THE OTHER INFECTIOUS DISEASE 
OR 
A PLEA FOR A NEW HOSPITAL 
By C. IRVING FISHER, M.D., 
SUPERINTENDENT OF STATE ALMSHOUSE, TEWKSBURY, MASS. 
REPRINTED FROM PROCEEDINGS OF THE SIXTEENTH NATIONAL CONFERENCE 
OF CHARITIES AND CORRECTION, HELD AT SAN FRANCISCO, CAL., 
SEPTEMBER, 1889. THE OTHER INFECTIOUS DISEASE: A PLEA FOR 
A NEW HOSPITAL. 
C. IRVING FISHER, M.D., 
The hospital is one of the highest and noblest achievements of 
Christian charity. It sets aside all questions of race, color, morals, or 
deserts, and considers the human body in sickness and pain, whether 
from injury or disease. It gathers to itself the best medical and 
surgical skill, the most approved modern appliances, and becomes 
the convenience of the wealthy in their hour of need, while it gives 
to the unfortunate dependent and stranger an equal chance with 
his more prosperous neighbor. Its benefits are not to its patients 
alone. They reach and bless every home into which the physician 
goes; for the wards open to the medical student have made practical 
and intelligent the teaching of the school, and trained nurses are 
here provided to second his efforts in behalf of the sick and suffering 
in all stations of life. 
To the mature physician and surgeon is thus opened a field of ob- 
servation and study such as is not to be found in any private practice. 
It constantly brings before the eye and puts upon record all the 
characteristics and modifications of disease. It affords the best op- 
portunity for the application and observation of new methods of treat- 
ment ; and thus, through a larger and surer knowledge of disease 
and its remedy, it becomes a direct agent in the improvement of 
the race. 
It is not the purpose of this paper to consider the general or the 
insane hospitals, with which you are all familiar, but to present a plea 
for a new departure by the State in the direction of self-protection, 
by the recognition of a disease which, now concealed and ignored, is 
CHAIRMAN OF THE COMMITTEE, STATE ALMSHOUSE, TEWKSBURY, MASS. 2 
nevertheless sowing seeds of physical and mental weakness, from 
which she is already reaping a large harvest of pauperism. 
Our present social and civil laws make and perpetuate dependents. 
In saying this, I do not call in question the benevolent intent of our 
law-makers or leaders of social thought. My point of observation 
has been for a term of years in the State Almshouse of Massachu- 
setts, whose constant population averages nearly one thousand peo- 
ple, while it admits and discharges more than two thousand annually. 
They belong chiefly to the dissolute and intemperate classes, and 
most of them are .found on admission to be hospital subjects. After 
remaining for a season, they are either discharged or become a part 
of our permanent population. Those who remain are largely persons 
whose life of reckless debauchery has borne its legitimate fruit, in 
exhausted vitality and seated disease, mental or physical. 
Those who go are of the same sort. They have been nourished 
and nursed at the expense of the State, and are then set free to 
return to their revellings, to contaminate others, and to propagate 
their kind, till nature again succumbs, and they return once more to 
be treated to the best the State can provide until sufficiently restored 
to go forth again. At length, they, too, return to end their days in 
the protecting arms of the State at this or some other of her fostering 
institutions, whose kindly care lengthens out for them the worse than 
useless span of life. Add to this the unlimited freedom with which 
we allow the overcrowded countries of Europe to pour in their dregs 
upon us, and let me repeat again my former statement, which might 
at first thought have seemed overbold,- " Our present social and civil 
laws make and perpetuate dependents." 
The hospital is rapidly becoming a more and more important 
factor in the care of these people. Its aim should be, not only to 
help the individual by giving shelter, relieving suffering, and curing 
disease, but still more to protect the public from possible infection, 
while making the period of dependency as short as is consistent with 
this end. Already those diseases which come as epidemics are 
recognized by local governments, and every precaution is taken to pre- 
vent their spread. The State already takes persons rendered incapa- 
ble through mental diseases into its custody, and keeps its control of 
them for life, unless they recover. Already some of our States are 
planning hospitals for inebriates, where, by patient care and restraint 
through a term of years, if need be, they may be weaned from the 
cup which has enslaved them. 
There is yet a disease which is infectious, which exists in every 3 
community, which is carried as a taint in the blood, and may appear 
after long lying dormant, which may be transmitted by inheritance, 
which, while existing mostly among the low and dissolute, is by no 
means confined to that class. It is refused by most hospitals; and 
many large cities afford no place where persons suffering with 
venereal diseases can be treated, outside a pauper or criminal insti- 
tution. Though carefully concealed, it is yet so common that every 
issue of our daily papers contains advertisements of remedies and 
promises of cure by so-called doctors, couched in language blind and 
vague, yet well understood by the initiated. It is associated chiefly 
with shame and dishonor, and may not so much as be mentioned in 
polite society; yet I conceive that this platform is pre-eminently the 
place where this "pestilence that walketh in darkness," this "de- 
struction that wasteth at noon-day," which so ruthlessly touches the 
purity and the very life of our land, may and should be openly 
discussed, if, by any means, its vile contamination might be checked 
or held in control. 
