BLACKWELL FAMILY ELIZABETH BLACKWELL Printed MatterHAS "REGLEMENTATION" (THE C.D. ACTS) PROVED TO BE A SANITARY BENEFIT TO THE EUROPEAN OR INDIAN ARMIES, SO AS TO CALL FOR ITS MAINTENANCE OR ITS RE-ENACTMENT? HAS THE ABOLITION OF THE SYSTEM BEEN FOLLOWED BY INJURY AND NOT RATHER BY BENEFIT TO THE TROOPS PREVIOUSLY UNDER ITS INFLUENCE? An Address DELIVERED BEFORE THE INTERNATIONAL FEDERATION FOR THE ABOLITION OF STATE REGULATION OF PROSTITUTION. SEPTEMBER 1896 AT BERNE, SUISSE 26 Devonshire Chambers [?Brohgate] St. [?Witherut] J. BIRKBECK NEVINS, M.D. LOND., President of the Federation: for three days under examination before the Select Committee of the House of Commons on the C.D. Acts, 1879-1881; late President of the Liverpool Medical Institution; Lecturer for twenty-nine years on Materia Medica and Therapeutics, Liverpool Royal Infirmary School of Medicine; Consulting Physician to the Liverpool Stanley Hospital; President Liverpool Literary and Philosophical Society. [THIRD EDITION.] PRICE, SIXPENCE; POST FREE, SEVENPENCE. ISSUED BY THE BRITISH COMMITTEE OF THE INTERNATIONAL FEDERATION 1, KING STREET, WESTMINSTER PRINTED BY THOMAS [?]WKEL, LIMITED, LIVERPOOL. 1897. BRITISH CONTINENTAL & [?] FEDERATION BRITISH COMMITTEE 17, Tothill St. WESTMINSTER b ABSTRACT OF THE FOLLOWING ADDRESS ON THE SANITARY RESULTS OF THE CONTAGIOUS DISEASES ACTS, WHICH WILL GIVE THE READER ITS GENERAL, RESULT IN THE SMALLEST POSSIBLE COMPASS. --- BRITISH ARMY. - HOME, pp 6-8, 18-19 - Venereal Diseases fell largely for 6 years previous to the Acts, They rose slightly during the 16 years of the Acts. They have fallen largely during the subsequent 11 years without Acts. INDIA, pp. 12-13, 19, 27-28. - These diseases fell largely for 7 years previous to Acts. They fluctuated slightly for the first 9 years of the Acts, being substantially the same at the end (190 per 1000) as at the beginning (185 per 1000). They rose largely, especially during the last 6 years of the Acts. They trebled in amount between 1873 and 1890. They have scarcely risen at all (1.25 per 1000 yearly) during the 4 years of abolished Acts. CROWN COLONIES, pp. 13-17. - In nearly all cases these diseases rose while the Acts were in operation, and fell after their abolition. FRANCE, pp. 3-6. - Acts in force throughout for about 100 years, therefore no means of comparing garrisons with Acts with garrisons without them. Pp. 21-22. - French tables, showing that they have had no appreciable influence upon the amount of disease in the French Army. HOLLAND, pp 8-10, 20. - Acts in force for about 60 years. No evidence that shows conclusively that they have done either good or harm in Holland; but apparently, upon the whole, harm rather than good has resulted. BELGIUM, pp. 20-21. - Acts in force throughout for about 40 years. Sanitary results in different garrisons differ largely. Upon the whole period a slight fall in the amount of disease. DENMARK, p. 10-11. - Acts in force in Army and Navy about 20 years. Large increase of disease in both, especially in the Navy. Acts abolished or never in force in some towns. Fall in disease in these places since abolition. _______________ SANITARY INFLUENCE OF THE C.D. ACTS UPON SECONDARY OR CONSTITUTIONAL DISEASE. BRITISH HOME ARMY, p. 23. - Considerable rise during the Acts. The rate of increase reduced since their abolition. INDIA, pp. 24-25. - Increased amount during the Acts; rate of increase reduced since their abolition. CROWN COLONIES, pp. 23-26 - Generally speaking, increase during Acts, and decrease since their abolition; but considerable fluctuation, and less regularity of either increase or decrease than in the primary forms of Venereal Disease. DENMARK, p. 26. - Considerable increase under the Acts. ____________________ SANITARY INFLUENCE OF THE C.D. ACTS UPON THE REGISTERED PROSTITUTES, p. 28. Great increase of disease during the Acts. Registration discontinued, and therefore no means of judging as to the result of their abolition. ___________ SANITARY RESULTS OF THE ABOLITION OF THE C.D. ACTS UPON THE BRITISH CIVIL POPULATION, pp. 32-35. DEATHS. ENGLAND AS A WHOLE. - Deaths from Syphilis at all ages rose considerably during the Acts; reduced considerably since their abolition. Deaths from Hereditary Syphilis largely reduced. LONDON. - Deaths from Syphilis at all ages rose during the Acts; reduced since their abolition. Deaths from Hereditary Syphilis considerably reduced. DISEASES SINCE REPEAL OF THE ACTS, AS DISTINGUISHED FROM DEATHS. ENGLAND AS A WHOLE. - Adult young men, Army recruits, Venereal Diseases of all kinds largely reduced. Hereditary Syphilis, among 180,000 children in Children's Infirmaries, disease largely reduced.OBJECT of the following ADDRESS. 1st. - Has "REGLEMENTATION" (the C.D. Acts) proved to be a Sanitary Benefit to the European or Indian Armies, so as to call for its maintenance or it's re-enactment? 2nd. - Has the ABOLITION of the System been followed by Injury and not rather by Benefit to the Troops previously under its Influence? PRELIMINARY PERSONAL EXPLANATION TO THE MEMBERS OF THE INTERNATIONAL FEDERATION PRESENT AT THE CONGRESS. Before entering upon the strictly statistical aspect of the subject, I must ask your indulgence for premising a few remarks, which may appear to be of a personal rather than an argumentative character, For some time after the controversy relating to the Contagious Diseases Act became active, I declined to take part against the then recently inaugurated system; partly because it was an unpleasant subject, in which I was not personally interested, but, mainly, because the system was so loudly and persistently advocated as a highly valuable sanitary measure by two or three London medical men of such eminence, that they practically led the medical profession of the country, and myself among them, at their chariot wheels. It was, however, urged me by counsel - which I felt it would be wrong to disregard - that it was my duty as a lecturer on Hygiene in one of the largest provincial medical schools in England, to make myself acquainted with the subject, so as to be qualified to give a well-founded opinion to the students under my tuition. I therefore resorted to the highest and most authentic source of information available, viz.: the evidence given before the Royal Commission in 1870, and I became convinced from it of the essential immorality of the system, and the inducement to sexual immorality that is offered2 to men generally, but to young men especially, by its avowed object as stated by the Royal Commission," to render the practice of prostitution, if not absolutely innocuous, at least much less dangerous." (Roy. Com. Rep., sec. 13.) The tyranny to which the system subjected women, and the almost incredible absence of common justice towards them which the provisions of the Acts organised; the debasing influence produced upon the character of the women by the infliction of the indignities to which they were subjected by it, thus destroying what might have been previously left of good in them, and the whole machinery of the Acts, converted me from being simply a passive observer into an active opponent of the new legislation. This change of attitude was, however, accompanied by a strong anticipation (arising from the previous medical laudations of the system in high quarters) that its opponents would have to fight a difficult uphill battle in consequence of the alleged sanitary benefit produced by it. I therefore undertook a careful examination of every Army and Navy Report that had been published by the War Office and the Admiralty, beginning from many years previous to the Acts being passed, and continued to the latest publication; the Police Reports, relating to the health and behaviour of the registered prostitutes, which were published annually by the House of Commons; and every other published official document I could hear of. The result of this wide examination of purely official publications was the startling discovery that so far from the system having proved to be a sanitary success, it had resulted in a diminution rather than an increase of improvement in the army, in a large increase of disease in the navy, and in the absence of any benefit either to the health or character of the prostitutes. Much of the improvement of health in the services, for which credit had been claimed for the Acts, proved to have taken place before they were in existence, and the final result of this anxious research was the settled conviction of the essential immorality and the injurious social character of the system, and the confirmation afforded by the official statistics to the truth of the ethical proposition: that a system inherently immoral and unjust does not, and cannot, produce sanitary benefit either to the individual or the community. The obstacle arising from the alleged sanitary benefit from the Acts being thus removed by their own governmental figures, my course was thenceforth clear, and I will now endeavour to lay the results before you. ADDRESS On the Sanitary Benefits said to have resulted from "Reglementation"* (the Contagious Diseases Acts--C.D.A.) in the Prevention or Diminution of Venereal Diseases in the Armies and Navies, and also in the Civil Population of European Nations, and on the Sanitary Evil alleged to have resulted from the Absence or Abolition of such Reglementation (C.D.A.) CONTRARY PROPOSITIONS MAINTAINED IN THE FOLLOWING ADDRESS. 1st.--"Reglementation" has failed to prove that it has either prevented or diminished Venereal Diseases in general or Syphilis in particular in the various European communities in which it has been applied. It has also failed to prove that the small amount or even a reduction in the amount of these diseases, when they may have occurred, has been due to its influence, and not rather to the operation of other more important causes acting at the same time along with it. 2nd.--The Abolition of reglementation, where it had been in operation, so far from producing sanitary injury, has been followed by a marked diminution of these diseases in some countries--notably in England and some of her dependencies. It has also been followed in other places by a reduction of the rate of increase that had been taking place for years previously, while they were under the operation of the system. In considering upon what subject an address from the chair might be most in accordance with the present position of our controversy and the province of your President, it has appeared to me that a reply to the Address lately delivered and so widely diffused by Dr. Commenge, † comparing the amount of Venereal Disease in the French and Russian Armies with that in the British Army, would fall in most naturally with your President's previous Statistical Researches, and would be the most appropriate that he could select when addressing an audience consisting of members of many nationalities; some of which Dr. Commenge has invoked as allies, but others of which he has left unnoticed, although not in his favour. I have therefore selected his Address in favour of reglementation as the basis of my own, which will be in direct opposition to his in almost every particular. FUNDAMENTAL PROPOSITION IN DR. COMMENGE'S ADDRESS. The fundamental point of his Address, and that upon which the whole of it turns, is the assertion that the amount of Venereal Diseases in the French and Russian Armies is approximately about a fourth ‡ of *This is the term generally employed on the Continent of Europe to indicate the systems in force for regulating Prostitution. It corresponds essentially with the English Contagious Disease Acts. +"Les Maladies Vénériennes dans les Armées Anglaise, Francaise, et Russe." Paris: 120, Boulevard Saint Germain, 1895. ‡ Commenge's Tables, pp. 23, 26, 28 and 31. B4 that in the British Home Army; - that réglementation is in operation throughout both the French and Russian Armies, but has been abolished in that of England; - and that the presence or absence of that influence is the cause, and in reality the only cause of the difference in the proportion of disease between these armies.* I give the statement as it is made by Dr. Commenge, but I have no official means by which I can verify or contradict it. REPLY. The alleged difference in the amount of disease in the French and British Armies is not here called in question, and it may be conceded for the sake of argument - for it does not affect my main proposition - "that the difference is not due to the presence or absence of réglementation, but to other causes." Dr. Commenge's deduction from it that the difference is wholly due to the absence or presence of réglementation is absolutely denied on the following grounds, viz.: - That there is no resemblance whatever between the conditions and general surroundings of the two armies to furnish a common basis upon which they can be compared; for The British Army is kept up purely by voluntary enrolment from a portion only of the population, and that consisting largely of the lower, less educated and less cultured or successful stratum of the community. The British soldiers are also enrolled for a period of 7 years at least, during which time they are removed from all home or refining influences, from the restraints imposed by the public opinion of the more elevated classes, and from the industrial occupations to which they may have been accustomed, so that they are reduced to comparative and compulsory idleness. They are also deprived of nearly all opportunity of marriage at a period of life when the animal functions are in their most overpowering activity. Of all these unfavourable surroundings immorality and intemperance are natural results, and disease is the consequence. The French Army, on the contrary, is kept up by compulsory service, every member of the community - high or low, educated or uneducated, rich or poor - being obliged to serve (though for a limited period only) as soon as he arrives at the age prescribed by law for his period of active service. For this he is taken from his home pursuits, whether industrial or professional, but with the full understanding that he will return to them when his period of service has expired. His relations with home and family ties are not broken for 7 years as they are in the British Army, and the beneficial influence from these, and the admixture in the ranks of the higher and lower classes of society during their active service, cannot fail to exert valuable influence upon the character and conduct of the rank and file of the French Army. To the above differences must be added the radical difference resulting from national characteristics. The Frenchman is a temperate, light-drinking man, neither possessing nor desiring to possess * This proposition is not put forward in his Address in the distinct definite terms here employed, but it is impossible to read the Address without recognizing that this is the position that he has taken up throughout. 5 a large family of children. The Englishman, on the other hand, is a beer drinking, and too often a drunken man, and has, as a rule, a large number of children. The Frenchman, then - temperate, and with a limited desire for increasing the population - enters the Army under the favourable circumstances already enumerated, and Dr. Commenge extols his comparative freedom from disease. The Englishman also enters the Army, but under the unfavourable conditions above described; and his friends and apologists are unable to deny (though they lament) the amount of disease which is the accompaniment, if not the natural result, of his origin, his constitutional temperament, and of his surroundings. Having acknowledged and possibly explained the alleged difference in amount of Venereal Disease in the two armies, I will now devote myself to the proof of the first proposition, "That réglementation has failed to prove that it has either prevented Venereal Diseases, or reduced their amount where it has been applied," and I will now add that it has also failed to prove that it has not, in fact, been a positive sanitary evil, by encouraging resort to immoral relations, and thereby promoting the spread of disease. A fatal defect in Dr. Commenge's tables and arguments in favour of réglementation, is that he has made no attempt to compare bodies of men that admit of scientific comparison,* in order to show that the one set under réglementation has had appreciably less disease than another similar set without it. On the contrary, he has taken the French Army as a whole, which has been under réglementation everywhere for a hundred years more or less, and has compared it with the British Army which, as we have seen, is incapable of a sound comparison from its totally different *In his Address (p. 12-14) Dr. Commenge has, it is true, made an elaborate comparison between the 14 stations of the British Home Army "selected" to be placed under the C.D. Acts and another set of 14 stations also "selected" to be left without them. But the entire value of the comparison depends upon whether the two sets of stations do really admit of scientific comparison independently altogether of the presence or absence of the Acts. Now, - 1st, in this Address; 2nd, in the evidence given before the Select Committee of the House of Commons, 1879-81; 3rd, in the "Statement" of the grounds for objecting to the Acts, prepared by desire of the Home Secretary, Sir R.A. Cross, M.P., and presented to him in 1874 and laid before the Select Committee of the House of Commons in 1879-81; and, lastly, throughout the entire controversy, - the contention has been that the two sets of stations do not admit of comparison, for there is no common ground of comparison between them. To put all the camps, all the arsenals, and all the great seaports into the protected set, and not a camp, seaport or arsenal in the other to compare with them; to put a couple of small cathedral garrison towns under the Acts and London and Dublin without Acts to compare with them; to leave every large manufacturing town without Acts and not to place a single manufacturing town under the Acts for comparison; to put together Aldershot - a camp of 12,000 men - and Maidstone - a little country town with 350 soldiers - as representing the influence of the Acts, - and London and the little Essex village of Warley (so small as not even to have a single medical man in it) as representing the sanitary result of the absence of Acts; -and then to assert that these two groups of stations furnish scientifically comparable combinations for settling the sanitary influence of a keenly-contested agent, is to reduce statistical enquiry to such a burlesque that we can only wonder that men making any pretence to scientific knowledge could commit themselves to the following judgment expressed upon the subject in the Army Report for 1873, p. 13: - "It is believed that the two groups of stations are fairly comparable, and that by a contrast of the results obtained at each since the application of the Acts, their efficacy may be tested." Such at any rate, were the two sets of stations that Dr. Balfour was comparing when he pronounced his encomium upon the Acts in his address to the Belgian Academy of Medicine in 1886 from which Dr. Commenge has so largely quoted. The character of these two sets of stations is, however, more fully discussed in Appendix A. (p. 29) B26 circumstances He has not attempted to take Paris, for example, or Lyons, or any other great French garrison, under the system for 20 years and without it for 20 years, and then compare the two periods. His assertion that reglementation has had anything whatever to do in producing the low ratio of disease is, therefore, a pure assumption without any attempt at proof. ENGLAND. But it so happens that England has made the comparison, both at Home and in India, and extending over a period of 36 years; Holland has made the comparison extending over nearly 40 years; Denmark also has made it during a period of above 20 years, and the result of these comparisons we shall find to be totally at variance with the claims asserting that reglementation has prevented or reduced Venereal Diseases. I shall take England and India first because they exhibit the greatest number of men, and also because Dr. Commenge has laid such special stress upon (according to him) their exceptionally unfavourable experience resulting from the absence of the system. In the first of the following diagrams, the amount and course of Venereal Diseases of all kinds combined in the entire Home Army is given from 1860 to 1894, and in the 2nd diagram, a single form only of disease, viz., "Primary Venereal Sores" is given for the same length of time in 14 stations "selected" by the army authorities for the "experiments" of the Contagious Diseases Acts (reglementation). During the first six years shown in the diagrams there were no Acts. and the combined diseases fell from 313 per 1000 men to 225 per 1000 men, an average yearly improvement of 147 per 1000 cases. At this date, 1866, the second Contagious Diseases Act was passed, and as disease did not improve under it as its authors had expected, a third Act of a much more stringent character was passed in 1869, and both remained in unobstructed force for 16 years till the end of 1882, by which time Venereal Diseases of all kinds combined had *Dr, Commenge always speaks of it as the "Metropolitan Army." No such title exists in the British Army. The Troops in question are those quartered in Great Britain and Ireland † See Appendix A. p. 29 ‡ In his evidence before the Select Committee of the House of Commons 1879-81, Insp. Gen, Lawson, Inspector-General of the Military Hospitals, informed the Committee that 28 stations had been "selected" out of the 130 stations of the British House Army for the purpose of trying this "great experiment" of the Contagious Disease Acts; 14 stations were put under them and 14 were not, and the difference between them was to be taken as the proof of their sanitary value. In making this "selection," all the most healthy and improving stations were placed under the Acts, and the most diseased and unimproving stations were left without them. The statement was then put forward, both in the Army Reports and in his evidence that the "Protected" stations had barely half as much disease as the "unprotected" ones and that the difference was solely due to the presence or absence of the Acts. The utter unfairness and worthlessness of such a comparison was exposed before the Select Committee (Ques. and Ans. 2854-8, and 2971, Evid 188); but