[Reprint from The Journal of the Arkansas Medical Society, for June, 1893.J THE PREVENTION OF VENEREAL DISEASES ANNUAL ADDRESS BY JAMES T. JELKS, M. D.( OF HOT SPRINGS, President Arkansas Medical Society. Chairman Section on Surgery and Anatomy of American Medical Association ; Member of Southern Surgical and Gynecological Society, of Mississippi Valley Medical Society, of Society of American Obstetricians and Gynecologists; formerly Professor of Genito-Urinary and Venereal Diseases in College of Physicians and Surgeons, Chicago, 111., and Professor of Gynecology and Syphilology in Barnes Medical College, St. Louis, Mo. BROWN PRINTING CO., LITTLE ROCK [Reprint from The Journal of the Arkansas Medical Society, for June, 1893.] THE PREVENTION OF VENEREAL DISEASES ANNUAL ADDRESS BY JAMES T. JELKS, M. D., OF HOT SPRINGS, President Arkansas Medical Society. Chairman Section on Surgery and Anatomy of American Medical Association; Member of Southern Surgical and Gynecological Society, of Mississippi Valley Medical Society, of Society of American Obstetricians and Gynecologists; formerly Professor of Genito-Urinary and Venereal Diseases in College of Physicians and Surgeons, Chicago, 111., and Professor of Gynecology and Syphilology in Barnes Medical College, St. Louis, Mo. [Delivered at the Eighteenth Annual Session of the Arkansas Medical So- ciety held at Batesville, May 31 to June 2, 1893.] In discussion of this subject it is well for us to review somewhat the history of prostitution. We may start out with the statement that illicit sexual in- tercourse is as old as the human race. The sexual passion may be classed as the strongest, and one which may well be termed inherent, in man as well as the lower animals. Then the study of the prevention of venereal disease is closely allied to the history of prostitution. We may view the latter under three heads or divisions, viz.: patriarchial, religious and legal prostitution. The first of this class takes us back—I liked to have said to the earli- est dawn of history—I should say to prehistoric times. Under the guise of hospitality, the patriarch of olden times, when he entertained a stranger in his tent, abrogated for the time being his position as head of the family—and, the stranger having eaten of his salt, was privileged to sleep with his wife or daughter, as the case might be. This form Prevention of Venereal Diseases. of prostitution was very common among the ancient patri- archs, and may today be found among the Japanese. It is said of this strange people that they are the kindest people in the world ; that they will give you anything they have ; give you their wives or daughters to sleep with you if you are a guest. Among a people so primitive the spread of venereal dis- ease must be an easy matter when once it is started, and, as a matter of fact, it has left an indelible stamp upon the Japanese. Religious prostitution may next claim our attention. And in studying this we uncover one of the strangest things in the annals of man, and one which should call the blush of shame to the cheek of humanity. There have been, and there are, many strange religions; and it may be truthfully said, “ man can believe anything, so it comes to him as a religion.” Witness in this, the nine- teenth century, the development and growth of Mormonism in this enlightened country. One of the most, if not the most widely distributed and popular religion of antiquity, was the worship qf the sexual organs—Phallic worship. The sun was regarded by the ancients as the source of all vegetable life, and as such was an object of worship. From this sun worship, the source of vegetative life, it was an easy matter to the worship of the sexual organs, the source of animal life—and, as a matter of fact, this religion was universal in the Old World. The temples erected to the gods and goddesses of old were the temples of prostitution. In India this worship was very ancient and was called the worship of the Lingam. The first fruits of everything belonged to the gods and god- desses, and hence virgins must sacrifice their virginity to the gods. “The latter being unable to leave their pedestals to accept the sacrifice, it was accepted for the gods by the priests.” Prevention of Venereal Diseases. 3 Given a syphilitic priest, and it is an easy matter to under- stand the spread of the disease through this form of pros- titution . Again, says, Rosenbaum, in his history of prostitution: “ Not only did the virginity of the women belong to the gods and goddesses, but all menstrual blood, as well as the blood from a ruptured hymen, was regarded as unclean (and you know the Hebrews regarded a menstruating woman as unclean), and hence they abandoned the act of defloration to strangers or to the priests. This latter custom survives among a certain priesthood, who claim as their right the first night with the bride. I say, given a diseased priest- hood, and you see how easy a matter was the spread of venereal disease.” What the worship of the Lingam was to the Hindoos, the worship of Baal Peor—the God Penis—was to the Midian- ites and Moabites, and later to the Hebrews. You may remember that while the Israelites were encamped on the borders of Midian they went over and joined themselves to the worship of Baal Peor—the God Penis—to the worship of the sexual organs. Moses, you will remember, called together the leaders of the tribes and directed that every man who had worshiped at Baal Peor, in the temples of Baal, should be put to death, because of the disease con- tracted—“the plague of Peor”—and, as a matter of fact, twenty-four thousand were slain in one day—a vigorous sanitary measure, but one which Moses thought justified by the nature of the