people—disposition could possibly be made by Congress of this surplus than to make sufficiently liberal appropriations to provide for all requirements in enabling ‘‘The Medi- cal Profession,” ‘‘The National Board of Health,” ‘‘The American Public Health Association,” etc., to successfully secure the enactment and enforcement of such laws as shall, from time to time, be found neces- sary to effectually bring about the absolute Prevention of Contagious and Infectious Diseases —including Special Acts and Provisions as to Syph- ilis, Scrofula, and Phthisis. Prevention of Adulterated Foods and Drinks. Prevention of Renting or Occupying Death-traps in the form of Houses. Prevention of Housing School-children in Sickly Dens. Prevention of the Causes of Disease, Injury, and 23 Death in American Manufactories and Work-shops. Prevention of Intemperate Use of Alcohol, To- bacco, Opium, etc., together with all other habits and customs leading to cause disease, vice and death. Prevention of the Publication of Unwholesome Literature. But it will be said that if prostitution be an evil and the source of syphilis, scrofula, and phthisis, the three most grave diseases known to mankind, instead of licensing it, it should be stamped out. Where is the power to do this ? Will the clergy stamp it out with his Bible, his tracts, and his prayers? The philanthropist with his money and his kindly acts? The philosopher with his subtle arguments and finely-spun theories? Or the legis- lator with his laws ? It has well been said that “ as well might we attempt to dry up the Atlantic Ocean, or to arrest the movement of the earth around the sun, as to attempt to arrest prostitution by such means.” The question arises here, Why, or how, do women become prostitutes ? This is so ably an- swered by Prof. Gross, that I shall quote his own language: ‘ ‘ What are the motives or incentives which induce them to enter upon a life of depravity and degrada- tion, rendering them objects of scorn and contempt with their fellow creatures, outcasts of society, and unfit for their heritage which is allotted to God’s people ? The question is easily solved; indeed, the whole matter may be summed up in a few brief sen- tences : “ i. Natural depravity, or want of innate moral principle, similar to that which makes a man a thief, a liar, or a drunkard. ”2. Uncontrollable sexual passion, similar to that which makes men and boys onanists and prompts them to resort to expedients and crimes to gratify their appetites. ”3. Cruel treatment of parents, driving their daughters from their homes, and thus compelling them to seek asylums among strangers. ‘‘4. The wiles of the seducer, by which a girl under promise of marriage becomes pregnant, and is afterwards cast off by her family and friends. 24 ”5. Poverty, or the impossibility of gaining a livelihood by honest labor. ‘‘6. Fondness for dress or show, so common in the female in all ranks of life that it may be regarded as an inherent principle of her nature. “ 7. The influence of bad company, often aided by privation and a love of liquor, finery, or sexual en- joyment. “ To these causes may be added, at least as being eminently true of our own country, our expensive modes of living, especially of female dressing, which prevent men from marrying women who would make excellent wives, but who, because of this circum- stance, are reduced to poverty, for the relief of which refuge is sought in public and private prostitution.” From what has been said, it is an incontroverti- ble fact that all that is known with any degree of certainty is that these three diseases exist everywhere, both among civilized and barbarous nations, where promiscuous sexual intercourse is practised. That the syphilitic virus is the primary infection, and that scrofula and phthisis are the children of father syphilis; and thus these three diseases have for their primitive cause or origin impure sexual intercourse. That the greatest channel of this infection lies in the great evil of prostitution. That the greatest good in prevent- ing these diseases must be looked for in suppressing or restraining and purifying—if it cannot be stamped out—the greatest of all vices, prostitution. The only remedy for this evil, says Prof. Gross, ’‘is the licens- ing of prostitution.” An appeal to the operations of the license law in foreign countries will convince the most skeptical of their beneficient influence in preventing these diseases. Mons. Lancersaux, with whose learned treatise on syphilis every physician is familiar, in speaking of oublic hygiene in its relation to syphilis, says : ‘‘All other things being equal, syphilis rages with greater frequency in proportion as prostitution is less watched over—that is, wherever there is unlicensed brothelism there is the greatest amount of syphilis, and con- versely. ’ ’ PREVENTIVE MEASURES—FOREIGN. 