Dr. Commenge would not appear to have seen the Minutes of Evidence when he adduced the difference in favour of the protected stations as being proof of the efficacy of the Acts. § An Act was indeed passed in 1864, upon the beneficial effects of which Dr. Commenge lays considerable stress. It was purely experimental Act passed for two years only, and not then renewed because of its proved worthlessness. It did not enjoin the periodical compulsory examination of women whether well or ill (the "Visite"), and it only enforced examinations when some particular women had been charged by some particular man with having diseased him. It was in force only one full year (1865), and was only applied even then to 3 of the 120 stations of the British Home Army. Its sanitary result was an increase of disease in these 3 stations, and it came to an end at once. DIAGRAM 1. VENEREAL DISEASES OF ALL KINDS, COMBINED IN THE WHOLE BRITISH HOME ARMY. 1860 TO 1894 7 risen to 245.5 per 1000, an average yearly rise of 1·3 per 1000 while under the Acts, instead of an average yearly fall of 14 ·7 per 1000 previous to their existence. In May, 1883, the Acts were suspended. Owing to a large importation of disease by the troops returning from Egypt, disease rose until October of the next year (1884), in which year it stood at 271 per 1000, and it rose still further to to 275·4 per 1000 in 1885. It began to fall in the following year, 1886, the Acts were entirely repealed. The latest Government Report as to the amount of disease is that for 1894, and it had then fallen to 182·4 per 1000, an average annual fall for 9 years of 10·3 per 1000 after the abolition of the Acts instead of an average yearly rise of 1·3 per 1000 during the 16 years they were in full operation. It is for Dr. Commenge and the advocates of réglementation to reconcile these changes with their laudations of that system. (See first diagram opposite, which shows the amount of changes in all forms of venereal disease, combined from 1860 to 1894. Mr. Jeffreys'* return only commence with 1870 for the United Kingdom, but the ratios from 1860 to 1870 were obtained from Parliamentary Paper 325, 1885, which contains the whole British Army from 1860.) At this stage it will be desirable carefully to read Appendix A, p. 29 of this Address - which will answer beforehand some questions that may naturally occur to the reader as to how improvement should have occurred without Acts to produce it. In examining the Diagrams 1 and II., it is also necessary to bear in mind that the first dotted line in both diagrams represents the fall in disease, which is attributed to Lord Herbert's improvements alone. In the black line that follows, these improvements were continued, and an INCREASED scale, and the Acts also were now added. The fall in disease continued, but at a REDUCED rate. The then Secretary for War, Lord Cardwell, was so dissatisfied with this reduced improvement that he imposed the loss of pay while in hospital upon every soldier admitted for Primary Disease, and the natural consequence was that the men concealed their disease from the regimental surgeon, and the broken line represents the great APPARENT diminution of disease under the combined threefold influences of Lord Herbert's improvements, the Acts, AND CONCEALMENTS OF DISEASE. This fall continued for three years, at the end of which time, from causes never explained by the Army Reports, DISEASE BEGAN TO RISE in spite of them all, and continued to do so at a fluctuating rate until May, 1883, when the Acts were SUSPENDED, the fine for being in hospital having been withdrawn at the end of 1879. After this, the dotted line represents two years of suspended and eight years of repealed Acts (the first portion 1883-4), being years of exceptional increase, owing to the large importation of disease from Egypt during that period. The curves in both diagrams show the large improvements WITHOUT Acts, and the absence of improvement in the second diagram and the actual increase of disease in the first DURING THE SIXTEEN YEARS OF THE APPLICATION OF THE ACTS. The second diagram exhibits the amount and course of one form only of Venereal Diseases, viz., Primary Venereal Sores, and these only in the 14 stations specially "selected" by the British War Office, to prove the supposed beneficial influence of the Contagious Diseases Acts *These returns were made by the War Office, in 1894-1896, by order of the House of Commons, on the request of Mr. Jeffreys, M.P. They are continually quoted by Dr. Commenge, and are his principal source of information as to the British Army.8 (réglementation). Primary Syphilis was at first recorded with simple venereal sores, owing to the difficulty of judging at first whether the affection might prove a simple or a constitutional one. And this system of recording them being once introduced, it was continued until the Acts had been repealed. Gonorrhoea also was recorded in these 14 stations, but it soon became apparent that the Acts had produced no beneficial influence upon that form of disease, and weight attached to the records was soon at an end. Secondary Syphilis was never recorded for the individual stations. as the primary disease might be contracted in one station, and the secondary might first appear in another station. It was therefore only recorded for the army as a whole. In examining the second diagram it will be seen that the disease fell rapidly for 6 years, from 146 per 1000 men to 87 per 1000 men, before the Acts were in existence, at an average yearly rate of 6.7 per cent.* The Act was then passed in 1866 and applied at the beginning of 1867, and continued in full operation for 16 years. Disease at first continued to fall, but at a diminished rate (6.3 per cent. instead of 6.7 per cent.) and after some years it began to rise and continued to do so until 1883; its amount at the end of 1882, the 16th year of its operation being 78 per 1000 - only less by 9 per 1000 than before they were in force at all. During the 16 years of their operation the annual fall in disease was only 0.56 per 1000, instead of 9.8 per 1000 before they were in existence. In the middle of 1883 the periodical compulsory examinations of the women (the "Visites"), which are the essence of the system, were suspended by the House of Commons, and this was followed immediately by a great rise of disease, which was owing to the return of the troops from Egypt, where they were largely diseased. This influence ceased by the end of 1884, and disease in 1885 began to fall steadily, and has continued to do so from 138 per 1000 in 1884 to 68 per 1000 in 1894, the last year recorded - an average annual fall of 7 per 1000 for 10 years (again without Acts), instead of the miserable 0.56 per 1000 during their operation These changes are shown in this diagram, which is commended to Dr. Commenge's consideration. HOLLAND. Holland has had the experience of the absence of réglementation, and also of its presence in the same garrisons, during periods varying from 3 to 30 years; and has also had the experience of 28 garrisons réglemented for many years, and of 9 other garrisons which have never been under the system, but admit in their general character and surroundings of a fair comparison with the réglemented ones. These 9 contain Amsterdam, Grave, Helvoetsluis, Naarden, and others; and the general result is an follows: - The 28 réglemented garrisons have had an average ratio of 8.5 per 100 men** of Venereal Diseases of all kinds, ranging from 16.67 per 100 in Vlissingen to 1.2 per cent. in Zwolle. *'Per cent.' of the original large amount of disease in the first period and of the smaller amount remaining in the second period. **In Holland the ratios of disease are given as per 100 men. In England they are always given as per 1000 men. This difference in the method of describing the ratios occasions a little confusion at first in comparing to the two sets of statistics. DIAGRAM II A SINGLE FORM ONLY OF VENEREAL DISEASES - VIZ. PRIMARY VENEREAL SORES - AND IN THE 14 STATIONS ONLY WHICH WERE "SELECTED" FROM 120 STATIONS IN THE BRITISH HOME ARMY TO BE PUT UNDER THE CONTAGIOUS DISEASES ACTS. 1860 TO 1894. [graph]9 The 9 garrisons never réglemented have had an average of only 5.2 per 100 of disease, ranging from 19.8 per 100 in Amsterdam to 2 per 100 in Doesburg - a difference of 3.3 per 100 in favour of the non-réglemented garrisons, and certainly not favourable to the claims of réglementation as a sanitary benefit. Another comparison must be made, viz., that between the results in the same garrisons during their réglementation and their non-réglement periods, and this comparison can be made in two different manners. 1st - The average ratio before réglementation may be compared with an equal number of years after its introduction, and the result is that 20 garrisons before réglementation had an average ratio of 12 per cent. The same 20 garrisons, for the same length of time during réglementation, had an average ratio of 10.95 per cent. The ratio of disease was less by 1.05 per cent. during réglementation than in its absence, which is so far in favour of the system, though that improvement in a dozen years or more cannot be called a striking success. But the last years of the periods before réglementation showed, in almost all cases, a smaller ratio of disease than the first years, disease have diminished under the influence of various causes before the introduction of that system. And when the period without réglementation in each garrison is divided into 2 equal portions, the average result is that 1st half of the period - average ratio of venereal diseases = 13 [?] 100. 2nd half " " " = 11.3 [?] 100. The average ratio in these garrisons had therefore fallen by 1.7 per cent. without réglementation; and when the 2nd half was compared with an equal number of years of the réglemented period which followed, the result was that the last half of the non-réglemented period had an average ratio of 11.3 per 100, while an equal number of the following years of réglementation had an average ratio of 12 per cent. This is higher by 0.7 per 100 than it was previous to the application of the system, and so far shows réglementation to have operated injuriously instead of beneficially to the health of the troops. It may be said, of course, that the difference was so slight as to be really immaterial. No doubt it was slight; but whether much or little it tells against a system the advocates of which proclaim it to be the only saviour of the Army from Venereal Diseases. SUMMARY FOR HOLLAND. To sum up, then. (1) The garrisons never under réglementation have had less disease than the réglemented ones by 3.3 per 100 men. (2) The last half of the non-réglemented period has had less disease than the réglemented period by 0.7 per cent. (3) But the entire non-réglemented period has had less disease than the réglemented stations, has had more disease than the réglemeted period in the same stations by 1.05 per 100. A total of 4 per 100 against réglementation, and only 1.05 per 100 in favour of it.10 The Dutch experience, then, of nearly 40 years, supports the proposition maintained in this address - " that réglementation has failed to prove that it has either prevented or diminishes Venereal Diseases." But if it should be objected, by advocates of the system, that this is simply the summing up of an avowed and therefore biassed opponent, we may conclude this section by the following summing up by Professor Mounier, of Utrecht, Doctor of Science, in his exhaustive analysis of the Dutch statistics*: - "The last result to which the statistical examination has conducted "us is to compel us to recognize that this examination is powerless to "solve, in any way, the question as to the efficaciousness of réglemen- "tation. In this last analysis behold the only conclusion that I can "give: - The study of the propagation of venereal and syphilitic dis- "seases in the garrisons of the Low Countries from 1850 to 1886 "inclusive, made by the aid of a purely statistical method, does not "permit me to put forward a conclusion either for or against the "réglementation of prostitution. Statistical science must then, by "virtue of its proper method, declare itself incompetent to decide the "differences which have arisen on the subject of this réglementation." DENMARK. Denmark, like England and Holland, is able to compare réglemented with non-réglemented garrisons, so as to judge what may be the proved sanitary benefits there to the first set of garrisons from the operation of the system in that country. The system has also been in operation that long enough to enable a comparison to be made between the early and the later periods of réglementation, so as to judge whether the continuance of the system has proved favourable or unfavourable to the health of the troops. The system has also been abolished for many years in six large towns, and the result is shown in the following tables:- Réglementation was not established by law in Denmark until 1874. and the Army and Navy statistics of Venereal Disease only date from that year. The following table shows the amount of Venereal Disease in the Army and Navy, divided into three periods of six years each:- VENEREAL DISEASE IN THE ARMY AND NAVY OF DENMARK during 18 years, 1874-1891, divided into three equal periods, the ratios being per 1000 of strength. Statistics. | 1st Period, 6 years, 1874-1879. Average Ratio per 1000 | 2nd Period, 6 years, 1880-1885 Av Ratio per 1000 of strength. | 3rd period, 6 years, 1886-1891. Av. Ratio per 1000 of strength. | Change in the third 6 years Copenhagen The Fleet | 24.0 | 53.4 | 60.1 | Increase of Disease 150% The Army | 16.1 | 22.0 | 20.7 | " 28.6% The results from this table for 18 years are that while under réglementation disease more than doubled in twelve years in the Navy, and increased by nearly one-third in the Army. * "Recherches sur la signification de la statistique des Maladies Veneriennes et Syphilitiques dans l'Armees due Royaume des Pays, Bas," par G.H.D. Mounier; Docteur des Sciences. La Hage: W.A. Beachon, 1889, and Bureau du Bulletin Continential, 6, Rue du Saint Leger, Geneva. 11 Sanitary Result of ABOLITION of Réglementaton in Denmark. The following Table extending from 1874 to 1893, illustrated the sanitary result of the abolition of réglementation in 6 Danish towns in which it had previously been in force. In Viborg it was given up in 1879; in Frederickshavn, in 1882; in Horsens, in 1883; in Aalborg, in 1885; in Elsinore and Aarhus, in 1886. This table relates to the civil population,* not to the Army. Town | 1st Period, 6 years, 1874-'79. Reglemented. Ratio per 1000 inhabitants | 2nd Period, 6 years, 1880-'85, Reglem'd in Elsinore, Aarhus, and Odense. Ratio per 1000 inhabitants. | **3rd Period, 8 years, 1886-'98, Not Reg'd Ratio per 1000 inhabitants. | Change after Abolition or Reglem. Diseases Reduced. Viborg | 6.10 | 3.81 | 1.60 | 2.21 o/oo Elsinore | 7.03 | 10.08 | 5.04 | 5.04 " Aalborg | 11.06 | 9.90 | 5.98 | 3.92 " Aarhus | 9.31 | 11.33 | 5.36 | 5.97 " Horsens | 3.53 |6.54 | 2.80 | 3.74 " Frederickshavn | 13.08 | 12.26 | 4.73 | 7.53 " The general result of this table is to show a remarkable diminution of venereal diseases, after abolition of réglementation, in every one of the towns in which the system had previously been in force. The ratios are not absolutely correct, for they are stated in proportion to per 1000 of inhabitants; and as the population varies from year to year but was only stated in decennial periods, an allowance must be made for some error on this score. But making every allowance for this source of inaccuracy, the important result will still remain, viz: that venereal diseases rose considerably in half these towns while under the influence of réglementation, but fell (though in a smaller proportion) in the other half; but that there was a marked fall in all of them after the system had been abolished. Denmark will certainly not be appealed to by the advocates of réglementation to prove that the system has reduced or prevented venereal diseases there. INDIA AND THE OTHER CROWN DEPENDENCIES OF ENGLAND. Having in the preceding pages shown the experience of the Home Armies in England, Denmark, and Holland, we may now turn to India and other Crown Dependencies of England and show in them also the sanitary results of réglementation and of its abolition. Our *In Denmark every private medical practitioner is compelled by law to report to the health officials every case of venereal disease under his care - whether in private or in hospital practice - as if it was a case of any other contagious disease: such as small-pox or scarlet fever. The health of the civil population, as well as that of the army and navy, can therefore be obtained from official publications of the Government in Denmark. **The figures for the 3rd period have been supplied to me in MS. by Dr. Giersing, of Copenhagen, from his personal examination of the official statistics. 12 source of information will be almost if not exclusively the returns made by the House of Commons, in 1894* and 1896*, to Mr. Jeffreys, M.P., for the period extending from 1879 to 1894 - partly because they are so recent, and can be obtained from the Queen's printer by anyone for a few pence; but chiefly because Dr. Commenge has quoted them unceasingly and approvingly as supporting his proposition, that "the abolition of the C.D. Acts in these places has been followed by disastrous sanitary results." He cannot, therefore, object to their being called in evidence to controvert his assumption at every point. INDIA. The following chart III shows the amount and curse of venereal diseases of all kinds in India as a whole, from 1860 to 1894, with the average strength of about 60,000 men. The official army returns commence in 1860, the beginning of the chart. In 1860 the ratio of disease was 329 to 1000, and it fell year by year until 1867, without any C.D.C Acts, ** to 185 per 1000, a fall in 7 years of 144 per 1000 men, or an average yearly fall of 20.6 per 1000 men. In the last year a C.D. Act was passed (much more stringent than the English one), and it was put in force throughout 1868, notwithstanding the previous improvement without it. According to the assumption of Dr. Commenge as to the sanitary merits of réglementation, the remaining 185 per 1000 of disease ought now to have been quickly reduced to a mere fragment of its amount: instead of which, during the first 9 years that the system was in force, its result was absolutely nothing, for disease fluctuated from year to year (now a little higher and now a little lower) until 1876, when it was 190 per 1000 against 185 per 1000 nine years previously. Réglementation had done neither good nor harm in altering the amount of disease during that period, but it had done the serious injury of stopping for 9 years the improvement that had previously been going on for 7 years without it. In 1878, however, it began to show its influence in earnest, for disease then began to rise (on the whole with steadiness) for the next 17 years of unhindered operation - an experiment long enough surely to satisfy even Dr. Commenge himself. In that year, 1890, the system was abolished - and as its introduction in 1867 put a total stop to the previous improvement, so its abolition put an almost entire stop to the increase of disease; for in the following 4 years of abolition (1890-94) the total rise was only 5 per 1000 men, a yearly average of 1.25 per 1000 while under the system. The rate of increase increased largely during the last 7 years of the Acts, having been 33.4 per 1000 yearly instead of 11.4 per 1000 during the previous 7 years; but if the increase had simply continued after abolition at its average rate for the whole 17 *Parl. Papers, No. 509, 1891, and 153, April, 1896 **Previous to the Act of 1867 there had been occasional employment of lock hospitals, under local "regulations," for a year here or a year there. But they had been given up as having produced no benefit, and the first systematic employment of lock hospitals is shown for 1865, in the accompanying diagram. DIAGRAM 3 - INDIAN ARMY - VENEREAL DISEASES - 7 YEARS BEFORE C.D. ACT (INDIA) 23 YEARS UNDER THE ACT 4 YEARS SINCE THE ACT WAS "ABOLISHED" IN INDIA IN 1890 13 years, disease would have amounted to 582 per 1000 men instead of being only 509 per 1000. What, then, has been the actual influence of the highly-lauded system of C.D. Acts or Réglementation in India, with above 60,000 troops? It has totally stopped the large improvement that had been going on for 7 years without it. For the first 9 years of its operation it was apparently without influence, good or bad, except in having stopped improvement; but during the past 17 years of its operation it has trebled the amount of disease. It was then abolished, and its abolition has been followed by a great diminution of increase, the rate being reduced from 19.2 per 1000 to 1.25 per 1000 yearly. The result of this experience in India has confirmed what we have already seen in England, Denmark, and Holland - viz., that réglementation was either almost without appreciable influence as in Holland, or had a distinctly injurious influence, as in England and Denmark. The other Crown Dependencies of Great Britain recorded in the Returns from the War Office through the House of Commons for Mr. Jeffreys, M.P. - 1894-1896.