disease. Later Moses made war on the Midianites, and ordered that men, women and children should be slaughtered; that no prisoners betaken. When he learned, after the war, that the soldiers had brought home with them, not only the cattle and spoils of the camp, but also the women and children, he said, in effect: “ We slew the Israelites who were afflicted with this plague of Peor, and now you have brought back to the camp the very 4 Prevention of Venereal Diseases. women from whom the disease was acquired; therefore, strangle every woman who has known man carnally, but let the virgins and young children live.” His orders were immediately obeyed. Did time permit, we might stop here to contrast the re- ligion of those people who worshiped the sexual organs and that of Moses, whose God was the Jehovah, and whose re- ligion, as embraced in the Ten Commandments and later in the New Testament, is the personification of purity and love. We now come down to a later period, and call your atten- tion briefly to the worship of Priapus and Venus among the Romans. The religion of the Romans was virtually the worship of the Lingam—of Baal Peor over again—and some of the remains have come down to us at this remote time. For instance, the virtues which the people place in the horseshoe as a charm to keep off the evil spirits, is a relic of Phallic worship. These ancients carried around their necks or elsewhere on their persons an engraving of the orifice of the female vagina, deprived of the arch which was formed by the nymphae and clitoris. This, it will be easy to see, is now the famous horseshoe, the harbinger of good luck, and the emblem which, hung over the door, keeps off the evil spirits. But may we not ask what has become of the other part of these famous organs, viz., the arch formed by the nymphae and clitoris, the original electric buttons? I answer, it is the arch which binds above us when we enter the open door of the church to pray, to marry or be buried, and forms the arch of every church window. Then, you see, it is even now impossible for us to get away from this ancient worship, for it is ever present with us in the famous arched doors and windows of our temples of worship. Did time permit, I might show you that the great religious festival at the beginning of spring, when a large tree, carved into an immense phallus, was drawn into the market place, Prevention of Venereal Diseases. 5 covered with flowers and garlands and followed by the peo- ple worshiping and rejoicing, was and is perpetuated by the May-pole dance and the modern picnic on the first of May. But I must now come to the third form, or legal prostitution. This latter form, we may say, is that which exists in all civ- ilized countries. If not legalized in the strictest acceptation of the term, it is tolerated and fixed, and hence becomes legal. This, I say, is the third and last stage or form of prostitution, of»which I will now say a few words. Let me briefly say that in India, where the worship of the Lingam was universal, venereal diseases were familiar to the every-day life of the people iooo years B. C., as we see so ably set forth in a book on “ Syphilis in Prehistoric Times,” by Buset, of Paris, and translated by Ohmann-Dumesnil, of St. Louis, Mo. Buset has also collected the evidence of the existence of syphilis among the Chaldeans and Babylo- nians and the Hebrews, tracing it back 1900 years before Christ. Again, syphilis was very common among the Romans at the time of the coming of Christ, and it has been a familiar disease under various names ever since. Coming down to the present, we find prostitution and venereal disease go hand in hand. In the City of Philadelphia it is estimated by those who should know that there are over 12,000 prostitutes. The City of New York has, or had ten years ago, 15,000 women who made a living by the sale of their bodies, and of course it goes without saying that these women are supported by a large number of men. It is an established fact that all pros- titutes sooner or later become diseased, and hence it follows that their patrons must. I am here speaking of facts as we find them, and of this I hope you will not lost sight, that prostitution has always and everywhere in every community existed ; and when attempts have been made to stamp it ■out worse things have followed. As a concomitant of the 6 Prevention of Venereal Diseases. universality of prostitution we find venereal diseases as old as man and as universally distributed. Some are inclined to say that “ these diseases are a just punishment for breaking the laws of society and religion,, and that they are God’s police,” etc., etc. If we grant this to be true, so far as the guilty are con- cerned, what of the vast number of those who innocently acquire syphilis? It is estimated that 25 per cent, of all cases of syphilis are undeserved—that is, syphilis innocently acquired by the wife or husband from the erring partner, syphilis inherited by the babe from its parents. This means syphilis among the living and does not include the vast number of miscarriages, or still-born children, produced by this disease. Neither does it take into account the fact that we may say that the life of every syphilitic who gets over his trouble is shortened by five or ten years. So much is the life of man shortened by it that life insurance companies refuse to take syphilitics. Now, then, it is estimated that in the United States alone there are about 2,500,000 of people who are suffering with this disease. Say you multiply this vast sum by the sum of years of which each one is deprived by reason of this disease, and the sum total of years of labor and acquisition lost to the human family is enormous. In London it was said in 1868 that sixty-nine in every thousand patients were afflicted with venereal disease (Pre- vention of Venereal Disease, by A. L. Gihon, chairman committee); and Wagstaff estimates that of the poor in London who receive medical attention free, one in fourteen have venereal disease. It is said that one in every forty of the population of Paris have the disease. According to Dr. Sturgis’ report and estimate of the pri- vate cases, of five to one of the charitable ones in New York, in 1880 there were 61,705 cases of venereal disease, or one case in every fifteen, including men, women and children. Prevention of Venereal Diseases. 