25 In Brussels the risk from syphilis, from intercourse with public prostitution, has become reduced almost to a nullity. In Paris, Berlin, and Vienna the diminution has been most marked. In the Ionian Islands, at Malta, and in the islands at Corfu, Zante, and Zephalonia, where the registra- tion and inspection of prostitution are rigidly enforced, venereal diseases have almost wholly disappeared. Mr. Deverell, of the Portsmouth Royal Hospital, declared at a public meeting : “I have watched the progress of the Contagious Diseases Acts from the first in their operation upon the sailors, and I believe that a greater blessing has never been conferred upon the Army or Navy.” In St. Louis, which has taken the lead in this matter, prostitution was legalized about fifteen years ago. But being only a few years allowed when the Legislature of Missouri saw fit to repeal the ordi- nance ; on what grounds does not exactly appear. Doubtless the prejudice of the religious portion of the community brought about this result. The Missouri Medical Record (May 15, 1874) says the following re- garding it: “ That the system had acted most bene- ficially in the interests of the community and the welfare of the prostitute. Many of the imates of the House of Industry, influenced by the ministration of good men and noble women, had been seeking the ‘purer and better wav,’ and had become so fully aware of the physical advantages arising out of the law, that not a few of them voluntarily subjected themselves to inspection, at their own expense, after the abrogation of the ordinance.” In Cincinnati attempts have been made in the same direction. In Illinois the Legislature had the matter under discussion. In Philadelphia, Pa., January, 1874, the Grand Jury, in its presentment to the Court, urged the adoption of some legal measure for the protection of society against the spread of venereal diseases. In March, 1874, the Legislature of Pennsylvania took PREVENTIVE MEASURES—DOMESTIC. 26 up the subject, and an admirable address was made by a member, Dr. Cressler, and a bill was framed containing numerous provisions for the suppression of this class of affections. Bill. — The provisions of such a bill should be couched in the clearest language, and should be enforced and carried out by the fewest number of officers consistent with their due observance. City Councils and city police authorities should be pro- hibited from serving on the board, the most suitable of which would be the Board of Health. The exam- ining physicians should be moral and well-educated men, appointed by the Board of Public Charities, with a liberal salary; they should be thoroughly ac- quainted with the nature of venereal diseases, and scrupulously conscientious in the performance of their duties. Inspections should be regularly made at least twice a week among the female prostitutes, and no male allowed cohabitation unless first subjecting him- self to an authorized examiner and furnishing a cer- tificate of cleanliness. All women or men found to be unclean should at once be placed in quarantine, or under proper restraint, as the only means of preven- tion. Prostitution is an occupation, a profession, a trade, a business ; and is the degraded creature who follows it and infects those who hold commerce with her any better than the baker who sells unwholesome bread, the woman who poisons her customers with decayed vegetables, or the butcher who sells infected meat, a crime which in the dark ages used to be punished with death? On this basis there remains no doubt in the rational mind but that the only ultimatum to the absolute prevention of these diseases is the sup- pression of prostitution. What effect the establishment of anti-prostitution societies might have in arresting the “social evil” is only a matter of conjecture, as the experiment has never been tried. Moral and religious influences have been attempted in promoting the reform of the “fallen sisterhood,” but with no apparent benefit. The first and probably only attempt of this kind was made in February, i860, at St. James’ Hall, Lon- don. A public meeting for this avowed object was 27 held in behalf of this class of women inhabiting the purlieus of the Haymarket and Regent Street. It was headed by a number of benevolent and pious persons, and about two hundred of the fallen women were present. Tea and coffee were liber- ally served. Elegant appeals were made, and many of the poor creatures expressed not only a willingness, but a great desire to forsake their evil and wretched life and to return, through the gates of a reformatory, to a respectability and usefulness. But the actual success of this meeting in its final results has never transpired. It must be obvious that all such attempts to “snatch a brand from the fire” must prove abor- tive. Tea and coffee are good things in their way; a kind word timely spoken has its efficiency; a sermon upon morality has its benefits; but a loaf of bread, a good, warm dress, a comfortable bed, and a sweet breath, a healthful and pleasing employment of the mind and body, have a greater potency, and do more towards reclaiming fallen women than all the efforts, the eloquence and the persuasive power of the pulpit, the missionary, or the legislator. I freely acknowledge that in this estimate I may be entirely in error ; but so strong are my convictions that I would be recreant to them did I speak less de- cidedly. Time, the test of the value of all things, will settle this matter, though I be among the small majority, who believe as I do, I am perfectly willing to entrust the solution of this problem to the verdict of time, the great crucible of human theories. It is devoutly to be wished that all men and women infected with the seeds of syphilitic virus and of the so-called scrofulous maladies, especially pulmonary phthisis, should altogether refrain from matrimony. Pains should be taken to instruct young men and women in our colleges and seminaries of learning as well as in our private homes, in regard to the dangers of promiscuous sexual intercourse; and, indeed, it would be well if the same kind act were extended to all large bodies of men or women, wherever or for whatever purposes congregated. Nor should it be forgotten that private prostitution is often quite as dangerous as public. 