* These consist of Gibraltar, Malta, Cyprus, Canada, Bermuda, West Indies (including Jamaica), South Africa and Saint Helena, Mauritius, Ceylon, China and Straits Settlement, and the three Indian Presidencies - Bengal, Madras, and Bombay. In considering them in relation to venereal diseases, some general remarks apply to the whole, which will render extended individual description unnecessary. They are all (except the Indian Presidencies) comparatively small garrisons, ranging from Gibraltar and Malta with 4500 and 6000 men (which are the only large ones), to Mauritius and Cyprus with only 400 and 600 men. They are therefore specially liable to changes in the amount of disease, which may arise from the advent of a moral or of a dissolute regiment; and the fluctuations of disease are therefore exceptionally large - sometimes even excessive. All except Canada and Mauritius have been under C.D. Acts, and have also had experience of abolition during the period contained in Mr. Jeffreys' returns. They therefore admit of comparison as to the sanitary influence of the ABOLITION OF THE ACTS; and this comparison was the object for which the returns were called for by Mr. Jeffreys. The following is a brief account of the special features of each garrison:- [The accompanying charts (shewn between pp. 14 and 15) of disease in each garrison will bring the matter more intelligibly before the eye and the mind than would elaborate figures.] GIBRALTAR. - An almost unbroken rise of venereal diseases for 7 years while under the Acts - from 85 per 1000 to 287 per 1000; being an annual average rise of 25.8 per 1000 with Acts. A fluctuating fall after abolition of the Acts from 287 per 1000 to 181 per 1000, and a *This Return was not absolutely limited to the Crown Dependencies, as Egypt is not one of them, and Canada and South Africa are self-governing Colonies. C214 subsequent rise to 309 per 1000. giving an average annual rise of 3.04 per 1000 without Acts instead of 258 per 1000 with them. MALTA. - Under C.D. Acts the whole period. Unceasing fluctuations from 91.3 per 1000 in 1879 to 178 per 1000 in 1891. Disease rose upon the whole period from 91 per 1000 at first at 129 per 1000 at last. CYPRUS. - Small, and the most fluctuating garrison of all; the fluctuations - both during the Acts and after their abolition - being so excessive as to render any sanitary conclusions impossible. CANADA. - Never under Acts during the period of Mr. Jeffreys' returns.* Disease fell in a fluctuating, but on the whole continuous line from 251 per 1000 to 96 per without Acts. BERMUDA. - Disease small in amount and almost unchanged throughout, except a great increase in one year, followed by an exactly equal fall the next. Disease fell from 74 per 1000 at first to 49 per 1000 at last. It was under Acts until 1887. WEST INDIES (including Jamaica.) - An exceptional almost unbroken rise in disease for 8 years under the Acts - from 61 per 1000 to 314 per 1000. This rise continued for the years after abolition, with fluctuations from 344 per 1000 to 346 per 1000. There was an average yearly rise of 35 per 1000 while under Acts - a reduced rise of only 0.33 per 1000 after abolition. SOUTH AFRICA AND SAINT HELENA. - An almost unbroken rise for 8 years, from 56 per 1000 to 365 per 1000, and then fluctuations from 365 per 1000 to 274 per 1000. But the Cape of Good Hope has had many C.D. Acts between 1860 to 1885, and all of them have been repealed or abandoned because they were found to be impracticable or worthless. And as the Cape was lately agitating for a new and workable Act, it is impossible to draw any reliable conclusion from that colony. MAURITIUS is a very small garrison, and it has never been under C.D. Acts. Disease fluctuates to a very great extent, as it always does in very small garrisons, but it has fallen from 353 per 1000 to 209 per 1000 between the first and the last years of Mr. Jeffreys' Returns. CEYLON. - Disease rose here with unceasing fluctuations for 9 years while under the C.D. Acts, from 232 per 1000 to 354 per 1000, an average yearly rise of 13.6 per 1000. Since their abolition it has fallen in 6 years from 354 per 1000 to 315 per 1000, an average yearly fall of 6.5 per 1000. CHINA AND STRAITS SETTLEMENT. - This Station presents great difficulty in attempting to describe it, for it is exceptionally at variance with the others. For the first 9 years recorded in Mr. Jeffreys' Return its amount of disease was exceptionally small, so small indeed for a Station lying between India and China, that no intelligible explanation has yet been given of the comparative absence of disease**. Such as it was, however, it fell from 215 per 1000 to 189 to 1000 while the Acts *Canada was under Acts for a short time immediately after their enactment. **Since this was written, the Rev. W. Pierson, of Holland, has suggested an explanation which appears far from improbable; but I am not sufficiently acquainted with the facts to feel justified in introducing it here. DIAGRAM 4 UNITED KINGDOM & BRITISH CROWN DEPENDENCIES AMOUNT AND CHANGES OF VENEREAL DISEASES IN THE ARMY DURING THE C.D. ACTS AND SINCE THEIR ABOLITION UNITED KINGDOM & BRITISH CROWN DEPENDENCIES Amount and Changes of Venereal Diseases in the Army During the C.D. Acts and since their Abolition. DIAGRAM 5 Bermuda Under C.D. Acts Acts Abolish West Indies including Jamaica Under C. D. Acts Acts Abolish South Africa & St. Helena Mauritius Not Under C. D. Acts Under Acts Shown By Plain Lines Without Acts By Dotted Lines UNITED KINGDOM & BRITISH CROWN DEPENDENCIES Amount and Changes of Venereal Diseases in the Army During the C.D. Acts and since their Abolition. Diagram 6 Ceylon Under C.D. Acts Acts Abolish China & Straits Settlements Under C.D. Acts Acts Abolish Egypt Not Under C. D. Acts Under Acts Shown By Plain Lines Without Acts By Dotted LinesDIAGRAM 7 UNITED KINGDOM & BRITISH CROWN DEPENDENCIES AMOUNT AND CHANGES OF VENEREAL DISEASES IN THE ARMY DURING THE C.D. ACTS AND SINCE THEIR ABOLITION 15 were in force. They were then abolished, and in one single year disease shot up by 171 per 1000, thus bringing up the amount to that prevailing generally in India itself. Since that time it has fluctuated, the latest ratio being 410 per 1000. For the last 6 years it has closely resembled India in its fluctuations and amount. EGYPT, though not an English Crown dependency, is included in Mr. Jeffreys' Return; but it has never been under C.D. Acts, and its disease is only recorded since 1883. The amount fluctuates unceasingly from 286 per 1000 to 249 per 1000, having again risen to 408 per 1000, and closed at 37 per 1000. BENGAL, with an average of about 40,000 men, began in Mr. Jeffreys' returns with a ratio of 250 per 1000, disease rose with occasional fluctuations for 11 years under the Acts to 466 per 1000. The Acts were abolished in 1890, and it fell largely for a single year; but during the entire 4 years since abolition it has risen again to 500 per 1000. There was an average yearly rise of 19.6 per 1000 men while under the Acts, but an average rise of only 8.5 per 1000 since their abolition. If the average rise during the previous 11 years under the Acts had simply continued for the next 4 years of abolition the ratio would have been 544 per 1000, instead of the 500 per 1000 that it really is, a difference of 44 per 1000 in favour of abolition. MADRAS, with an average strength of about 12,000 men, began in 1879 with a ratio of 246 per 1000. In 11 years under the Acts it rose to 432 per 1000 - an average yearly rise to 17 per 1000. The Acts were then abolished, and in the next 4 years disease rose to 517 per 1000, an average rise of 21.2 per 1000 men, a higher yearly rate of rise than while under the Acts. If the previous rise had continued during the 4 years of abolition, disease would have stood at 500 per 1000, whereas it really stood at 517 - a slight difference against abolition. BOMBAY. - With about 12,000 men, began at 259 per 1000, and rose in 11 years under the Acts to 481 per 1000, an average yearly rise of 20 per 1000 men. After abolition it still rose in 4 years to 545, an average yearly rise of 16 per 1000 men under abolition, against 20 per 1000 while under the Acts. If the previous increase had continued during these 4 years, the ratio would have been 562 per 1000, while it was really only 545, a slight difference in favour of abolition. INDIA AS A WHOLE. - We have already seen that when the three Presidencies (varying so largely in strength and also in their health results) are combined together to form the British Army in India as a whole, the result of the Abolition of the C.D. Acts was a reduction of the previous rate of increase from 19.2 per 1000 yearly to only 1.25 per 1000 yearly, and also a prevention of 73 per 1000 of Increase that would have taken place but for the Abolition. Objection to the foregoing "Presumptive Ratios." It may be said that the foregoing calculations and the estimated benefit or injury from Abolition of the Acts are all purely hypothetical; for it cannot be proved that the previous increase of disease would have continued, and if it did not, then all the conclusions are worthless.16 In answer to this feasible objection it can be replied, as a matter of fact, Venereal Diseases of all kinds combined have increased upon the whole throughout the whole period of the Acts from 1868 to 1890. Further, there have been such fluctuations throughout in all the Presidencies and other Stations contained in the Returns, as to make it highly probable that such fluctuations of fall and rise would still continue, and yet that the progressive increase on the whole period of 22 years in India would, with the highest degree of probability, continue unless some new well-defined cause was brought into operation which would naturally tend to check the increase. But no such new influence, either moral or sanitary, is or has been seriously put forward by the advocates of the Acts, On the contrary, the whole cry has been "Extend and make still more stringent the system which has proved such a sanitary failure,"* or else there has been a demand for still more incentives to immorality in the form of an increased number and greater attractiveness of prostitutes for the supply of the Army.** It may therefore be assumed with the fullest confidence at the present stage of the controversy that the previous increase would have continued, and that, judging from the past, it would have done so at an increased rather than a diminished rate. Summary of the foregoing accounts of the British Crown Dependencies of the Sanitary Results of the C.D. Acts and of their abolition, as shown by Mr. Jeffreys' return. Increase of Venereal Diseases while under the C.D. Acts. Disease rose in Gibraltar ... from 85 per 1000 to 287 per 1000 " Malta ... " 91 " 129 " " West Indies and Jamaica ... 61 " 304 " " South Africa ... 56 " 365 " " Ceylon ... 232 " 354 " " Bengal ... 250 " 466 " " Madras ... 246 " 432 " " Bombay ... 259 " 481 " A result totally against any Sanitary benefit from Réglementation in these various garrisons in so many parts of the world. *Memorandum - Army Sanitary Commission (see p. 27, par. 6). **The following official "Circular" was issued in India in June, 1886, and it is addressed from the office of the Quartermaster-general of India to every general officer in India. The following are the important portions of the "Circular Memorandum" No. 21 June 17, 1886; and it was followed in 1887 by the "Thirteenth Annual Report of the Working of the Lock Hospitals in the North-western Provinces and Oudh." - Parl. Papers, 197, 1888. Circular No. 21, 1886, see f. - "In the regimental bazaars it is necessary to have a sufficient number of women; to take care that they are sufficiently attractive; and to provide them with proper houses." See. g. - "Young soldiers" are to be "carefully advised to avoid the risks involved in associating with women who are not recognized by the regimental authorities." Circular No. 42, 1884, desires that in constructing houses for the registered women, they should be built so as to please the women, "otherwise the ts will not be satisfactory." Circular 69, 1883. - The women are to be examined every day, to see that they ae free from disease." See also p. 19 of this Address - "Report of the Working of Lock Hospitals in the North-western Provinces of India and Oudh, 1886," - Dyer Bros, Paternoster Square, London. 17 Changes per 1000 in venereal diseases after the Abolition of the C.D. Acts: - Gibraltar ... fell from 365 to 308 Bermuda ... " " 74 " 49 South Africa ... " " 365 " 274 Ceylon ... " " 354 " 315 Canada (without Acts) " " 210 " 96 Mauritius ( " ) " " 353 " 209 PER CONTRA. China and Straits Settlement rose from 189 to 410. The West Indies and Jamaica had risen 35 per 1000 yearly while under the Acts, and the rise continued after Abolition of Acts, but only by 0.33 per 1000 without Acts instead of 31.5 per 1000 while under them. West Indies rose under Acts 35-00 per 1000 yearly, but without them only 0-33 Bengal " " 19-60 " " " " 8.50 Madras " " 16-97 " " and " 21-25 Bombay " " 20-20 " " but " only 15-90 In 6 of the stations disease fell, and in 4 of the remainder (W. Indies, Bengal, Madras, and Bombay) the yearly rise was materially reduced after Abolition of the Acts. The Straits Settlement was the only marked increase of disease after Abolition. The Influence of Réglementation as a Sanitary Agent is insignificant and practically inappreciable when compared with the other agencies that operate in the production of Venereal Diseases. Having shown in the preceding pages the strong proofs, derived from the experience of England, Holland, Denmark, and India - 1st, of the absence of all power in the system of réglementation to limit the amount of venereal diseases; 2nd, of the positive injury resulting from its introduction in England and India; and 3rd, of the sanitary benefit resulting from its abolition in England, India, and Denmark—we may no examine a still further aspect of the subject. That is, it’s insignificance as a sanitary agent when compared with the other influences which operate in the production of venereal disease. In this portion of our enquiry we shall not be confined to England, Holland, And Denmark but we shall summon France also, and Dr. Commenge himself to witness against his own theory, and to prove that it is immaterial whether réglementation is present or absent when we examine the amount of venereal diseases in the armies of these four various countries by every test to which we can submit it. The particular test to which we shall now have to resort is — That the order in which the different garrisons in these countries take rank in th amount of disease, is utterly independent of the presence or absence of réglementation. To begin with England, as the most trying test, because exactly one half of her home army has been for years under the system, and the other half has been without it during the same period; and because the evidence now to be adduced was put before the Select Committee of the House of Commons in 1879, in the presence of most accom- 18 plished war-office critics, and was subjected to cross-examination by them, and has therefore had to run the gauntlet of an exceptionally severe tribunal. The following table shows the ratio per 1000 men of primary venereal sores and of gonorrhoea in the 28 stations selected by the War Office for the trial of the "great experiment" of the C.D. Acts, and it covers the 3 years (1870-1-2) in which the Acts were in full unhindered operation. In 1878 the men began to conceal their disease in order to escape losing their pay when in hospital to such an extent that the Army Reports year by year (until 1879, when the penalty was removed) always added a footnote, "Statistics not reliable, on account of concealment of disease." After this year no evidence of a similar character was given on the comparison before the House of Commons, and therefore it could not be subjected to cross-examination. TABLE IV.--Ration per 1000 men of the amount of Primary Venereal Sores and Gonorrhoea in 28* selected stations in the British Home Army from 1870 to 1873. Name of Station. Ratio per 1000. Condition. Athlone 85 Not under C.D. Acts. Shorncliffe 98 Under them. Fermoy 100 Not under. Curragh 104 Under. Pembroke Dock 105 Not under. Dover and Cork 114 Under. Winchester 117 Under. Hounslow 141 Not under. Windsor 135 Under. Warley 145 Not under. Isle of Wight 153 Not under. Chatham 155 Under. Edinburgh 157 Not under. Portsmouth 163 Under. Three other Stations, Great Camps, or Arsenals 165 Under. Limerick 181 Not under. Plymouth and Devonport 188 Under. Manchester 215 Not under. Canterbury 224 Under. Three great Manufacturing Towns 248 Not under. Dublin 262 Not under. London 262 Not under. Curragh, one of the largest camps, had only 104 per 1000, while Chatham had 155 per 1000, Portsmouth had 163 per 1000, and the three great garrisons, Aldershots, Colchester, and Woolwich (averaging about 7000) had 165 per 1000, Plymouth had 188 per 1000, and Canterbury 224 per 1000,--above twice the amount present in the great camp--the Curragh,--yet all were equally under the C.D. Acts. The lowest ratio was 85 per 1000 in Athlone, and Edinburgh had 157 per *Maidstone is not included in the Table. Its garrison was so small, and the fluctuations were so great, as to render it valueless in a comparison. Aldershot, Colchester, and Woolwich. :Belfast, Preston, and Sheffield. 19 1000 (about twice as much), while the great metropolitan cities of Dublin and London, and three of the greatest manufacturing towns in the country had the highest ration of disease, not being under them. How is it possible to show that the system of réglementation has had any influence whatever among these extreme variations in the amount of disease, whether under or not under its operations? Remarkable Evidence relating to the amount of Venereal Diseases in the camp at Aldershot, given to the Select Committee of the House of Commons, 1879, by the Inspector-General of Military Hospitals, Dr. R. Lawson. The camp, of about 12,000 men, is occupied by numerous regiments which have a nearly equal strength of about 600 men. During a visit of inspection, extending over many months, Dr. Lawson found that the amount venereal diseases in one regiment was only 23 per 1000 men, in another, it was 42 per 1000, in another 84 per 1000, in another 114 per 1000, and in another it reached a maximum of 142 per 1000 men, yet all were in the same camp and surroundings, and all were equally under the C.D. Acts. What degree of sanitary value, then, can be claimed for réglementation when it results in 23 per 1000 in one regiment and in above 6 times as much (142 per 1000) in another at the same time and in the same place? He was called by the War Office to give evidence before the Select Committee in favour of the C.D. Acts as a sanitary measure, and the only explanation he could offer of the extraordinary difference was a difference in the character of the men, and in the traditional habits of the regiment. (Quest. and Ans. 406 to 416, Min. of Evid., 1879.) Réglementation, whether present or absent, is evidently an insignificant influence compared with the character of the men as to the amount of venereal disease in the army. Dr. Lawson was by far the ablest and the most trusted medical witness called by the government in support of Acts, and the above evidence is therefore of exceptional importance. Evidence furnished by the 14 garrisons of the North-western Province of India and Oude, all under the C.D. Acts. (Reports of the working of Lock Hospitals in the North western Province of India and Oude, 1886). Number of Stations. Venereal Diseases of all kinds. Average ratio per 1000 men. 4 203 per 1000 3 263. " 4 402 “ 3 546 “ They were all under the strictest C.D. Acts, which were carried out to the utmost of their power. What, then, can account for the difference? No one can claim that it is the absence of réglementation; but possibly the following difference may solve the question. In the 1st 4 garrisons the military authorities provided 1 public woman forevery 16.5 men; In the 2nd, 1 woman for every 9.8 men; in the 3rd, 1 woman for every 7.1 men, and in the 4th, 1 woman for every 3.9 men-and the Table shows the result. The amount of disease was in proportion to the amount of immorality and the provision made for encouraging it, and reglementation will not be claimed as having proved a sanitary benefit there. HOLLAND again contributes to our information on this head, and the following Table shows the alternations of disease between eight* stations that for about 20 years have never been under reglementation and a rather larger number of reglemented stations for about the same length of time. Stations. Ratio per 1000 men Condition 1. Zwolle ……………….. 12 Reglemented. 2. Schoonhoven ……. 18 Not. 3. Grave …………………. 19 Not. 4. Kampen ……………… 28 Reglemented. 5. Willemstadt ………… 38 Not. 6. Gouda ………………… 38 Reglemented. 7. Helvoetsluis ………… 39 Not. 8. Maestricht ………….. 42 Reglemented. 9. Neuzen ………………. 52 Not. 10. Gorinchem ……….. 59 Reglemented. 11. Naarden ……………. 58 Not. 12. Leiden ………………. 84 Reglemented. 13. Delft …………………. 87 Reglemented. 14. Breda ……………….. 96 Reglemented. 15. s'Gravenhage ….. 109 Reglemented. 16. Utrecht ……………. 129 Not. 17. Haarlem ………….. 135 Reglemented. 18. Vlissingen ……….. 166 Reglemented. 19. Amsterdam …….. 178 Not. The smallest ratio but one, and the largest ration, have neither of them ever been under reglementation, and the intermediate 17 garrisons come almost alternately under and not under the system. As far as freedom from Venereal Disease is concerned, the possession of reglementation is apparently a matter of complete indifference. BELGIUM is not able to assist in the comparison between Reglemented and non-Reglemented periods in any of its garrisons, as they have all been under the system from the first; but its experience of 17 years confirms the proposition that it is the character and general surroundings of the garrison, and not the presence or absence of reglementation, which influences the amount of venereal diseases. *There were five other stations that have never been under the system; but they are so small, and the recorded periods have been so short, as to render them valueless in a comparison. Average Ratio of Veneral Diseases per 1000 men in 14 Belgian Garrison Towns for 17 years. 1. Arlon ……… 46.8 per 1000. I 8. Berverloo … 90.0 per 1000. 2. Antwerp … 70.9 " I 9. Termonde 95.2 " 3. Ypres …….. 73.8 " I 10. Namur ……. 95.4 " 4. Bruges ….. 73.9 " I 11. Malines ….. 100.2 " 5. Ostende …. 83.4 " I 12. Ghent …….. 101.7 " 6. Louvain ….. 84.4 " I 13. Liege …….. 117.5 " 7. Brussels …. 84.7 " I 14. Diest ………. 119.1 " Brussels--the head-quarters of the system--having nearly twice the disease of Arlon, and Diest nearly three times the amount. Disease in relation to the frequency of the "Visites." In Arlon, Antwerp, Ostende and Termonde, the visite is once a week, and in the orther garrisons it is made twice a week. On looking at the above order of disease, it appears that where the visite is least frequent the amount of disease is most moderate--speaking in a general way. French teaching on this question, and Dr. Commenge's own evidence support of the proposition maintained in this article--that "the influence of reglementation, as a sanitary agent, is insignificant and practically inappreciable, when compared with the other influences which operate in the production of venereal disease." We may pass from England, Denmark, Holland and Belgium, and put Dr. Commenge himself into the witness-box. In his address are 3 pages (32, 3, 4) of exceptional importance as coming from the maintainer of the proposition that it is reglementation, and that alone, which causes the difference in the amount of venereal diseases between the French and Russian and the English armies, and in page 14 he emphasizes by italics, that "one single fact remains impregnable, and that is, the necessity for reglementation, moderate and legal. The necessity for reglementation is a brilliant demonstration, as the result produced by the English statistics." He commences the portion now to be put in evidence as follow:-- "It seems to me useful to show, from what takes place in the French army, the influence of "--of what? of non-reglementation?