7 In the United States navy it is estimated that “one-ninth are afflicted with these diseases.” Gihon, in the report above alluded to, says that at least one man in every thir- teen in the naval service, one in every nine in the army, one in every six among the negro troops, one in every seven in the British army, and in one every four in the merchant marine who present themselves for treatment at the hospi- tals have venereal disease. This does not include the officers, who rarely report themselves as diseased.”—Report of Com- mittee on Prevention of Venereal Diseases, A. L. Gihon, chairman. I have alluded to what might be called undeserved syph- ilis. This disease may be acquired by the young woman from the kiss of her betrothed and vice versa, by the child from the diseased nurse or cook, and from the innocent child it may be again transmitted to the loving mother. The writer has seen cases where it was acquired from the pipe of a friend, from drinking cups about the hotels, from towels used by a friend, and from the kiss of affection. Not many months since he had on hand at one time three extra-genital chancres; one was situated just in front of the ear, and had been acquired from using the towel of a friend who had syphilis of the mouth. Two more, situated on the lips, and were caught in kissing. Many cases are on record where it was acquired from cigars. I find that it is quite common for cigar-makers to apply the last fold of the wrapper to the lips to moisten it before giving it the last turn or twist to fasten it in place. You can readly perceive the danger to the smokers, if one of the men has a chancre or mucous patch on his lips or in his mouth. Paper money is a source of contagion. So also is small coin when the mouth is used as a purse or depository while making change. Sheets and blankets about hotels and sleeping cars may be classed among the means of contagion. 8 Prevention of Venereal Diseases. One glass-blower frequently spreads the disease through an entire establishment. Cracked or chipped glass and queensware of hotels and restaurants may spread the disease. So you see there are many sources of this disease, and, as I have said above, about 25 per cent, of all cases are innocently acquired, un- deserved syphilis. From the above you will readily perceive that syphilis is not necessarily a venereal disease, as may be said of gonor- rhoea. All that has gone before has been said of syphilis; but it has been well said that “ where syphilis slays its hun- dreds gonorrhoea kills its thousands.” Then think for a mo- ment of the vast number of young men who have gonor- rhoea, and who, believing themselves well, contract matri- mony and give the disease to their young and innocent wives. Think of the vast amount of suffering of women with gonorrhoeal disease of the fallopian tubes; of the vast number of children who contract blenorrhoea neonatorum from gonorrhoeal mothers, and lose their eyesight as a result; think of the vast numbers of the blind in every State- children who may be said to have been born blind. Let your mind’s eye run over the blind asylums and see how vast is the number of people who see nothing of the beau- ties of nature by reason of gonorrhoea in the father, con- tracted by the mother, and given to the child during labor. And add to this vast amount of suffering and expense to the State those diseased with syphilis, and the picture is fairly appalling! Shall we stand with idly folded hands while all this misery goes marching by us, and do nothing to stop or limit the spread of these fearful diseases? The community rapidly rises up in arms and quarantines a case of smallpox for fear it will spread. Scarlet fever, diphtheria, yellow fellow and cholera, are all preventable diseases, and each community feels justified in quarantining such cases, and yet if all these scourges were piled into one, that one Prevention of Venereal Diseases. 9 would not produce half the suffering, loss of health and life and property that syphilis and gonorrhoea produce. How horrified the community becomes if a rabid dog is dis- covered within its bounds ! And yet we nurse, or rather ignore, the presence of venereal diseases as though they were a benefit to the community. Shall we sit idly by and see all this misery from prevent- able diseases produced and do nothing to prevent it f What can we do ? This subject is tabooed in all genteel society because it pertains to the sexual organs, and yet I have just shown that syphilis is not necessarily acquired in sexual con- tact. The people may say that if man wilfully violates the laws of God and man let him suffer, but what of the in- numerable number of diseased women and children who are innocently so ? Does the community not owe to the thou- sands of unborn babes and the thousands of mothers as much protection from the results of the viciousness of man as it owes these same people from the results of the carelessness of the person who knowingly introduces smallpox, measles, scarlet fever, yellow fever or cholera into the community ? These latter afflictions