Pauperism indicates weakness, and whatever tends to reduce the 
physical condition below the normal standard tends to pauperism in 
those of weak will and dissolute inheritance. Next to intemperance, 
I hold that syphilis is the most important factor in the development 
and perpetuation of the dependent classes. There is not a tissue of 
the body which is exempt from its subtle and undermining influence. 
It renders the system more liable to other diseases, behind which it 
hides itself as under a mask ; while the physician, led astray by its 
subtlety, treats the apparent symptoms, and fails to discover the 
insidious poison which is sapping the life of his patient. 
Insane persons received by us as chronic cases, especially the de- 
ments and the epileptics, are frequently found to be syphilitics, and, 
when treated on this basis, show great improvement and even re- 
cover. I am confident that there are to-day large numbers in the 
hospitals of our land under treatment for other diseases who would 
show this taint if carefully examined, and who would improve to a 
condition above dependence if treated with this in view. 
But, while all vestige of venereal trouble may disappear in the 
individual, the community is not yet rid of it. Let the person be- 
come a parent, and the disease may reappear as a blight upon the 
babe in its mother's arms, or to curse its later life with weakened 
intellect or epileptic convulsions. Pitiable, indeed, are these weak 
and sickly offspring of poisoned human bodies ; and we can but 
cheerfully acquiesce in the interposition of Divine Providence when 4 
it removes them from our sight and care while the unequal struggle 
for existence has but just begun. 
A case in illustration taken from the records of private practice 
may be given, showing the subtle nature and far-reaching influence 
of this disease. The patient was a man of seventy years, an hon- 
ored and respected citizen, having, to all appearance, a sound mind 
in a healthy body. He was the father of seven children, two of 
whom were cripples; while other evidences of congenital syphilis 
showed in the remaining five. Four grandchildren also were defec- 
tive. The sickness to which the physician was called was of a trivial 
nature, the mysterious feature being that the patient did not rally as 
men usually do. A careful examination was made to find the cause, 
and evidences of syphilis were discovered. The family physician 
could hardly believe his own diagnosis, and sought older counsel, 
who confirmed his opinion. The patient, questioned, admitted that 
he had the disease when a young man ; " but," said he, " I thought 
that was cured forty years ago." A larger knowledge of this case 
convinced both patient and physician, that the physical and mental 
defects in both children and grandchildren were due to this cause 
alone. 
Most of those admitted to our State hospital at Tewksbury show 
traces of syphilis, either inherited or acquired. Many of the chil- 
dren born there show unmistakable evidence of the disease, which 
was not present in the mother, and which shows all too surely the 
character of those who beget illegitimate children. And yet this 
disease, which in some of its manifestations is more loathsome than 
small-pox, which is as destructive and, under certain conditions, as 
infectious as leprosy, which by vile persons is voluntarily contracted 
and communicated, which probably causes, directly and indirectly, 
more deaths annually than all the epidemics which visit our land, is 
not recognized in the statute-book. It does not appear as the cause 
of death upon the physician's certificate or books of statistics, because 
the practitioner does not always recognize it, or because, out of 
kindly consideration for the friends of the deceased, he writes instead 
the name of the complicating trouble. " Rheumatism is written 
over the graves of strong men crippled in their prime,- ' scrofula ' 
hides the secret sin of the parent stamped on the slender frame of 
the invalid child,- 'cancer' is the foul lie buried with the wife who 
has silently suffered a life of the most excruciating agony which 
human flesh can endure."* Nor is the public protected by the tem- 
porary withdrawal which it sometimes seeks, because no place has 
been provided for it. 
* See foot-note on p. 7. 5 
I would urge the establishment of wards in every municipal and 
State hospital, and in some private ones also, where all forms of 
venereal disease may be admitted. In some cities, a special hospital 
might be established. Our friends of the Cancer Hospital in New 
York, I have been told, sometimes feel that the name which they 
have adopted, and which so clearly expresses the character of that 
noble charity, is not a wise one. People do not like by their acts to 
acknowledge to themselves or their friends that they have a loath- 
some or incurable disease. Much less will patients care to enter an 
institution the name of which implies shame and dishonor. So the 
ward or hospital here proposed will need a name more honorable 
than that which would specify its real work. Perhaps " Hospital for 
Skin Diseases," or some similar term, would be sufficiently expres- 
sive. 