--by no mean--"of clandestine prostitution in the increase of venereal diseases in the different corps of the army." Reglementation of the utmost stringency that all have; but it is powerless to prevent clandestine prostitution, which is next alleged as the great source of disease in the French army. "In Algeria as in Paris clandestine "prostitution is very widely spread, and the proportion of diseased" soldiers is very great. It is the same with the 3rd corps, which "occupies the large manufacturing towns, where the young women" give themselves up readily to debauchery." And then he adds--The 11th corps occupies Brittany, "where the manners are less dissolute." And what is the result of this difference in morals? not, 22 be it observed, of a difference in réglementation, for that is uniform everywhere in the French army :— The ration of disease in Paris... is 54.8 per 1000 men. the 3d corps—the large manufacturing towns—is 84 " " in Algeria ... is 98 " " but in the 11th Corps—in moral Brittany it is only 26.3 " " Above twice as high in Paris—the head-quarters of réglementation —and four times as high in Algeria, as it is in Brittany! How much value does this Table show the system to possess in reducing the amounts of venereal disease in the French Army when compared with the other influences which he acknowledges to be so potent? Not only, however, is it the different corps that differ so widely, but the individual garrisons also have thier own different standards of disease, that appear to be upon the whole very constant and very noteqworthy. He continues—"Each different army corps has a yearly average nearly identical and peculiar to itself, and the difference is dependent upon the greater or less facility which the different garrisons supply to the soldiers for trying thier chance in debauchery"—'aventure' (page 33 ) . So here is another influence, independent of réglementation, which maintains a standard of disease that is nearly identical year by year, and is also "peculiar to each garrison itself." He gives the following Table of these differnet garrisons as under:— Vernon 6.75 per 1000 men. Caen 78.56 per 1000 men. Elbeuf 6.84 " Evereux 83.95 " Lisieux 35.70 " Bernay 89.51 " Falaise 62.78 " Le Havre 97.27 " Dieppe 73.71 " Rouen 98.32 " Our witness concludes this important evidence as follows:—"If Le Havre and Rouen have among the soldiers a proportion of venereal diseases so high and so nearly identical, how rudimentary must apear the statistics of venereals found in the garrison of Elbeuf, since it is only 6.84 per 1000! It shows that the progressively increasing amount is closely in proportion to the laxity of morals and the development of clandestine prostitution." The following table of large French cities, better known to many people than the above, has been supplied to me by Miss Doctor Agnes McLaren, from her own researches of the French Army statistics. They enlarge the area of Dr. Commenge's table, and entirely form the conclusions drawn from it:— Lyons 33 per 1000 men. Marseilles 58.7 per 1000 men. Amiens 38 " Constantine 60 " Bordeaux 49 " Oran 71 " Toulouse 50.6 " Rouen & Neighbourhood Tunisia 51.1 " 74 " Paris 54.8 " Algiers 98.6 " But it would be difficult to produce stronger testimony than that of Dr. Commenge to the truth of the proposition maintained in this section—that "the influence of réglementation as a sanitary agent is insignificant and practically inappreciable when compared with the other influences which operate in the production of venereal disease." 23 Constitutional of Secondary Syphilis since the Abolition fo the C.D. Acts - Reglemeentation. This form of disease is so much more serious from its liability to reappearance from time to time in the sufferer himself, and from tis frequent descent to his offspring, that its alleged increase as an inevitable result of abolition of the systems of Acts, is much more dwelt upon by their advocated that the possible increase of the non-syphilitic forms of venereal disease. It therefore requires special attention in this Address, and the result from Mr. Jeffreys' returns is to show how largely true syphilis increased while the garrisons were under réglementation, and how much its spread has been checked, if not entirely stopped, by the abolition of the system. The British Home Army has to be compared separately, as there are three periods to be compared instead of only two, as in the other stations— 1st period—3 years of full C.D. Acts—1870- 1-2. 2nd " 4 " " " 1880. 1-2-3. 3rd " 11 " abolished " 1884-94. The period of 7 years between 1872 and 1879 is omitted from the examination, as the soldiers at that time concealed their venereal diseases as much as possible, in order to avoid punishment. The statistics of those 7 years are therefore unreliable, and are left out of the comparison. Secondary Syphillis per 1000 men, from Mr. Jeffreys' Reports. Name of Station —United Kingdom. 1st reliable period— 3 years with } C.D. Acts. } GENERAL RESULT.— The average Average ration } Change per 100 } ratio per 1000 has risen in each per 1000—23.53. } in 2nd period } period, and the proportion of upon the previous } changed. the rise in the 2nd period 2nd reliable period—} amount— } with Acts was 24.82 per cent. The 4 years with } Rise of 24.82 percent.} rise in the 3rd period without Acts C.D. Acts. } Acts in force. } was only 18.80 per cent. The rise Average ratio } } after abolition of the Acts was much per 1000—29.37. } } smaller in proportion than the previous rise while the Acts were in 3rd period—} Change per cent } force. the abolition of the Acts has 11 years without } upon previous } been followed by a reduced rate of C.D. Acts. } period— } increase in Secondary Syphilis. Average ratio } Rise only 18.80 } per 1000—34.92. } per cent. Improvement with Acts repealed. GILBRATAR... Almost unbroken Rise under the C.D. Acts from 7.8 per 1000 to 39.4 per 1000. Average yearly rise 3.95 per 1000. Almost unbroken Fall after abolition of Acts from 39.4 per 1000 to 20.8 per 1000. Average yearly fall 2.51 per 1000.24 Malta ........... Constant fluctuations (under Acts throughout), from 6:0 per 1000 at first to 15:7 per 1000 at last. Cyprys ............ Excessive fluctuations throughout. Final Results - Disease was lower by 29:2 per 1000 after 7 years without Acts than it was after 8 years with them. Canada........... Without Acts throughout. Considerable fluctuations the first 7 years. Generally progressive fall the last 7 years. Fell in the 14 years from 38:7 per 1000 at first to 15:9 per 1000 at last. Bermuda........ Disease has gradually risen under the Acts from 10:7 per 1000 to 21:5 per 1000 in 7 years, and has gradually fallen in 6 years after abolition from 21:5 per 1000 to 5:7 per 1000. West Indies.... Disease rose while under Acts from 7:5 per 1000 to 37:8 per 1000. After abolition of the Acts in 1888 it continued to rise to 45:6 per 1000. The average yearly rise being 1:3 per 1000 without Acts against 3:37 per 1000 with them - a great reduction without Acts in the previous rate of increase with them. Mauritius....... Never under the Acts, but without them secondary disease fell on the whole from 120:7 per 1000 the first year to 30:4 per 1000 the last year. Ceylon ........... Great fluctuations, but with an average yearly rise of 1:84 per 1000 during the 8 years of the Acts. The rise continued after abolition, and at an average of 2:3 per 1000, an average increase of half a man per 1000 after abolition of the Acts. China & Straits Settlement. Sudden and excessive rise in 1889, after the Act was repealed. Gradual yearly rise of 2:19 per 1000 while under the Acts, which increased to 8:06 per 1000 after their repeal. (See comments on this station at p. 14.) India as a Whole Average yearly increase of 3:67 per 1000 men under the Acts, for the 11 years of Mr. Jeffreys' return. After the abolition of the Acts in 1890 the yearly rise was only 2:07 per 1000. The previous rate of increase while under the Acts was reduced by nearly one half (44 per cent.) If the previous rate of increase had simply continued, the ratio per 1000 in 1894 would have been 81:06 per 1000, but under abolition, it was only 74:65, a saving as the result of abolition of 6:41 per 1000 men yearly in this most serious form of disease. Bengal ................Average yearly rise of syphilis while under the Acts was 2:95 per 1000. The rise continued after abolition, but at the reduced rate of only 1:49 per 1000, just one half its rate while under the Acts. 25 If the previous rate of increase had continued, the ration in 1894 would have been 72:0 per 1000, but it was only 66:6 per 1000, a saving since abolition of 5:4 per 1000. Madeas ............The average yearly rise of syphilis under the Acts was 6:1 per 1000, but after abolition the continued rise was only 2:57 per 1000. If the previous rise had continued the ratio in 1894 would have been 115:5 per 1000, but it was only 101:4 per 1000, a saving of 14:1 per 1000 men since abolition. Bombay........... The average yearly increase while under the Acts was 3:34 per 1000, but the rise continued after abolition at the higher rate of 3:62 per 1000 yearly without Acts than with them. If the average rise had continued, the ratio in 1894 would have been 73:36 per 1000. It was really 74:5 per 1000 - an additional loss of one man and a seventh per 1000 after abolition. Egypt ............... Not a British Dependency, and disease is high in it, and has risen during the English occupation of the country. The fluctuations are so great as to forbid any definite information upon the whole combined diseases, but syphilis rose materially. South Africa and St. Helena ..... The changes in disease in South Africa have been so little influenced by the numerous C.D. Acts that have been passed there and have soon come to an end as having proved useless or inapplicable, that no inference of weights can be drawn from them except that they furnish no proof of sanitary benefit from C.D. Acts legislation. Syphilis rose from 15:72 per 1000 yearly under the two first Acts, and fell 8:8 per 1000 yearly under the 3rd Acts. (See p. 14.) Summary relating to Syphilis proper in the British Army and Dependencies. Under Acts. Since Abolition. British Home Army, Rose throughout. Continued to rise, but at a reduced rate. Gibraltar........ Almost unbroken rise. Almost unbroken fall. Malta..............Constant fluctuations throughout. Cyprus............Great fluctuations. Disease lower by 29:2 per 1000 after Abolition. Canada.......... Never under Acts. Generally progressive fall. Bermuda........ Rise from 10:7 to 21:5 Fall from 21:5 to 5:7 per 1000. West Indies and Jamaica ........ Avg. yearly rise 3:37 Since Abolition. Avg. yearly rise only 1:3 per 1000. Rate reduced.Mauritius ... ... Never under Acts. Fell from 120.7 per 1000 to 30.4 per 1000. Ceylon ............ Avg. rise 1.84 per 1000. Av. rise 2.3 per 1000; half a man per 1000 more. China and Straits Settlement ... . Avg. yearly rise 2.19 per Avg. yearly rise 8.06 per 1000. 1000. India as a whole .. Avg. yearly rise 3.67 per Avg. yearly rise only 2.07 per 1000. 1000. Bengal ............ Avg. yearly rise 2.95 per Avg. yearly rise only 1.49 per 1000. 1000. Madras .......... Avg. yearly rise 6 1 per Avg. yearly rise only 2.57 per 1000. 1000. Bombay .......... Avg. yearly rise 3.34 per Avg. yearly rise 3.62 per 1000, 1000. one-quarter man per 1000 more. Egypt and S. Africa. See previous page. An almost unbroken fall after Abolition, instead of the almost unbroken rise while under C. D. Acts. The above summary is limited to England and her Dependencies. I have not been able to find any comparison as to the proportion of syphilis with and without reglementation in the armies of France. Holland, Denmark, or Belgium, as they have not established the system in their garrisons. But the experience in the Danish army and Navy in Copenhagen, from 1874 to 1891, while still under reglementation, is as follow, when divided into three equal periods of six years each: SYPHILIS -- DANISH NAVY Avg. ratio Avg. ratio Avg. ratio 1st period. per 1000. 2nd period. per 1000. 3rd period. per 1000. 1874-1879. 8.2 1880-1885. 8.0 1884-1891 11.3 A progressive increase of syphilis in the navy while under reglementation from 3.2 per 1000 to 11.3 per 1000. SYPHILIS -- DANISH ARMY Avg. ratio Avg. ratio Avg. ratio 1st period. per 1000 2nd period. per 1000 3rd period. per 1000. 1874-1879. 1.7 1880-1885. 5.5 1886-1891. 4.6 An increase in the army from 1.7 per 1000 in the first period to 5.5 per 1000 in the second period, but a decline to 4.6 in the third period, though still an increase from 1.7 per 1000 in the first period to 4.6 per 1000 in the last period with reglementation throughout. In the BELGIAN ARMY SYPHILIS has, on the contrary, declined from an average of 15.5 per 1000 in the period 1869-76, to an average of 14.8 per 1000 in the equal period 1878-1885, the last period I can obtain. A small decline, but still a decline. Summary of the Results shown in the foregoing Statistics. 1.- No statistical evidence is offered by DR. Commerge or the advocates of reglementation whom he quotes, that the introduction of the system into the garrisons previously without it has been followed by a reduction of venereal diseases. 2.- Evidence of incontrovertible character is here adduced which shows that the introduction of the system has immediately stopped or largely reduced improvement previously taking place without it, and has further largely increased the previous amount of venereal diseases. 3.- In England, Holland, and Belgium evidence is here given which shews that when garrisons under the system, and similar comparable garrisons not under it are compared for the same periods of many years, the influence of the presence of reglementation is utterly inappreciable as regards to the amount of venereal diseases in the two sets of garrisons. 4.- The abolition of the system during an experience extending over many years has been followed by a very marked reduction of disease in the majority of cases, and by a marked reduction of the rate of increase that was going on before, even when the abolition has not been followed by a total cessation by the previous increase. 5.- The experience here put forward from England, India, France, Holland, Denmark, and Belgium confirms the following conclusions arrived at by the British "Army Sanitary Commission," which related to England and India alone. Conclusion of the report of the British "Army Sanitary Commission" as to the advisability of restoring the system of the Contagious Diseases Acts (Reglementa- tion) in England or India "MEMORANDUM by the Army Sanitary Commission on the statistics of "Venereal Disease among British and Native troops in India for "for the year 1892. "When the rules were first promulgated, the Sanitary Department "was sanguine that venereal diseases, which always occupied such a "prominent place as a cause of sickness and invaliding among "European soldiers in India, would be reduced to a mere fraction "of what they had been, and even after years of unsuccessful result "it was still hoped that with increased care and greater stringency the "desired end might be attained. But there can be no question that "the outcome was a failure. "Not only did these hospitals fail to effect a reduction in the ratio of "venereal cases among European troops, but, as it happens, these diseases "increased during the term of years in which they were in full operation. "The facts, so far, as we can ascertain them, lead us to the conclusion "that a compulsory lock hospital system in India has proved a failure, "and that its re-institution cannot consequently be advocated on sanitary "grounds. In stating this conclusion, we may add that we are merely "repeating the opinions which the Army Sanitary Commission have "uniformly held, that venereal diseases in the army of India could not be "repressed by such restrictive measures, and in support of this statement "we may refer to the memoranda on the Indian Sanitary Reports, which "have issued from this Office for many years. We believe that the best "practicable means of diminishing the prevalence of these diseases is to be "found in establishing a system of voluntary lock hospitals, and in pro- 28 "viding the soldier, as far as possible, with healthy occupation and "recreation * * * * "Commanding officers should also be urged to encourage in every way "all forms of athletic amusement, as physical fatigue acts as a deterrent "to sexual indulgence. * * * * "We may remark that statistical returns from the Army Medical "Department, showing the amount of venereal disease in the Army at home "during the period when the Contagious Diseases Acts were in force "as compared with the period since their abolition, do not show that "any more favourable results obtained during the time the Acts were in "operation. * * * * "As a matter of fact, the ratio of admissions per 1000 has decreased "since the Acts have been abolished." "War Office, 25th January, 1894. Such is the Report of the Army Sanitary Commission in 1894, after nearly a quarter of a century of the Acts. The Royal Commission in 1870 (twenty-two years previously) reported: "There is no distinct evidence that any diminution of disease among the men of the Army or Navy, which may have taken place, is attributable to a diminution of disease contingent upon the system of periodical examinations amongst the women with whom they had consorted." -Report, Sec. 37, and it added, Sec. 66: "We recommend that the periodical examination of the public women be discontinued." But they were not discontinued, and these two reports, issued by such totally different commissions, show that the system has been a sanitary failure from first to last. Influence of Reglementation - the C. D. Acts - upon the Health of the "Registered" Prostitutes. This is an important consideration when estimating the sanitary influence of reglementation. I have not been able to obtain official information upon the subject from any Continental sources; but in England the House of Commons published a report every year of the numbers and condition of health, and of behaviour, &c., of the prostitutes registered under the Contagious Diseases Acts, which was laid before the House by Captain Harris, the official head of the police employed in carrying out the Acts. His returns showed that for a period of six years there was a rise in venereal diseases among the women from 121.6% to 143.5%; which was followed by a fall for three years from 143.5% to 136.5%; and, after that, by a rise for six years from 136.5% to 169.5%. At the end of the recorded period of the fifteen years, disease had risen from 121.6 per 100 prostitutes --its amount at the date of the passing of the Acts--to 169.5 per 100 women in the last year published by the Government. It is not surprising that disease should have failed to lesson among the men when there was such an increase in its amount among the registered women. Réglementation (the Acts) certainly did not prove a sanitary benefit to the registered prostitutes. 29 APPENDIX A. Influence under which the great Improvement in the British Army took place previous to the introduction of the C.D. Acts of 1866 (see Diagrams I and II); and the worthlessness of the comparison between the two sets of stations in the British Home Army, so strongly dwelt upon by Dr. Commenge in his Address (pp. 12-14) as proving the sanitary value of the Acts. The diseased and demoralized condition of the British Army having become a grave scandal, the late Lord Herbert, when Secretary for War, appointed a Commission to enquire what could be done to raise its character and improve its health : and this Commission reported in favour of a number of most important and valuable sanitary, moral, intellectual, and social improvements, which began to be carried out in 1860, when the yearly records of the Health of the Army also began to be published. There are about 130 stations (more or less) in the British Home Army, ranging from large camps of 12,000 men or upwards- as at Aldershot--- to small country places not having alone 50 men, or possibly fewer still. Of these 130 stations, the Medical-Director- General of the Army at the time " selected " 14 to be put under the Acts, and he " selected " another 14 for the purpose of comparison which were not put under them ; and the remaining 100 stations (more or less) he left entirely out of the comparison, though they embraced about 20,000 men, and such large and important towns as Birmingham, Leeds, Newcastle, Nottingham, York, and others. "As different conditions attach to residence in camps and in towns," the Army was divided in 1860,* for sanitary purposes, into the following " groups," viz.--- Seaports, Dockyards, Camps, Manufacturing Towns, London and Windsor, Dublin, Depôt Battalions, " Remaining " Stations. And all the beneficial agencies urged by Lord Herbert's Commission were applied with great earnestness and speed to the seaports, the dockyards, and the camps ; and with such good results that before the Act was passed in 1866, venereal disease had fallen by 38 per cent. in the " seaports," by 29 per cent. in the " dockyards," and by 28 per cent. in the " camps." On the other hand, London, Dublin, and the Manufacturing Towns were supplied with them slowly and imperfectly, with the result that London increased in disease, Dublin was the worst station throughout, and the " Manufacturing Towns " only improved by 21 per cent. instead of 28, 29, and 38 per cent.