kill quickly and in great numbers and then the epidemic is over ; whereas, these venereal diseases perpetuate their work in the quiet walks of life. Truly, may it be said that, “ They are the pestilence that walketh in darkness.” In looking about to see what can be done to prevent the spread of venereal diseases we should ascertain what has been done in the past and from it take our bearings. I will only briefly allude to the fact that Moses under- stood the contagious nature of both gonorrhoea and syphilis. The former he quarantined for seven days and if the patient was not well, for seven days longer, and so on until recovery took place. His dread of syphilis, or as it is known in the Bible, the “ plague of Peor,” was so great that he slew with the sword every man who had worshiped at Peor, and hence 10 Prevention of Venereal Diseases. was supposed to be infected, and then later slew all the captured Midianitish women who had been connected in any way with the worship of Baal. This latter was a vigor- ous sanitary measure, you will say ; yet it was one which Moses believed he was justified in using, because he knew the terms of the disease ; he was familiar with it in Egypt as the “ Uchet disease.” But to come down to the present times, we may learn something for our guidance in the his- tory of quarantine regulations as carried out by the British army and navy; by the experience of Paris, St. Louis and other cities which have tried isolating these diseases. England, some years ago adopted what was called the “ Contagious Diseases Act,” which provided for police con- trol and medical examination of prostitutes in stations of the army and navy. From Dr. J. M. White’s paper on Preven- tion of Syphilis, we learn that “ the Surgeon General of the British navy writes that during ten years from 425.8 per thousand, venereal diseases has fallen to 112.1 per thousand. “In Portsmouth, England, the number of brothels were reduced one-half.” “ The Davenport surgeons report that the percentage of syphilis has steadily and greatly dimin- ished.” Mr. William Thompson, a Dublin surgeon, reports that “ in ten years there was a decrease of 3028 women living as prostitutes.” Mr. Berkley Hill writes, that since the “ Contagious Dis- ease Act” went into operation venereal diseases have de- creased one-fifth in towns subject to its operations; and that in the rest of England they have increased one-fifth. In St. Louis, Mo., at the expiration of two years, after police supervision and medical examination were instituted, the Chief of Police wrote that “ the number of public women had reduced 46 per cent, in eight months; that soliciting upon the streets was almost unknown ; that a con- siderable number of the women had been reclaimed ; that Prevention of Venereal Diseases. 11 private prostitution was materially checked; that juvenile prostitution was almost wholly removed ; that deaths among the registered women had largely decreased, and that vene- real disease was in a great measure prevented.” In Nashville, Tenn., during the war the prostitutes were subjected to some character of control and examination for the protection of the soldiers of the United States army; and from Col. Fletcher’s report we learn “ that the amount of venereal disease was markedly decreased; that the women became reconciled to the system, and that the lock hospital was supported by the fees paid.”—J. Wm. White. From Dr. White’s article we learn that in France the pro- portion of venereal diseases among the troops was only one- fourth of that found in the British army before the promul- gation of the Contagious Diseases Act. In Paris, among the registered and examined prostitutes, one in twenty-five have syphilis; while among those not registered one in four have it. In Bordeaux, among the registered prostitutes, eighteen per thousand were found diseased ; while of clandestine prostitutes three hundred to five hundred per thousand were suffering from syphilis. Fournier, the great French syphilologist, says that “ syph- ilis was practically stamped out of Paris, when the German army again introduced it.” I gather these statements from the article by Dr. White above referred to. Again let me quote from P'ournier. Among 387 cases of syphilis which he observed, in twelve of them only was the disease acquired from regular licensed and examined prosti- tutes; while 375 cases were acquired from clandestine pros- titution. These are facts from which there is no appeal. What then ought we to do to stay the tide of venereal dis- eases which are sweeping over our land ? The country at large look upon the saloon as an evil, but one which it cannot get rid of without incurring greater Prevention of Venereal Diseases. evils. Hence we find license and surveillance generally rec- ognized as the proper way of dealing with this evil. May we not compare the social evil with this other evil— that of intemperance—and treat them both in the same manner. Intemperance and illicit sexual indulgence arc both as old as humanity, and humanity today regards both as evils—necessary evils—and hence should have similar treatment. CONCLUSIONS. 1. That venereal diseases are as old as prostitution and that the latter is as old as the human race. 2. That clandestine prostitution is much more dangerous to the health of the community than licensed and medically inspected women. 3. That while we quarantine against smallpox, scarlet fever, diphtheria, yellow fever and cholera, and the state at- tempts to prevent the spread of the same, yet 4. We hold up our hands in holy horror at any attempt to regulate the “social evil.” 5. That police supervision and medical examination of prostitutes should be practiced by every community.