28 The subject is one of deep interest to life insurance companies, and to every charitable citizen disposed to spend his means in the promotion of the public weal. Man)' of the inmates of our deaf and blind asylums are the descendants of syphilitic parents, who thus manufacture diseases and infirmities to be treated at the expense of public and private charities. Our hospitals are filled with persons affected with ma a- dies dependent, directly or indirectly, upon syphilitic infection. The path is not a new one; other men have walked upon its slippery surface, and have shown the world that they were not afraid to en- counter its perils. It is the duty of the medical profession to know in how may instances, forming, indeed, a vast majority of the whole, bodily suffering and sickness are the natural fruits of evil courses—of the sins of our fathers, or of our own unbridled pas- sions, of the malevolent spirit of others. It is equally our duty to see, too, the uses of these judgments, which are mercifully designed to recall men from the strong allurements of sense and the slumber of tem- poral prosperity. Being thus constantly reminded, and by virtue of our calling having brought beneath our minute and daily notice that most remarkable portion of matter, with which the human spirit is here mysteriously tabernacled, and which, apart from that singularly interesting thought, awakens increas- ing wonder and admiration the more closely we inves- tigate its marvellous construction, the sad varieties of human pain and weakness with which our daily vocation is familiar should rebuke our pride while they quicken our charity ; for it is our profession that is alike to the quality of mercy, of which it is the favorite handmaid, “ it blesseth him that gives and him that takes,” reading continuously to our hearts and understandings the most impressive lessons, the most solemn warnings. Prejudice is a most powerful obstacle to success in any great, difficult, or novel enterprise ; and it is only by associated effort, and by undaunted perseverance that anything within the limits of human reason and ingenuity is eventually brought to a triumphant issue. The age of miracles is past; the sun no longer re- volves around the earth ; the belief in witchcraft has ceased to be a crime ; the inquisition has been abol- ished ; lawyers no longer believe in witchcraft as did Blackstone, nor do physicians in the theory of Galtn, that the arteries were for the circulation of air ; and, although the world is still infected with numerous superstitions and follies, many, many things, consid- ered at one time as impossible, are in successful opera- tion, lightening the burdens of labor, extending the boundaries of civilization and Christianity, and bring- ing us daily into more close and infinite relation with the Creator. Knowledge is originally bounded by narrow limits ; it is only by degrees that it expands and assumes definite proportions, shedding its luminous rays upon the objects of its investigations. Deep-thinking, rational man will never stop at facts: he will ever seek to search for ultimate causes, however fruitless his efforts may be. He will possi- bly push his investigations to the first beginning of things, but beyond this is the original act of creation, ‘ ‘ thus far shalt thou go and no farther. ’ ’ But what- ever good may result from the discussion of this sub- ject, we must agree that no positive good can result from one-sided legislation. The enactment of laws should not be limited to the female sex ; they should be made to equally apply to males. In the language of John Simon : “A quarantine which is ineffective is a mere irrational derangement of commerce; and that to be effective, it must be of such a nature as to ab- solutely prevent all intercourse with the infected country.” With your cordial cooperation in securing proper legislation, many lives, much suffering and sorrow, and untold wealth can be saved to the people of this State every year by preventing or restricting the spread of these diseases. Without it all of our labors and all the rules and regulations we have made or can make will continue to be “ as idle as a painted ship upon a painted ocean. ’ ’ Kvery word of which is as true as gospel. Much of this sickness is preventible, and I appeal to each and every one of you brethren in the profession for careful sanitary measures in the name of the great science whose dis- ciples we all are, and in the name of the humanity 29 30 for whose good and protection we all labor to join in the effort to place the medical profession in the front rank of this movement—the position it has occupied in the past on all great questions and reforms. This is the estimation of all true physicians : No pent-up dogma restricts our powers. The boundless universe is ours.