* Utterly worthless manner in which the Two Sets of Fourteen Stations were " Selected " for Comparison out of the 130 Army Stations. At this period the Act of 1866 was passed, and the whole of the camps, the whole of the seaports, and a majority of the dockyards, which had all improved so largely already, were put under the Acts. * Collected from the Army Reports yearly from 1860 to 1866.30 The number of 14 was filled up by four or five from the "remaining" stations, and the beneficial agencies already at work were pushed on in the "protected" group with still greater energy. (Evidence Select Committee, House of Commons, 1881. Questions 2854-8 and 2971-5.) For the "unprotected" stations, on the other hand, Dublin (the worst station throughout) London, which had fallen off instead of improving, and the four large manufacturing towns, Manchester, Preston, Sheffield, and Belfast, which had already shown their largely diseased and comparatively unimproving character, were "selected"; one dockyard was added, and the number of 14 was filled up from the "remaining" stations; and this collection of the six worst stations, of one improving one, and of seven others of no specially marked character, was left poorly supplied with those improvements which had previously worked such benefit in the stations to which they had been liberally furnished (Ev. Sel. Com., H. of Com., as above). IMPORTANT IMPROVEMENTS (LORD HERBERT'S), Introduced into the 14 Stations ultimately subjected. 1860-1866 before the Acts ………………………………………… 35 1867-1878 after the Acts ……………………………………………. 48 __ Total ………………. 83 ___ ___ Introduced into the 14 "selected" Stations never under the Acts. 1860-1866 …………………………………………………………………. 20 1867-1878 …………………………………………………………………. 23 __ Total ………………. 43 __ The bad stations "selected: for comparison were supplied with barely half the improvements supplied to the 14 good stations, also "selected," to show the benefits alleged to have resulted from the Acts, and the Acts alone. (Taken from the Army Reports year by year, and given in evidence by Dr. Nevins, before the Select Committee of the House of Commons in 1881. See Questions and Answers above.) It would be difficult to devise a method better adapted for producing a misleading comparison by throwing every advantage into the scale of the stations without them on the other. And these two "selected" sets of stations were then put forward in the Army Reports as representing* the beneficial sanitary result of the Acts, and the Acts alone, by comparing the amount of Primary Venereal Sores in the bad, neglected set with that in the other highly favoured set. Not only was this worthless comparison put forward and constantly dwelt upon by the Army Reports and advocates of the Acts; but in the Address from Dr. Balfour to the Belgian Academy of Medicine in 1886-upon which Dr. Commenge lays so much stress in pp. 12-14 of his own address-a still further fallacy was introduced, which is inexplicable in a responsible statistician like Dr. Balfour. The Army *Army Report, 1873, p. 13. 31 Reports, of which he was the statistical head, stated year by year from 1874 to 1879, that the statistics for those years were unreliable, and that the great apparent reduction in the amount of disease was due to the soldiers concealing their diseases in order to escape the loss of pay while they were in hospital for venereal diseases. This penalty was removed at the end of 1879, and the men then reported themselves as usual to the regimental doctors; and the result was seen in the sudden rise of disease in 1880, as shown in the charts. Now, not only did Dr. Balfour endorse the composition of the two sets of stations as constituting two bodies fitted for a scientific comparison, but in his address he actually employed the statistics of these seven years which he had himself year after year declared to be worthless, in order to obtain the "50 per 1000" from 1870 to 1882 which he puts forward with laudation as being the beneficial result of the Acts in the 14 stations under their influence.* Unquestionably the 14 stations under the Acts had far less primary Venereal Sores than the "selected: fourteen stations not under them; but until 1873 the Army Reports never alluded to the other 100 stations which were also not under the Acts, or informed either Parliament or the public as to their health condition. In that year, however, an unobtrusive notice of a few lines said that of these 100 non-subjected stations "so many" had no cases of Venereal Disease at all and that the whole of the non-subjected stations had "so much" less disease than the 14 stations "selected: for comparison; and a similar notice was afterwards published year by year in the Army Reports until the Acts were suspended in 1883. New and Complete Comparison in 1885. In 1885 the House of Commons ordered a return from the War Office of the ratios of primary sores for every year from 1860 to 1884 in these 100 previously discarded stations, which have had an average strength of about 20,000 men, and the return shows the following results (t):- Primary Venereal Sores in the 14 Stations under the Acts, the 100 Rejected Stations not under them, and the 14 "Selected" Stations not under them. 14 Stations under Acts during the whole period of the Acts, average ratio " " " " " " 70 per 1000 100 Stations not under Acts, previously discarded from comparison, during the whole period of the Acts, average ratio .. 74 " 14 Stations not under Acts, always "Selected" for comparison, during the whole period of the Acts, average ratio ….. 136 " The 100 Stations not under the Acts, but hitherto discarded from the comparison, had barely higher ratio of disease than the Stations under the alleged protection of the Acts, and have had little more than half the amount present in the 14 specially bad stations always "selected" for comparison to show the remarkable sanitary benefit alleged to be derived from the Acts. * Commenge's Address, page 13, par. 3. (t) Parliamentary Paper 325, 1885.32 APPENDIX B. "The results of the suppression of the C.D. Acts have been "disastrous, in the sense that Syphilis has developed in a frightful "manner(Commenge's Address, p.6), ... and there is an "enormous danger not only to the Army but also to the civili popula- "ion in which Syphilis must necessarily extend, from the return of "diseased soldiers to their own homes" (Commenge, p.8). Such is the alarming prediction as to the future of the general community to rest from the Repeal of the Contagious Diseases Acts, which is put forward by Dr. Commenge with the most unreserved con- fidence. He brings forward no evidence to support his prophesy, but he has, no doubt, a considerable amount of support from the popular language of military and naval men, the daily press, and also the medi- cal press, which appear to entertain the same fears, and express them in similar strong and confident terms. The assertion is one of such national importance, if it is really correct, that is appeared to me to be an imperative duty to ascertain wether it is true or false, if it should be possible to do so. But the difficulty of arriving at an answer which should carry conviction to thoughtful earnest men has been almost insuperable, from the absence of official authoritative information on the subject. the Registrar General gives the returns of deaths from Syphilis for England as a whole, and for London separately, but not for any other individual towns, and his returns give no clue whatever to the amount fo disease of this nature as distinguished from deaths. The practical question therefore was how to obtain the mortality from Hereditary Syphilitic Diseases in the large towns as distin- guished from London, and also how to obtain the amount of disease of this nature as distinguished from deaths throughout the whole community. With this object in view, a circular was addressed to Medical Officers of Health from Aberdeen to Exteter, and from Chatham and Sheerness to Dublin and Cork, and to the 16 towns formerly under the C.D. Acts, asking them for their returns of death from syphilis under 5 years of age (which would show the hereditary mortality) and at all ages, which would include the whole population. The period embraced was the years Ince the repeal of the Acts in 1886, and an equal period previously while the Acts were in operation. Forty-eight Medical Officers of Health have sent their Reports, and the results will be given later on in this Appendix. They show the mortality from hereditary syphilis for 8 *years while the Acts were in force, and 8 *years since their abolition. In order to judge of the amount of syphiltic diseases throughout the community at the present time, after many years of abolition, and to compare it with the amount 20 years since, while the Acts were in *In 4 of the Reports the records had not been kept for the full 8 years previous to the repeal of the Acts, and 1895 is only recorded in a single instance. 33 force, I sent a circular to every Hospital and Dispensary throughout the three kingdoms, asking for a copy of their most recent Hospital Report, and, if they could be conveniently given, of Reports for 2 or 3 years, which would yield a more reliable average than a single year could give. About 750 of these requests were sent out. Some Hospitals sent Reports for two or three or more years, which amount altogether to about 800 Reports. It has been impossible in the time at my disposal to examine and tabulate all these Reports as yet, and I can only venture upon a guarded general expression of their results as being favorable to Abolition, from the two or three hundred the I have examined care- fully. But one important exception has been made. Every Children's Hospital in the three kingdoms was written to, and I have received Reports from above 20 of them, which give returns embracing above 197,000 children. The results will be shown further on. In 1875, I made a similar enquiry, and received above 700 Reports, and Returns from Children's Hospitals, showing the hereditary disease among 166,000 children admitted into them, and these results I laid before the Select Committee of the House of Commons when under Exami- nation in 1879-81. The above Reports relate to the sections of the community which go to hospitals for advice- the lower-middle, and the artisan and labouring, but not the pauper classes; but they really number mil- lions, and the experience is therefore a large one. These returns are, however, unpublished, and do not claim governmental authority. But there is another section of the community for which authoritative and official reports are published, and laid before parliament every year, viz., the 50,000 young men who, on an average, are enlisted in the army every year. They come from a class of society and at an age little inclined to self-restraint, and often with unfavourable surround- ings, which render them peculiarly liable to class of diseases under consideration. Every recruit, before being finally enrolled, is carefully examined by an army surgeon, and frequently (before that) by a civil surgeon also, and if he suffers in the slightest degree from disease of this kind he is rejected, and the number and causes of rejection are published yearly in the Army Reports. The results of the Abolition of the Acts upon this class also, spread throughout the whole nation, will be given later on. It is well, before attempting to give the general results of all the above enquiries, to state distinctly that the result cannot possibly be exact. From the nature of the case it can only approximate to accuracy. For example, one medical man, if in doubt as to the direct cause of death, may certify "general debility or marasmus," while another, if strongly impressed by the theory which has prevailed in the medical profession for many years, might certify "secondary syphilis," or "secondary marasmus." So also in the hospital returns, one recording medical officer will place the disease of a child's eyes under a simple general heading, while another will register it as "constitutional," or "congenital" or "secondary corneitis," &c. But although allowance, and possibly a considerable one, must be made for these sources of inaccuracy, they will frequently balance one another, owing to the multitude of medical men from whom the reports come, who will not all err in the same direction. And it will be for the thoughtful reader to consider whether the evidence is so overwhelmingly for or against the abolition of the Acts as to leave no doubt upon his mind as to what his verdict will be, or whether it will leave him uncertain and not able to pronounce a verdict at all. Another important consideration must be borne in mind when endeavoring to estimate the weight which the following summary may legitimately claim for or against the abolition of C.D, Acts. During recent periods sanitary improvement have been widely extended among the population generally, in their homes and education, their food and water supply, their clothing and, in short, their general environments, to say nothing of the improvement in medicinal treatment; and it would be a strange thing if these influences had produced no reduction of deaths and of diseases due to inherited as well as to other causes. He would indeed be a very bold partizan in the controversy who should claim the large reduction of deaths and disease, to be shortly noticed, as having been brought about by the sole influence of abolition of the Actus during the last 10 years. But when we find from the Registrar General's Reports that, as a matter of fact, syphilitic deaths have fallen about one-eighth (13 per cent.) in the entire community, and we find from a totally different, but still an official source (Medical Officers of health Reports) that they have fallen one-fifth (20 per cent.) among children, and from official sources also that disease have fallen by above one-half among the 50,000 army recruits, and when we learn from Hospital Reports that inherited syphilitic dieseases have fallen by above one-third among 180,000 children since the repeal of the Acts, we may confidently challenge the advocates of the system to produce their Official and Hospital figures, and from them or from equally unbiassed witnesses prove their assertions, that "the result of the suppression of the system of Reglementation (the C.D. Acts) has been disastrous in a frightful manner, and is an enormous danger to the civil population, in which syphilis must necessarily extend." (Commenge's Address, page 8.) Without claiming that the reduction of disease in the army, and of deaths and disease in the community has been produced solely, or even, we may grant, principally by the abolition of the system we may boldly call upon the advocates of the system to show what sanitary benefit they can prove to have been produced by it while it was in force, and what sanitary evils they can prove to have resulted from its abolition. But we may now sum up the foregoing evidence and leave the verdict to the judgment of the readers. SUMMARY of the sanitary condition since the abolition of the C.D. Acts. DEATHS FROM SYPHILIS AT ALL AGES (Reg. Gen Returns.) England -- 7 years before the C.D. Acts ….. 68 per million population. 16 " during " ….. 84 " " 10 " since the abolition …….. 73 " " London -- 7 " before ACTS ………………. 119 " " 16 " during " ………………. 132 " " 10 " since their abolition ….. 114 " " Deaths from HEREDITARY Syphilis (Med. Off. Health Ret.) All England Average of equal periods -- generally 8 years during Acts and 8 years since their abolition--- Throughout the country. Above eight millions of population recorded. During Acts ……………….. 107.2 per million. Since their abolition …. 85.8 population. VENERAL OR SYPHILITIC DISEASE, AS DISTINGUISED FROM DEATHS. Army recruits (average 50,000 yearly) rejected for some form of venereal disease-- Last 5 years of the Acts in force …….. 11.1 per 1000 recruits. Last 5 years of abolition of Actus, only 5.46 " " Children's Hospitals (average 180,000 children). Average proportion of children recorded as suffering from some hereditary form of syphilitic disease-- 1875, Acts in force ……………. 1 child in every 71 (1.4 per cent.) 1895, Acts abol. for 10 yrs. 1 " 124 (0.81 " The above results must speak for themselves as to whether abolition of the Acts has been followed by the "frightful increase in syphilitic disease in the civil community" prophesied by Dr. Commenge, or whether, on the other hand, it has been followed by unmistakable sanitary improvement. SEQUELCE OF THE ABOLITION OF THE C.D. ACTS IN THE STATIONS FORMERLY UNDER THEM, SO FAR AS THEY CAN BE ASCERTAINED FROM THE RETURNS FROM THE MEDICAL OFFICERS OF HEALTH. Plymouth is worse by 1 additional infantile death in 100,000 population. Southamptom " 1 " 200,000 " Portsmouth " 1 " 117,600 " Maidstone has one death fewer in 340,000 population. 36 Chatham has not kept any record of the deaths, as "deaths from syphilis have always been entered under the heading of 'all other diseases.'" Sheerness.--"No record of deaths from syphilis. Disease almost unknown here." Cork.--"No record of the deaths from syphilis. Of this I am, however, satisfied, that during the period specified they have been very few and far between." Winchester and Dover have no record of deaths from syphilis. Windsor.--"The number of deaths attributed to syphilis is so small (e.g., there has not been one so registered in Windsor this year) and bears so uncertain a proportion to the deaths really due to that cause, that I have not thought it worth while to tabulate them separately." Woolwich.--No returns, because "no medical officer for Woolwich previous to 1889." No information has been received from Aldershot, Colchester, Shorncliffe, or the Curragh--the four great camps--or from Canterbury. It has been applied for more than once, and its absence is to be regretted. THOMAS BACKELL LIMITED, LIVERPOOL.THE PRESENT POSITION OF THE STATE REGULATION OF VICE IN BRITISH INDIA. THE PRESENT POSITION OF THE STATE REGULATION OF VICE IN BRITISH INDIA. In order to clearly understand the position in India to-day, it is desirable to give a brief sketch of the regulation of vice in that country in the past, so far as I have been able to trace it. The system has been established in India under two distinct authorities, and over two distinct areas; the military and the civil. Of these, the action under Military authority is much the older; but, as it is the one that alone survives at the present day, I will leave it for a moment on one side and explain the more short-lived Civil system. This was established by an Act of the Governor-General in Council in April, 1868. It was passed in that most dangerous form--that of a permission Act--which our rulers have invented to enable them to baffle the popular will. The Act provided that "The places to which this Act applies shall be such places as the Local Government shall from time to time, with the previous sanction of the Governor-General in Council, specify by Notification in the Official Gazette." In this way an Act may be suddenly applied in any place without the previous knowledge or consent of the inhabitants. If too much hostility is aroused in any place, it can be suspended there till the storm has blown over, and be again revived as soon as the diversion of public attention to some other matter makes it seem safe to do so. This Act of 1868 was very similar to those with which we were sadly familiar at home, but, as might be expected, it was more cynical and bare-faced. Its victims, low-caste women of a conquered and alien race, were even more help-( 2 ) less than their English sisters, and there was familiarity with many years of military brutality in the same direction. It was not thought necessary, therefore, to make any pretence of piety or to hide the real purpose of the system. Its advocates tell us that "the Act was of the greatest benefit to the women, both physically and professionally." That nevertheless they have a deep-rooted and unaccountable aversion to the hospital, which may be partly due to their "being worried," while there, "by the attempts of pious persons to effect their conversion or reformation." The Act itself was more outspoken than here in England. "Every woman carrying on the business of a common prostitute" and every person, male or female, "carrying on the business of a brothel-keeper" was to be registered and licensed and furnished with a permit to carry on their "business." Every woman failing to notify her change of residence to the registrar, or refusing to show her licence when required, might be fined £5 and imprisoned for fourteen days. Any keeper of a bad house offending in like manner might be fined £10 and imprisoned for a month, and the penalty for allowing an unregistered woman to resort to the house was £100 and six months' imprisonment. The women were subject to examination, as here, if sent to hospital there was no limit whatever to the time they might be kept there, and for "carrying on their business" while under medical treatment they were liable to a find of £50 and six months' imprisonment. These rules cannot be said to err on the side of leniency, we shall see, presently, what measure of success attended them. The Act was never applied but in the three Presidency town-Calcutta, Madras, and Bombay; and only in Calcutta was it maintained for any length of time, or administered with much thoroughness. There it seems to have remained in force till 1882, when it was found necessary to abandon it in every part of the city except that occupied by women consorting with European troops. ( 3 ) It was in Bombay that the most determined resistance was made to the system. The expenses of working it-in Calcutta there were about £6,000 a year-were borne partly by the Government, but half was to be defrayed by the municipalities; and the Municipality of Bombay, after a year's experience, flatly refused to contribute anything. This practically suspended the Act in that city, and though for years the Government tried by alternate threats and cajolery to induce the Municipality to restore the system, it persistently refused to do so. At last, in the autumn of 1880, the Government re-inforced the Act in spite of the municipal opposition and deducted a sum of £1,500, due from them to the city, and applied it to this purpose. This high-handed proceeding raised such a storm as practically led to the entire suspension of the Act; for the Municipality of Bombay appealed to the Governor-General in Council who, after investigation, wrote home in June 1882, reporting the failure of the system, and asking the sanction of the Home Government for the repeal of the Act. Lord Hartington replied, refusing repeal but permitting suspension for a time. It was accordingly suspended for a year, but never actively revived, and, in 1888, just 20 years after it was passed, this Act establishing the system in