It is made obligatory on the part of physicians to report to the 
proper civil authorities the existence in their practice of such con- 
tagious diseases as small-pox, yellow fever, scarlet fever, etc. These 
maladies are in no way associated with dishonor or impurity. They 
may wipe out their victims from the face of the earth, but they leave 
no taint to be transmitted to descendants. If the State thus guards 
its citizens from these lesser scourges, why should it not extend its 
protecting power to a disease which affects not only the present, but 
future generations, and which is developed and perpetuated by the 
voluntary violation of both Divine and civil law ? 
Does it not seem strange that, while we have made laws to preserve 
the chastity of the community, no attempt whatever has yet been 
made to secure us from disease which by violation of these laws is 
scattered broadcast over our land ? " Grant that the individual may 
play what havoc he chooses with himself and his happiness, society 
has the right to demand that self-indulgence shall bring no evil to a 
single other being than the transgressor; and hereafter it will look 
to the Public Health Officer to close up the avenues of disease 
which lead from this as from every other centre of violated rightful 
living." * I urge that there should be some legislation looking to 
the State control of those who have venereal diseases in the infec- 
tious stages. 
I am aware that there are many difficulties in the way. Laws for 
the pauper and criminal usually find passage through a legislative 
body; but a law which may touch the pleasure of some who indulge 
in crime behind the screen of wealth and respectability, a law which 
* See foot-note on p. 7. 6 
may put to shame some in places of influence, by bringing their 
secret sins to the light of day, a law which in its execution may bow 
with grief worthy families, because some honored and esteemed one 
is shown to be untrue and impure,- this is not easy of enactment. 
But this at least might be secured: that persons who have come 
under State control,- whether by laying themselves liable to law 
they have become inmates of some penal institution, or have thrown 
themselves temporarily upon the State's bounty for support,- if 
found to have venereal diseases, shall not be allowed to go out until 
the infectious stages are passed. 
This cannot be done without legal authority. Patients under 
treatment and subjected to the regular life and habits of an institu- 
tion soon begin to feel well, and are anxious to return to a life of 
liberty ; and the authorities in charge, not appreciating the medical 
aspect of the case, and not willing to appear to harbor able-bodied 
men and women at the State's expense, are quite willing to be rid 
of dissolute inmates chafing under restraint. So they go out to 
neglect themselves, yield to their passionate desires, and infect others 
who, it may be, are innocent of wrong-doing. In illustration, I have 
known a young woman having the initial lesion of syphilis to go out 
from an institution and be married to a respectable man within three 
weeks, he being ignorant that any trouble existed. Again : a woman 
was under sentence in one of our State Prisons. She was young, 
with a pretty face and pleasant manners. She attracted the notice 
and won the confidence of certain visitors. They interested them- 
selves in her behalf. They could not see what the physician saw, the 
vile taint concealed beneath a fair exterior. Mistaken philanthropy 
prevailed, and the woman was pardoned and released,- virtually, 
though not nominally, on the ground of good looks. She went out, 
and in a few weeks had communicated her disease to eleven persons. 
Within a month, I have received a letter from a friend residing 
midway between the Atlantic and Pacific, asking for suggestions in 
behalf of a young man to whom kind friends earnestly desire to 
extend a helping hand. -Born of good family, with fair inheritance, 
in early youth he was led into vices and blighted with loss of moral 
virtue and physical taint. Greater maturity has brought to him a 
period of thoughtfulness and a desire to reform. But with moral 
restoration he needs also healing for his sick.body. Friends stand 
ready to advise and encourage, and are anxiously asking, Where 
can he go ? Is there no hospital or asylum to which he may retire, 
where, in care of skilled physicians, health may be regained and the 7 
man become physically fit for useful activity among men ? But they 
ask in vain ; for no such door is open. 
Do you wonder that we who live within sight and knowledge of 
these things feel a thrill of alarm when we consider the future of our 
country and the rapidly increasing number of her dissolute and de- 
fective classes ? There is perhaps this consoling aspect of the sub- 
ject. Its seeds of corruption are also the seeds of death. A race 
thus poisoned must soon run itself out from exhausted vitality; but 
meanwhile the innocent suffer with the guilty, and the pure are being 
dragged down to swell the ranks of impurity. "It is folly to extermi- 
nate diphtheria, small-pox, and typhus, and let syphilis, the most pro- 
lific mother of evil of them all, send forth her brood of whelps to be 
the cause of more bodily and mental misery than all other shapes 
of human error combined." * 
These facts, however unpleasant, are facts none the less; and this 
disease must sooner or later receive the recognition which all other 
serious infectious diseases have received. The State will yet put its 
restraining hand upon the dissolute and vile, and exercise its legiti- 
mate power to preserve inviolate the manhood and womanhood of 
its citizens. 
* The foregoing quotations are from the address entitled " Protection from Venereal Diseases," by 
Dr. Albert H. Gihon, Medical Director U. S. N., before the American Public Health Association at 
Nashville, Tenn., in 1879.