civil areas was repealed in consequence of the Resolution of the House of Commons moved by Mr. McLaren. What success had attended it? I will quote only official statements. "The working of the Act has hitherto been very costly, and the results obtained cannot be deemed satisfactory." "No improvement can be claimed as a result of the system . . . a stricter enforcement of the Act is not likely to be useful." "The false security the Act gives increases not only the number of men and women who practise immorality, but also the disease which it professes to stamp out," and Lord Ripon in the despatch already referred to, says "we are much impressed with the grave evils which are inseparable from the operation of any such enactment in (4) this country.... The benefit to be derived from it is, on the other hand, very doubtful.... In Calcutta... the results have been at best unsatisfactory and uncertain... In Madras the Act seems to have had no effect whatever upon the health either of the European troops or the civil population... the cases in the hospitals are in excess of those reported in Bombay, although the Act had been in abeyance in Bombay, and the population is nearly 200,000 over that of Madras." It is difficult to trace exactly when, or under what sanction, the system was first put in force as a piece of military administration. Probably it was at first a mere regimental order. As far back, however, as 1810, in the palmy days of the old Company, there was a Regulation of the Bengal Code for Military bázárs, and later ones in 1821, 1827 and 1832, which may probably have had reference to this subject, and portions of them were still retained until two years ago, when they were repealed by the last Cantonments Act. At any rate we know that the system was fully established in practice at least 35 years ago. A Dr. Ross of the 92nd Highlanders described to the Royal Commission in 1871 the method of procedure. He said that when a regiment arrived in India a certain establishment was told off for it, and that, among others, there was an establishment of prostitutes who were housed in básárs, and regularly looked after by the matron appointed for the purpose and examined by the surgeon of the regiment. That when a regiment went on a line of march, a form was filled up containing a column for prostitutes, shewing the number who were permitted to follow the regiment. The matron selected the women and obtained a larger or smaller number according to the character of the regiment. "When I got to Indi with my regiment," says Dr. Ross, "there were only twelve women came, but I desired that they should increase the number." This appears to have been a mere military arrangement, a regimental system, liable to vary in detail in different places, (5) the arbitrary act of a conquering army in a conquered country; and it is not until 1880 that we find it sanctioned by an Act of the Governor-General in Council-Act III. of 1880-which lays down a uniform rule for the treatment of these unhappy women in all military stations. This, the first Cantonments Act, so far as it applied to this subject, simply empowered the Government to make rules and regulations "for inspecting and controlling houses of ill-fame, and for preventing the spread of venereal disease." The Rules made under it provided for dividing prostitutes into two classes, those who are visited by Europeans and those who are not, and it is only the former who were subject to the rules. Everyone of these was to be registered; to reside where she was ordered to reside; to pay such sum, not exceeding two shillings, monthly, as she might be ordered, to the Lock Hospital Fund, except when she was herself in hospital, and if she was in arrear wit this payment, a distress was to be levied on her goods. She was to be provided with a printed ticket, to be renewed annually, was to be examined at least once a fortnight and the result entered on her ticket, and, if ill, she was to be sent to hospital, where she might be kept an unlimited time. At Lucknow, in 1866, it is officially stated that they were examined daily. The officer in charge of the hospital was to have power to punish any breach of the rules with regard to attendance for examination and conduct in hospital with a fine not exceeding 10s., which might be levied by distress. Special quarters were provided for the women in cantonments though neither the Act nor the rules sanctioned this. No person was to keep a bad house except by permission of the Government, but the keepers were not required to pay for the support of the system as their inmates were. The premises were to be inspected and approved, and then the keeper was to be registered as permitted to keep a bad house for a specified number of inmates. He, or she, had to furnish lists of their inmates and of every female servant(6) under forty years of age in their employ; and such female servants, wether prostitutes or not, were to be treated exactly as if they were such. No woman, or her necessary clothing, might be detained by the keeper for debt; but the departure of any woman from the house was to be notified to the Sanitary Officer within twenty-four hours. This effectually made a prisoner of her- chained to her fate- for she would be at once pursued and forced back to the same house or a similar one. For any breach of rules the keeper might be fined €5 of be imprisoned for eight days with or without labour. These rules were, in 1887, in force at seventy military stations. The District Superintendent of Police, under the control of the Commanding Officer, was to administer them. There was no provision whatever, either in this case or in that of the Civil Act, for any appeal on the part of woman from any amount of tyranny or oppression. With the system thus established both in large towns and the military stations, the officials vie with each other in proclaiming its utter failure. One says that sickness among the troops is steadily increasing, that year by year it becomes more evident that in India it has proved a complete failure. Another, the Sanitary Commissioner with the Government of India, states that "the Acts have failed in India to protect the health of the troops." Another Sanitary Commissioner, who evidently entirely approves of it, has to admit that the ratio of disease is increasing, and is higher than before the system was established. Repealers with remember that when in the spring of 1886, Mr. Stansfeld carried the Repealing Act, and the accursed thing was abolished at home, we were promised as a necessary con- sequence that it should also be abolished in the Crown Colonies and in India, but in spite of that promise, and with the ful knowledge of the official admission of complete failure, no attempt was made to interfere with the administration of the Cantonments Acts for two years, when some information with (7) regard to the way in which they were being worked was privately sent home- though it was not officially communi- cated to the India Office, -which led to their immediate suspension and ultimate repeal. As was certain to be the case under a brutal and brutal- ising system, whose victims were the most helpless upon earth, the officials neglected "cast a veil over the thing" and scandals not only occurred but came to the knowledge of the public. The culminating outrage was the issue, in June, 1886, of a circular memorandum, signed by a certain Major Chapman, so abominable that, when Mr. McLaren brough, it to the notice of the House of Commons in June 1888, the Ministry dared not defend it and were obliged to acquiesce in a Resolution requiring the abolition of the whole system. This Memorandum, among other things, set forth the desire of the Commander-in-Chief that care should be taken to provide a sufficient number of attractive women for the soldiers, that they should be provided with proper houses and that the men should be taught that it was a point of honour for them to point out to the authorities any woman from whom they had contracted injury. The House having adopted Mr. McLaren's Resolution Resolution of June 5th, 1888 which declared "that any mere suspension of measures for the compulsory examination of women and for licens- ing and regulating prostitution in India is insufficient, and any legislation which enjoins, authorises or permits, such measures ought to be repealed;" the Indian Government was instructed from home to govern its conduct accordingly, and, after considerable delay, and the professed suspension of the system, a new Cantonment Act was passed on the 11th Act of 1889 October, 1889, and fresh rules were issued under the Act. We believe that the new Act is so framed as to legalise everything that was done before- with one exception- and we believe that, in the teeth of the orders of the House of Commons, and of the will of this country, everything is going on exactly as before.(8) The new Act and Rules make no mention of prostitution, there is no provision for registration, or periodical examination, for approving and licensing either women, or houses. The form of a licence ticket is not, as in the old Act, set forth in the Schedule. But the Act empowers the Government to prescribe where persons following any calling shall reside, to maintain as many hospitals as may necessary within or without the Cantonment "for the treatment of persons suffering from infections or contagious disorder;" and to order any person who is "supposed" by the medical officer to be suffering from any such disorder (the rule says 'from the disorder") to go to the hospital, or to leave the Canton- ment within 24 hours. Return without leave being punishable with 8 days' imprisonment or €5 fine. This is quite sufficient. It is practical compulsion. If the hospital doctor may order into hospital everyone whom he "supposes" to be ill, he has only to "suppose" it of as many women as he pleases. The power given is frightful, for it may be exercised over perfectly innocent people whenever "more and more attractive women" are needed by a Commander-in-Chief. See how the whole system is obtained without any allusion to it. Once in the hospital, the victim's name and address will be written down, there is practical registration. She will be forcibly examined, to ascertain whether the doctor "supposed" correctly. She is to be kept under compulsory treatment as long as he chooses, and he has only to repeat his suppositions once a fortnight, or week, or day, as he thinks proper, and her fate will be exactly what it was before. The practical uselessness of the printed ticket has been long ago demonstrated. The being at large under such a system is as good a voucher. The omission of this licence and ticket is the only point in which the new Act differs from the old, except that the fines are not as numerous nor as heavy. But it may be said that these regulations, though capable of being wrested to this purpose, need not be so used, and (9) that under the circumstances some control over the careless spread of infectious disease is justifiable. I will not here discuss the merits of compulsory powers over any sick people, but we have a right to demand that this particular class of maladies should be exempted in terms from these regulations. The new Rules permit and authorise what I have described, and the House of Commons expressly forbade that such should be done. However much, therefore, we might trust the good faith of present administrators, the law does not conform to the resolution of the House of Commons and it must be made to do so. There will be no safety till this is done. But, from the India Office to the lowest regimental assistant-surgeon, we do not trust the present administrators. Lord Cross had told us that he considers it right that these maladies should not be excluded from the rules, and he sneeringly supposes that we should "consider it impossible for the Government to confer special privileges and exemp- tions upon persons suffering from these particular maladies." The Governor-General in Council, after taking a year-and- a-half to think about it, has sanctioned Rules which justify the doing of everything as before. The Indian papers rather rashly boasted of what had been done:-"Government," said one, "is to be congratulated on the step it has taken to check the further spread of this terrible scourge, while keeping its remedial efforts well within the limitations prescribed by the House of Commons." "It requires no keen insight into the motives which influence the human mind, to discover how readily a resident of the kind indicated would yield ungrudging obedience to any injunctions which it might please the Commanding Officer to impose as a consideration for the postponement of what might otherwise be an immediate sentence of expulsion. Such in its essential features is the scheme which the Government has indirectly, we had almost said covertly, formulated for dealing with the crying evil."( 10 ) Another paper is still more frank:- "The religious fanatics who howled until a weak Government gave way to their clamour . . . will probably howl again now at the way the old order of things will be enforced under another name, but with very little difference in manner. . . . The way the Indian Government have got over the difficulty is simply by classing venereal diseases in the same category as smallpox and other contagious diseases which the law provides for by segregation, special hospitals, &c., so that really the authorities have turned Dyer & Co.'s flank, and the soldier will no longer be the victim of a dangerous experiment." Yet another, the Medical Record, says of the new Rules :- "Their phraseology is the work of a master in the art of making a thing look as unlike itself as it well can be." Lastly, we are assured by numerous private correspondents that everything is going on exactly as before; that the hospitals are again in full swing, and the medical officers in charge drawing the same allowances as formerly, that when questions are asked as to what is going on, the officials are forbidden to "publish the secrets of the office." - Why should they be secrets? That the women are confined to certain quarters and that women are "encouraged to take up their residence in those quarters." This then is the present condition of the question. A condition which the British Committee of the Federation has set itself to alter. A condition which it is desirable should be as widely known as possible. Our friends in Parliament are only waiting for some further definite information which we are expecting, to bring the matter again before the notice of the House of Commons, which must either take immediate steps to enforce obedience to its former Resolution; or must acquiesce in what would practically be, not the concession by England of Home Rule to India, but a rebellion and assertion of Home Rule on the part of the Indian Government itself. I cannot conclude without inviting special attention to the fatal dangers to ourselves at home involved in the particular ( 11 ) form of treachery by which we have been for the moment baffled. I have already said that we have a right to demand that this class of maladies shall NOT be treated as identical with small-pox or measles; shall not be classed with them under the same set of rules. We not only have a right to claim this but it is of vital necessity that we should do so. We have a right, for the two things are essentially different. Other infectious or contagious maladies may by carelessness be spread among those who cannot defend themselves - These cannot. In this case a man must seek danger to meet it, and he has therefore no right to claim the help of society to save him from that from which he can save himself by decency of life. Besides, who ever proposed to examine everyone at short intervals to see if they were suffering from scarlet fever or measles; and to allow no one to leave his house for the street without a ticket of leave from a Government doctor? The pretence that they treat all these maladies alike is a false pretence. And it is a vital necessity for us to refuse to allow them to be classed together; for what we allow in India we should soon have to submit to here. The whole train is already laid. This one thing, - the power to class these with infectious maladies and subject them to the same control, is the only thing wanting to re-establish the accursed thing among ourselves. The doctors have already got all the power needed over infectious diseases. Time after time have we had the word "contagious" which they had inserted, struck out of their Bills; which Bills, however, all contain power to the local authority to bring any fresh class of diseases under the rules made. If we weakly allow this system to be established abroad on such grounds, we shall at once have the whole back here again, in force all over the country, and in a shape infinitely more difficult to combat than that which it took us so long to destroy; our seventeen years' cruel war and our hard-won victory will have been quite thrown away. Women's Printing Society, Ltd., Great College Street, Westminster.NOTES ON STERILITY IN WOMEN. BY B. S. TALMEY, M.D., NEW YORK. Reprinted from the MEDICAL RECORD August 22, 1908 WILLIAM WOOD & COMPANY NEW YORKNOTES ON STERILITY IN WOMEN. By B. S. TALMEY, M. D.' NEW YORK. GYNECOLOGIST TO THE YORKVILLE HOSPITAL; FORMERLY PATHOLOGIST TO THE MOTHERS, AND BABIES' HOSPITAL. Two desires control and govern mankind, one, the desire for nourishment, is founded upon the instinct of the preservation of the individual, the other, the desire for offspring, upon the instinct of the propagation of the kind. The former concerns only the individual, the latter is of a far more reaching importance, from a social as well as an economic point of view. Progeny is of an incalculable economic value to the body politic. Although the age of forty is not just the point in a person's life to be chloroformed out of existence, yet there does arrive a time in the life of the individual when its usefulness to the community is nil. The individual does not any longer produce new wealth, and what it consumes, even of its own savings, is a direct loss to the sum total of the nation's wealth, except the individual has created new producers in its children who continue in the work of their parents. Sterile marriages are, therefore, a failure even in modern times and even from the materialistic point of view. No wonder, therefore, that the problem of steril- Copyright, William Wood & Company. 1ity has occupied the great minds of all times. Among the ancients barrenness was punished by the dismissal of the wife. The Roman law allowed the putting away of the wife for infecundity. The Jewish law allows a divorce after ten years of childless wedlock. Hence married women were since time immemorial in search of fertility and sterility has engaged the attention of the medical profession from the earliest periods. Before entering upon the discussion of the causes of sterility, let us pass for a moment in review the mechanism of impregnation. When the sperm has been deposited in the vagina, or rather, has been aspired by suction during the organism within the cervical canal, the spermatozoa begin to move towards the interior. The celerity of their motion is, according to Henle, Kramer, Hensen, and Lott, from 1.2 to 3.6 millimeters a minute. They will, therefore, finish their way to the vagina through the uterus and tubes within one or two hours. According to Bischoff and His, the impregnation takes place in the distal end of the tube. After impregnation the ovum continues its wandering by the current of the ciliated epithelium of the tube towards the uterus. The ovum needs according to Hensen from three to five days, according to Bischoff eight days, to traverse this way. It could not last longer, says Winckel, because the uterine end of the tube has a diameter of only 2 to 3mm. while the diameter of the ovum in the second week is 3 to 6 mm. When the impregnated ovum has reached the cavity of the uterus, it penetrates through the epithelium into the submucous fibrous tissue of the uterus where it completes its development. 2 The complexity of the mechanism explains the importance of the presence of perfect organs to facilitate the accomplishment of this great task of nature. Any deviation from the normal condition at any point of the genital canal may cause prevention of impregnation or destruction of the impregnated ovum and thus cause sterility. The time that has to pass before a childless wedlock is to be considered sterile is not the same with different authors: Chrobak, Rosthorn, and Hofmeier consider a marriage sterile when two years of childless married life have passed, while according to Jaquet two and a half years, and according to Kisch three years have to pass before they call such a marriage sterile. At the outset two groups of sterility may be distinguished, the sterility caused by the man and that caused by the woman. In regard to the former we could say that not only impotency and aspermia will cause sterility but a certain changed quality of the spermatozoa will render the marriage sterile. According to Boweri the ovum had all the organs and qualities necessary for the development of the fetus except that its centrosoma, which starts segmentation, is in a state of inactivity while the spermatozoon possesses the active centrosoma but lacks the protoplasma, the material, by means of which this organ could begin its activity. Hence when through some cause or other the spermatozoon had lost its active centrosoma the result will be sterility. But male sterility will be eliminated in this paper and we will consider only female sterility. Here we must again distinguish two kinds of sterility, the primary where no conception has ever taken place, and the secondary where there was fecunda- 3tion but an abortion has taken place or the child died and after the first conception the woman ceased to propagate. In considering primary sterility we have again to make a distinction between idiopathic and relative sterility. Idiopathic sterility is absolute and irremediable; treatment is useless. Relative sterility is an anomaly that yields in the majority of cases to appropriate treatment. Under the heading of idiopathic sterility we may name: (1) Absence of vagina; (2) fetal or rudimentary uterus; (3) absence or imperiousness of the tubes; (4) absence or fibrous degeneration of the ovaries. Relative sterility which is eminently curable has the following causes: (1) Atresia valvae; (2) vaginism with the painful tetanic contraction of the sphincter cunni; (3) rigidity of the hymen; (4) carunculae of the urethra; (5) ulcerations of the introitus vagina; (6) inflammation of the carunculae myrtiformes or of the Bartholinean glands; (7) hypertrophy of the rugæ; (8) excessive acid reaction of the vaginal contents; (9) one lip of the cervix is considerably elongated, covering apronlike the external os; (10) obliteration of the cervix caused by caustics or scars after tears during confinements; (11) ectropion; (12) stenosis of the external or internal os or of the cervical canal; (13) endocervicitis causing an increased secretion; (14) swelling of the plicæ palmatæ; (15) polypi of the uterus; (16) hypertrophic chronic metritis; (17) endometritis chronica hyperplastica; (18) uterus infantilis or hypoplasia of the uterus; (19) uterine deviations; (20) bilateral salpingitis with swelling of the cervical folds and vili and often with closure of the ends of the tubes; (21) pelviperitonitis, peri- 4tion of the vaginal contents destroying the mobility of the spermatozoa, will require alkaline douches. The hypertrophy of the apron-like cervical lip as well as obliteration of the cervix, ectropion, and polypi will require surgical interference. Deep lacerations of the cervix may cause abortions and thus indirectly sterility. The latter may be cured by a trachelorrhaphy as in the following case: Mrs. K., seven years married, has two boys living, the younger four years of age. Since her last confinement she had six miscarriages, as a rule in the third month of pregnancy. At the examination two deep lacerations of the cervix were found. Trachelorrhaphy was performed, and six months later the patient became pregnant and carried her child to term. Stenosis of the os or of the cervical canal may in extreme cases—the popularity of the stenosis and atresia theory of sterility, says Massey, is due to the operative furor—require surgical treatment. But even in such cases slitting of the cervix is too radical an operation to be generally followed. This mutilation removes the stenosis but the result may be habitual abortion. When the ends of the tubes are closed, as in hydrosalpinx, surgical treatment may be of some benefit. Also abdominal tumors which cause such pains during coition as to render it impossible and thus indirectly cause sterility will require surgical interference. In uterine deviations a sharp anteflexion could be first treated by a thorough dilation of the cervix, slight curettage and introduction of Foerster's pessary for eight to ten days. In extreme cases of retroflexio ventrosuspension by the round 6 ligaments as advocated by the writer is of advantage. All these accessible lesions may sometimes cause sterility but, in regard to frequency, are of slight significance in comparison with endometritis and pelviperitonitis. These two affections are the causes of sterility par excellence and are just the lesions which are seldom or never amenable to surgical treatment. Here electricity is almost the only remedial measure that promises success. The physiological effects of the electric current take place by virtue of the vital properties of the body through its action on the nerve supply, influence upon circulation, secretory and excretory processes and the acceleration and absorption of morbid products. Electricity promotes the nerve tone, increases muscular activity and quickens circulation. When the current passes through living tissues the interpolar action of the positive pole is, by contracting the capillaries, anodyne sedative, anticongestive, denutritive and antihemorrhagic. The interpolar action of the negative pole is, by increasing the blood supply, stimulating, congestive, derivative and alternative, thus favoring absorption. The physiological effects of the farradic current are mainly mechanical, producing a veritable interstitial massage. These physiological qualities make electricity the best remedial agent in the treatment of endometritis, metritis, salpingitis, ovaritis, and pelviperitonitis. Now endometritis and pelviperitonitis are by far the most frequent causes of sterility. Fraenkel says chronic endometritis is the most frequent cause of sterility. Virchow called the attention of the profession to the perimetric inflammations being 7often the cause of sterility. Rokitansky teaches that perimetric adhesions as a cause of sterility are equal in importance to impermeability of the tubes. When the tubes are buried in adhesions sterility is inevitable; when the ovaries are covered by thick exudative membranes, ovulation is prevented, and only negative electricity with its quality of favoring absorption could remove these exudates. The absorption power of this current which dissolves even good-sized fibroids will surely remove all inflammations and adhesions, provided there is no pus present. In this event electricity is very dangerous and strictly contraindicated. But when pus can be excluded there is no better remedy for endometritis and pelviperitonitis than the electric current. We need only to see at one sitting the dirty mucus leaving the uterus under the influence of the negative pole and we understand how electricity can cure the worst endometritis. By increasing the blood supply negative electricity acts also like Bier's hyperemia, upon all internal inflammations, but particularly upon chronic endometritis. The latter is seldom benefited by the routine currettage. It has been repeatedly proven beyond the shadow of a doubt that curettage never removes the entire diseased uterine mucosa, but rather leaves its greater part intact even in the most skilled hands. Hence before resorting to curettage electricity should first be given a fair trial. For the deep inflammations as metritis, salpingitis, oophoritis and pelviperitonitis no surgical operation should ever be tried. Cases of sterility that could be benefited by serious surgical operations are very few indeed. Uterus infantilis is another anomaly that is greatly 8 benefited by electricity. Some times a previous small operation is necessary. Uterus infantilis in itself, says Beizel, does not prevent conception but the conical elongation of the cervix is often so closed up by the vaginal walls as to leave no room between this point of contact and the external os. In such a case the amputation of the cervix and subsequently the application of the faradic current will be of great service. When the cause of the sterility is deficient activity of the ovaries any remedial agent promoting the activity of the pelvic circulation, e. g. massage, will be of great benefit; but here again the best means to promote this desired activity is the uteroabdominal galvanic application. Sometimes sterility is caused by orgasmus retardatus. Kisch found among sixty-nine sterile women twenty-six with dispareunia. He is, therefore, of the opinion that the sexual excitement of the woman is not irrelevant to impregnation. Fraenkel found in his one hundred cases of sterility the causes to be: dispareunia and lack of libido four times, pains in coition twelve times, and lack of orgasm five times. This deficient orgasm, as shown by the writer, is mostly caused by early masturbation. It is thus a weakness of the nerves and is greatly benefited by an electric tonic. Nervous weakness is also not infrequently the cause in relative sterility where one child was born and no more children were desired. In such cases impregnation is prevented and the physiology defeated by coitus interruptus for a certain length of time, which weakens the entire nervous apparatus of the genital sphere. When later on, for some cause or another, the woman yearns for another child 9 and the father is anxious for further progeny, they find that their wedlock has become sterile. In such cases no other treatment except the tonic effect of electricity will be of any benefit. The last class of cases of sterility are those where the genital organs are apparently normal, but the uterus is not able to furnish the necessary nutritive elements to the growing ovum. It suffices not, says Gruenwald, that copulation of sperma and ovum had taken place and the pregnancy had set in, but it is necessary that the uterus in its texture and nutrition be of such a quality as to be in a position to fulfill its function of furthering the development of the fertilized ovum and bring it to term, otherwise the patient without being aware of the fact may have an abortion almost every month. In such cases very few remedies except electricity will be of any value. The electric current tends to give to the uterus a certain amount of tonic which it requires to harbor the ovum to the end of its development. The histories of the following six cases taken from numerous similar cases of the writer's private practice will prove the efficacy of the electric current in the treatment of sterility: CASE I. - Mrs. S., 25 years of age, had always had regular menstruation. She has been married four years and remained childless. For the last two years she has been running from one doctor's office to that of another without success. The obligatory stretching of the womb and the so-called cleaning had been performed on her without having the desired effect. The examination showed a large uterus with a thick hard cervix and an erosion. The adnexa were sensitive but otherwise normal. 10 Electrical treatment was recommended and accepted. The patient received at the first sitting - the negative electrode within the uterus - 10 milliamperes for five minutes, which was increased at every sitting until twenty-five milliamperes were administered for ten minutes. Three months later the patient became pregnant and gave birth to a healthy girl at term. CASE II. - Mrs. St. is four years married and sterile. The examination shows a chronic endometritis and an enlargement of the right adnexa and a considerable uterine discharge. The patient received ten treatments, the first two with the positive pole within the uterus to cause a diminution of the discharge. The other applications were made with the negative pole within the uterus. Four months later the patient became pregnant and gave birth to a healthy boy at term. CASE III. - Mrs. A. was three years married and sterile. The examination showed a stenosis of the external os, a narrow cervical canal and anteflexio. In the beginning only a very thin electrode, with the negative pole within the uterus, could be used until the lumen of the os and the canal was enlarged. Thereupon six treatments with the ordinary electrode were given. Three months later the patient got pregnant and gave birth to a healthy boy at term. The following three histories are of cases of relative sterility. CASE IV. - Mrs. H., 30 years of age, has been ten years married and has one child nine years of age. A year after her first confinement she became again pregnant but had an abortion and was curetted. To avoid any more pregnancies impregnation was 11prevented by some means or other for about five years. During this time the patient suffered repeatedly from endometritis. For the last three years the couple have wished another child and coition is normal, still the patient does not conceive. At the examination the uterus was found enlarged with a knotty swelling at the left uterine horn. The left adnexa are enlarged, the tube being of the thickness of a small finger. The patient received eight treatments with the negative electrode intrauterine. The uterus became smaller but the knot in the horn and the swelling of the tube had not entirely disappeared. Six months later the patient became pregnant. In the seventh week of pregnancy the patient suddenly had a fainting spell while leaving the bath tub but soon recovered when brought to bed. The following day after a hearty breakfast she had again a spell, but this time remained in collapse for several hours. The examination showed a considerable meteorism of the abdomen, pulse 112, temperature 102 F, and a soft mass in the cul-de-sac. The rupture of an extrauterine pregnancy was diagnosed and the patient operated upon the same evening. The left tube was found ruptured, the embryo of about six weeks floating in the blood which filled the pelvic cavity. The swelling in the left horn was found to be a small subserous fibroid. The ruptured tube with the left ovary, on account of the precarious condition of the patient, was removed en mass. For the same reason the fibroid was left untouched to avoid the prolongation of the operation on a collapsed patient. The recovery was uneventful. CASE V. - Mrs. L. was confined with her first child eleven months after she was married. The 12 child died when a year old. Since her first confinement three years have passed and the patient is still sterile. The examination showed an endometritis and erosion of the cervix. The patient received six treatments with the intrauterine negative pole. Two months later the patient became pregnant and gave birth to a healthy boy at term. CASE VI. - Mrs. M. was curetted three months after she was married presumably to remove the secundines of an interrupted pregnancy, but no traces of a preceding pregnancy could be discovered. From this time on impregnation was prevented by different means for about two years. When the couple then wished a child they found their wedlock sterile. The examination did not reveal any anomaly whatsoever. It was apparently a weakness of the nerves caused by the continuous prevention of impregnation. The patient received six treatments with the negative pole within the cavity of the uterus. Three months later the patient became pregnant and gave birth to a healthy girl at term. From these six histories taken from the numerous cases of sterility seen by the writer it is easily seen that in cases of sterility caused by a diseased condition of the internal genital organs electricity is, if not the only remedy, the remedy par excellence. It is, therefore, to be marvelled at the extreme tenacity of the majority of surgeons to the efficacy of major surgical operations in such cases of sterility. BIBLIOGRAPHY. Massey: Sterility in Women, Medical News, October 3, 1896. Boweri: Das Problem der Befruchtung, p. 26. 13Hofmeier: Centralbl, f. Gynaecol., 1893, No. 33, p 764. Schenk: Die Patholgie u. Therap. der Unfruchtbarkeit des Weibes, Berlin, 1903, p. 121. Beigel: Pathol. Anatomie der Unfruchtbarkeit, Braunschweig, 1903, p. 320. Fraenkel: Clinische Beitraege der Sterilitaet; Samml. kiln. Vortr. n. f. 460 N. 188-9. Virchow: Arch. f. pathol. Anat., Vol. XXIII., p. 45. Rokitansky: Lehrbuch der pathol. Anat., 1861, Vol. III., p. 438. Gruenwald: Arch. f. Gynaecol., 1875, Vol. VIII., p. 414. Chrobak: Wien. med. Presse, 1876, N. I, p. 4. Kisch: Die Sterilitaet des Weibes; Wien, 1895, p. 225. Bischoff: (1) Zeitschr. f. rat. Med., N. T. IV., 1854; (2) Wien, med. Wochenschr., 1875, N. 21, P. 449. Talmey: (1) Woman, New York, 3d Ed., 1908, p. 102; (2) MEDICAL RECORD, December 29, 1906. 55 WEST ONE HUNDRED AND TWENTY-SIXTH STREET. SCIENCE AND SOUL. The refined, and yet strong and broad introduction to the programme of the course of Humanitarian Lectures now being given in St. Martin's Town Hall, has in it the germ of a profound truth. The burden of these Lectures is the plea for a Humane Science. The word Science has too long been appropriated by, or made over to, that kind of investigation and experiment which deals with but a part, and often the least living or effective part, of life. The result we see in the rather ridiculous scorn of so-called Science in relation to the overwhelming grave subject of Psychology. Much that passes for Science is sheer grubbing in the dust-heap, and vast numbers of our science-men are no more than what Emmerson called the "thieves and pirates of the universe,' who 'shut out daily to a more thin and outward rind, turn pale and starve'—spiritually. We want a Science that shall correlate and blend, unite and compare, and never forget that while the things seen are temporal, the unseen things are eternal. Wisely this circular:— An uncorrelated department of science tends to lose either life or balance. To illustrate thus, and to show methods of research which do not violate the essential unity of Nature, and the excellent results to be obtained by such methods, is one of the aims of the proposed course of lectures. It is always necessary to test scientific methods by bringing them into close touch with the facts and ideals of human life. Apart from these, the pursuit of science may degenerate into a pastime, or serve for the gratification of curiosity, cupidity or vanity, and its methods thus become inhuman. Therefore the proposed Lectures will endeavour to demonstrate the necessary subordination of physical science to the science of life as a whole. Mr. Edward Carpenter, who gave the first Lecture, went clean into the camp of the (must we say?) enemy, and quietly challenged the materialists and semi-materialists to admit the validity of all this. Some will only scoff at these dwellers in the psychical moonshine: others will plead that men can do but one thing at a time, and that they are willing enough to divide the field; but there will be some who will sympathetically respond, and find the right answer to that pitiful cry: - Canst thou not minister to a mind diseased? Indeed, a pitiful cry! and not only the cry of a base murderer. As a great Paul said, more than 1800 years ago, so many we say, with even more subtile meanings, "The whole creation groaneth and travaileth in pain together until now." And, although the pain is the pain of birth and not of death, it is there as the tragic element in life, and has deep occult and vital relations to the cry, 'Canst thou not minister to a mind diseased?' The theory and practice of medicine itself will have to be slowly revoluntionised by the discovery that physical disease is very largely mental, and that only by first understanding and then ministering to the mind diseased can the body be healed and kept pure. The medical practitioner who reads all symptoms in the same way, and gives to them in all cases the same value, is a coarse bungler, There is any amount of room for the education of such as one in the elementary principles of his fine art. Both the family doctor and the family lawyer need, in truth, to be psychologists and, in a way, father-confessors and priests. The misery of it is that we have not yet got many men or women fit for this sacred position. Now it it is precisely that reflection which brings us round to Edward Carpenter again by another path. He contended that Science, as at present understood and worked, is, for the most part, crudely external, and therefore radically imperfect. Nature is very complex, and what we call Science is. as a rule, very much on the surface. Science deals with what it calls 'the facts,' but, in the main, its 'facts' turn out to be the mere rinds of things. It cuts up a terror-stricken and anguished dog, and takes no notice of the terror and anguish in its calculations; and certainly brings into the reckoning nothing but the sheerest selfishness of a crude tyrant, using his power and admitting no other consideration. Is it really probably that such a process conducted in such a spirit, will yield the deep secrets of life? It is precisely the same all round. The Political Economy which deals only with what are called 'the laws o trade' is wofully deficient. Hence we never seem to stand on any sort of rock, but the old conflicts go on, upon the quicksands, with even increased violence and stress of uncertainty. Why? Because our Political Economy has only dealt with society as a machine, and because it has taken little or no account of human nature with its immensely complex checks and forces, turning upon moral, emotional and spiritual realities that never cease to worry and upset the so-called 'scientific' laws. Mr. Carpenter very rightly drew attention to the fact that no living thing or process resembles in the least a machine or a mechanical operation. A machine is an object constructed for and adapted to one purpose only; and there its power, however wonderful, ends. But a living creature is altogether different. Its capabilities are enormously complex, and its developments and possibilities often seem infinite. And the song of a skylark is no less wonderful than the speech of a man, considered in its unlikeness to anything merely mechanical. And so it is wherever there is life. Ad yet Science, as a rule, deals only with the mechanism, and even thinks it desirable to scoff at those who go beyond! We might go farther, even to the extent of saying that the merely intellectual being is unspeakably inadequate. He may master the whole of the apparent mechanism of life, and know, let us say, all about that skylark ; may have cut it to pieces, every muscle and fibre of it - may, with keenest knife and keenest brain, have found all about the little throat and diaphragm, and weighed the tiny brain - a triumph of intellect ! But where is the song? Where is the emotion that the song struck out from the soul ? Where is the deep, deep relation between the bird that sang and the man who heard? Where are the tears in the eyes that responded to the music in the blue? Ah, God ! Thou hast made man in Thine own image, and he never finds Thee, nor himself, nor his brother, nor the bird in the sky, until he knows and feels that Thou hast made him to be- A LIVING SOUL. From Light. 'Watchman! what of the night? what of the night?' 'The watchman saith, "The morning cometh!" ' Isaiah. THE COMING DAY. EDITED BY John Page Hopps. 140. AUGUST, 1902. WILLIAMS & NORGATE, HENRIETTA STREET, COVENT GARDEN, LONDON. SOUTH FREDERICK STREET, EDINBURGH; BROAD STREET, OXFORD. Price ThreepenceDOES GOD CARE? A BOOK OF HOPE & CONSOLATION. By JOHN PAGE HOPPS. REVISED EDITION. Large Type, Special Paper, Gilt-edged as a Gift-book. ONE SHILLING, NET. Over two hundred reviews have commended this book, as giving a reasonable and sympathetic answer to this greatest of all questions. LONDON: ELLIOT STOCK, PATERNOSTER ROW; And all Booksellers. Post free from the Author, Sanderstead Hill, South Croydon. The Coming Day. AUGUST, 1902. THE LORD'S TRUSTEES. SPOKEN AT CROYDON. Children, obey your parents, in the Lord: for this is right. And, ye fathers, provoke not your children to wrath.—Ephesians vi. 1 & 4. NEXT Sunday will be young people's morning. This is father's and mother's morning. Let us consider together our duties and our rights, in the light of these two statements which form an admirable summary of the relative positions of children and parents, and are as full of good sense and practical wisdom as they are of genuine religion. They offer no special solution of any particular difficulty, but they furnish a permanent principle of action, they supply a key that will unlock all doors, they shew both children and parents the way in which they should go. On the one side, there is a duty of self-yielding of a well-defined character,—' Children obey your parents': and, on the other side, there is to be a method of government, sufficiently indicated by the utter absence of actions and feelings that 'provoke to wrath.' In the first place, there is to be, on the part of children, obedience:—an old-fashioned, homely, lovely common-place, but none the less important for being old-fashioned, none the less desirable to talk about because homely, none the less imperative in its claims because a common-place. It is, however, somewhat questionable whether there is not a special need at the present time to bring to the front this good old law of social and domestic life. Whatever the cause may be, the fact is scarcely questionable—that young people are at all events in danger of breaking away from that law. 222 It may be owing to the earlier development of character now, to the immense facilities given to the young, both as regards education and enjoyment, to the relaxation of the stern methods of an earlier day, to the unbending of an iron religious rule; but, whatever the cause, the fact is undeniable, and it may become a very important part of the Christian teacher's duty, to make a stand on principle for obedience to parents. There are beautiful exceptions, - it would be an awful thing if there were not - but, in far too many instances, it seems to be regarded as a sign of manliness to make a stand against one's own father, or even a mark of womanhood to treat a mother as old-fashioned, - all very well until she seeks to exercise control. In days gone by, children were taught to keep their distance, to speak when they were spoken to, to do as they were bid; the rod ruled where the word did not, and the terrors of the law were potent to regulate the rights and duties of the house: and it must be confessed that all this was overdone. But now all is changing. We all love rapidly, and children share the excitements of the day. Books abound, amusements multiply, and the forcing process goes on everywhere. At ten, the child has definite intentions; at fifteen, its ways are past finding out; and all through, the duty of obedience, as a duty, has hardly been present; such obedience as has been rendered having been rather the submission of one took weak to resist than the loyalty of one too well educated to rebel. I repeat, there are many beautiful exceptions to this but there is at at all events the danger that it may become the rules. The charge before us brings the whole subject into the clearest possible light. It lays down the duty and it suggests how that duty may, on the one hand, be taught, and on the other hand, discharges; for, in saying that children are to obey their parents 'in the Lord,' the duty is not only enforced but sublimed and explained. I would, however, fix your attention on two very striking thoughts here, - first, that you have here, on the one hand, a very solemn sanction given to the 223 duty of obedience, and, on the other hand, a very important limitation to the obedience. In other words, - the obedience must be rendered because God has ordained it; but, because He has ordained it, it must be under regulation. The parent, therefore, may quote this verse to urge upon the child its duty, while, on the other hand, the child may, in certain circumstances, quote it, to justify refusal. Let is look a little at both sides. In the first place, then, there is the sanction given to this duty of obedience, which is here called 'right' as 'in the Lord': the thought here being that such commands as the patent may rightly lay upon a child, and such authority as he may rightly lay upon a child, and such authority as he may rightly exercise, are 'in the Lord,' i.e. in harmony with the will and intention of God. And this, whatever people's religious opinions may be, may be regarded as one of the first and most necessary as it is one of the most beautiful of the laws of Nature. The parent is naturally the guardian of the child - his experience being first of all available on the child's behalf, to save it from the multitude of evils that would inevitably harass and torture one who had to find out everything for itself. The parent has tried the wrong path or has observed those who have tried it, and he is able to give this young traveller the benefit of his experience, if he will only listen. He has bought his experience, if he will only listen. He has bought his experience at a great price, and he is able to impart many a precious secret. He has fought the most serious part of the great battle of life, and he can tell many a trick of the enemy, many a way to make friends, many a method of warfare against foes. He is therefore the natural guardian of the child, and , on this view of it, his commands are only counsels put into the imperative mood; his laws are only finger-posts with 'Thou shalt' interpolated; his authority is only guidance that does not wait to be asked. Obedience to the parent is therefore clearly right, on the lowest, the most practical, and the least religious ground, - as a sound, wise, and necessary law of Nature. But the words take us up to higher ground: the phrase 'in the Lord' implying a deliberate purpose, intention, ordainment by the Great Power who, in the facts and relationships of life, has224 made know His will. And there is here a thought which, by even religious people, has not received due regard. God's will is seen in a variety of objects and incidents in nature and life, but he has been seen least where we may well look for Him most, --in the universal facts of our relationship to one another, which I am disposed to accept and regard as the clearest and deepest revelation of the mind of the eternal. Why should we look for God in miracle, and miss Him in that which is constant? Or why should we see Him in the starry heavens and not discover Him on the earth? Or why should we find Him in the circuit of life: Why should He be visible in nature and not in the house? Why should He be known in spring and not in infancy, in summer and not in youth, in autumn and not in maturity, in winter and not in age? Why should He be to us the God the mighty laws of the outward world, and not the God also of the laws that make human beings husband and wife, parent and child, brother and sister? Nay, why should we not see Him supremely in what is really the supreme fact--the fact of human life, with all its changes and relationships, --the God of the heavens and the earth indeed, but above all, the God of humanity and of all that makes humanity one? It is this view that supplies us with the key to these words-- 'Children obey your parents in the Lord: '---obey them because the relationship between you is one that God has appointed; obey them because the bond between a parent and a child is one that no human hand created, that no human hand can destroy, obey them because their authority is (for you, through natural law) the authority of God whose servants and representatives they are. But this suggest at once the other side of the thought, -- that these words, while they give a divine sanction to the parents' authority, also mark out most definitely the character and limits of that authority: for the statement is expressly made that the obedience to be rendered is obedience only 'in the Lord': in other words, the authority of the parent is to exercised as a trust, -- as for God, and the child is to obey only while it is so exercised. 225 a parent's right to command is not the right of the strong to rule the weak, is not the right of a proprietor to do as he likes with his own, is not the right of a master to get his own turn served. A parent's right is an altogether different, an altogether more sacred thing, --it is the right of a divine authority to bless and help. A parent, therefore, has no right to command that which is selfish, unjust and wrong, and a child who is calmly and clearly convinced that a command is selfish, unjust and wrong, may rightly and even religiously disobey. And this swiftly leads me to the second charge, --that namely, to the parent, -- "and ye fathers, provoke not your children to wrath.' Thus the relative duties of the parent and child are religiously and beautifully adjusted. The child is to obey the parent in the Lord, and the parent is not to provoke the child to revolt. Now that provoking of the child which is forbidden will begin the very moment the obedience asked for is not 'in the Lord," in other words, the very moment the authority of the parent is exercised in a selfish, unjust and righteous manner: and, instead of rebelling against this resistance on the part of a child, a good and wise parent will even train his child to see the reason and the unreason, the righteousness and the unrighteousness, the beauty and the ugliness of authority and command; and, instead of feeling angry when he sees the rush of revolt against an improper use of authority, instead of resisting the flow of feeling that wells up in the young heart against wrong and selfish treatment, he will rejoice to see first beginnings of moral discernments and the new-born revolts of the young soul against tyranny, selfishness and wrong: and you may depend upon it that the only wholesome cure for this rebellion is the cessations of the provocation to wrath that justified it. I proceed now to very briefly point out in what ways this provocation to wrath may arise. Certainly by the exercise of authority that becomes mere self-assertion. The moment that begins wrath begins. There is, indeed, all the difference in the world between the wise exercise of authority and the mere assertion of self-will: and yet it is 226 just here that half the provocations to wrath arise. The child, made to feel that the parent is simply setting up one will against another, loses the restraints that naturally temper self-will, and accepts the situation as one of struggle and battle. And no wonder! There is in the young mind an instinctive feeling that this is not what the parent is entitled to, and that the right of the parent to rule is somehow forfeited by the selfish and self-willed element introduced. And this is really the fact, for the authority of the parent, as I have said, it not an authority based on a personal right, but on parental duty; and the whole extent of the parent's authority is included in the discharge of a serious trust, - a trust which is really violated when the rule exercised is the rule of mere personal assertion and self-will. 'We'll see who is master,' from a parent, is only a declaration of war which provokes to wrath. Closely connected with this is the making of unreasonable demands. Children keenly feel injustice, and it is a very necessary and useful instinct which leads them to rebel against it. A parent is too apt to be tempted into the position of saying a thing and sticking to it, right or wrong. That surely is a blunder. It is a common saying that if a parent has once said a thing should be done, done it ought to be, right or wrong; the argument being that a parent would lose dignity and authority if a command were to be withdrawn: but what dignity can there be in standing by injustice? and what authority can be preserved by sticking to what is unreasonable? The only effect of that will be the loss of dignity and the loss of authority resulting from the provocation to wrath that will naturally follow. So, in like manner, with severe punishments. A child very easily and very swiftly measures the extent of the discipline that is either necessary or deserved, and hates nothing so much as the punishment that tells of mere personal vexation and selfish anger. A parent has no right to punish because heh as been thwarted, or in order to get his own way, much less out of revenge or as the expression of mere anger. His right to punish is a part of his duty to educate and guide; and 227 that is altogether removed from self-willed, angry, or merely personal infliction of penalty. The first, a child instinctively feels to be just and right, and it is helped by it; the second it hates, revolts against, and takes as a provocation to wrath. Severity and punishment may also be as easily impolitic as provocative. Merely as a question of getting your own way, the crowbar may be less efficacious than the key. There is a good deal of philosophy in the childlike lines; - Hearts, like doors, open with ease To very, very little keys. I can only name, finally, an unpaternal spirit as one other provocative to wrath. This spirit may accompany even justice and reasonableness in outward things. The scales may be held evenly but unlovingly: the hand may do no wrong but the heart may be far from right. Thank God, this is not often the case: Nature has taken too much care of her little ones for that; but still it is far from being understood that the true paternal spirit may be present even when the most righteous discipline is maintained, while, on the other hand, it may be absent, where even foolish fondness is to be found: the great thing needed being a clear, calm, sweet perception of the fact that all rights are duties, that all duties are ours for the good of others, and that we are all only servants and representatives of the Most High. Where this perception exists, all things will become clear to both child and parent; and the obedience of the one and the ruling of the other will be indeed 'in the Lord,' as the yielding up of the spirit to the blessed giver of all life, and the merciful appointer of all duties, - before whom we all stand, whether children or parents, and say together - 'Our Father who art in Heaven, - our Father upon earth - hallowed by Thy name.' 228 INDIVUALISM AND THE BROTHERHOOD - NOTES OF A DISCOURSE AT CROYDON. - Stand by thyself.-Isaiah lxv., 5. These words form part of an indictment against a self-righteous egotists who believed himself to be more righteous than others, or who talked as though he did. It is a curious psychological study,-to note how near skin to selfishness is self-righteousness. But we will isolate these three words, and consider them as the short, sharp, precise expression of the growing individualism of our day. These prevailing social characteristics seem to come in cycles-like the changes in the climate. Perhaps to-day we are at a stage which needs the development of personality or individualism. If so, that will carry with it some ugly forms of self- consciousness, self-assertion, and the like. If so, moreover, it will be one of the great social duties of our time to watch this tendency, lest it become too strong. It must be treated like an appetite,- to be regulated, not blindly given in to. We must comprehend the meaning of this special characteristic of the age, and all along recognise that it is temporary, not final and eternal. If it is a fact that the social drift is towards individualism it will be our duty, and it will be especially prudent to take note of the dangers of it. 1. It seems clear that its tendency must be to induce a certain narrowness, both of vision and feeling,-a certain narrowness, both of vision and feeling,-a certain hardness, too, both of mind and manner. In society, the good companion or comrade is pliable, receptive, responsive, sympathetic. In religion, the devotee or believer is gentle, reverent, yielding, humble, loving. In business, the man of the guild, the freemason, is for good- fellowship and geniality, with an outstretched hand for a fallen brother. Individualism puts all these in peril. 2. It seems clear, too, that excessive individualism must lead to conceit. It may be necessary reaction from blind submission, but the change will not be lovely. Conceit is only one stage in the 229 upward way: but it needs to be comprehended and kept down. 3. It seems also clear that individualism must lead to loss of power in some directions. This is very seldom noted:--but it is true that the very strength of individualism may become a weakness. The direct route, of sheer superiority even, is not always the surest and shortest. The Catholic priest, with his entire self-abnegation of mind, has a hundred times been more influential than the highly developed rationalist. There is magic power in self-surrender: and mighty power in gentle communion. The Hebrew poet went deep down when he said to God, 'Thy gentleness hath made me great.' 4. Individualism, too, may not only hurt our- selves, but others. It tends, of course, to isolation. In science--how terribly it would work if pushed to extremes! In politics; --what if every man scrambled for himself; --no union, no one great aim? In business, co-operation is as necessary as competition. In religion; what innumerable evils have come of sectarianism! Individualism in religion may be greatly necessary, but only in union can its best fruits be found. It is greatly necessary to remember that even good things, ay! the best of things, may lead to excessive isolation. Even the sense of sanctity may do it. Tennyson profoundly shews how love of art and estheticism may do it. His 'Palace of Art' is a very deep study. I built my soul a lordly pleasure-house. There was no more sin in it than that. It was built four square, and looked over all, --north, south, east, west; 'and the sweet incense rose and never failed.' Likewise the deep-set windows, stained and traced, Would seem slow-blaming crimson fires From shadowed grots of arches interlaced, And tipt with frostlike spires. Full of great rooms and small the palace stood, All various, each a perfect whole From living nature, fit for every mood And change of my still soul. Then, in the towers I placed great bells that swung, Moved of themselves, with silver sound; And with choice paintings of wise men I hung The royal dais round,-- 230 Milton and Shakspeare, Dante and Homer, Plato and Bacon. then the soul said; 'O God-like isolation which art mine, I can but count thee perfect.' And so she throve and prospered: so three years She prospered; on the fourth she fell, Like Herod, when the shout was in his ears, Struck through with pangs of hell. Deep dread and loathing of her solitude Fell on her, from which mood was born Scorn of herself; again, from out that mood, Laughter at her self scorn. Back on herself her serpent pride had curled. 'No voice,' she shrieked in that lone hall, 'No voice breaks through the stillness of this world: One deep, deep silence all.' Shut up as in a crumbling tomb, girt round With blackness as a solid wall, Far off she seemed to hear the dully sound Of human footsteps fall. So, when four years were wholly finished, She threw her royal robes away. 'Make me a cottage in the vale,' she said, 'Where I may mourn and pray.' Yet pull not down my palace towers that are So lightly beautifully built; Perchance I may return with others there When I have purged my guilt. 'With others'! There find the meaning of it all. Everything the poor soul had done was good up to the point of its egoism and its pride. It had to learn that not in one's self can the whole of life and peace be found. Yes! there can be no final joy or fruitfulness of spirit in isolation, - in the individualism which says:-Stand aside, and stand by thyself. I am holier, or wiser, or more refined than thou! But we must, at the same time, remember three things. 1. That individualism may be right or wrong entirely in relation to circumstances. For generations the Church has denounced 'The sin of Schism,' and there may be such a sin, but, on the other hand, there are times when, as John Stuart Mill said; 'The mere example of nonconformity, the mere refusal to bend the knee to custom, is itself a service.' 2. Or it may be right or wrong in relation to individual natures. Everyone of us is at school, 231 and we have different lessons at different stages. 'To thine own self be true.' The supreme thing is not that you shall be right, but that you shall be honest. You must shoulder your cross, and go on to Calvary, if that seems right for you. If not, you are a coward and a traitor, even though your conviction is all wrong: for your supreme duty is to follow your conviction. 3. And yet the proper course for each individual may be the very reverse of what seems desirable. The strong who can stand alone, and who are perhaps tempted to assert themselves should cultivate the reverse of individualism. The weak, who seem unable, should try hard to stand alone. But the deepest and highest ideal is not individualism but combination-co-operation. Let us keep our eyes on the final and ideal state. It is necessary for the human being to develop and exercise the will: but has he not reached the height who can stand erect before God and say; 'Our wills are ours to make them Thine.' 'I delight to do Thy will, O my God, yea Thy law is within my heart'? So then, individualism tends to narrowness, and it is the insight into the unity of the whole that broadens and deepens. Emerson, as usual, was right;- All are needed by each one; Nothing is fair or good alone. I thought the sparrow's note from heaven, Singing at dawn on the alder bough; I brought him home, in his nest, at even; He sings the song, but it cheers not now, For I did not bring home the river and sky;- He sang to my ear, - they sang to my eye. The delicate shells lay on the shore; The bubbles of the latest wave Fresh pearls to their enamel gave; And the bellowing of the savage sea Greeted their safe escape to me. I wiped away the weeds and foam, I fetched my sea-born treasures home; But the poor, unsightly, noisome things Had left their beauty on the shore, With the sun, and the sand, and the wild uproar. Beneath my feet The ground-pine curled its pretty wreath, Running over the club-moss burrs; I inhaled the violet's breath; Around me stood the oaks and firs; 232 Pine-cones and acorns lay on the ground; Over me soared the eternal sky, Full of light and of deity; Again I saw, again I heard, The rolling river, the morning bird;- Beauty through my senses stole; I yielded myself to the perfect whole. _______________________________ _______________________________ AAN DE MANNED EN VROUWEN VAN TRANSVAAL EN ORNAJE-VRIJSTAAT. _______________ BROEDERS EN ZUSTERS, Voor onszelven en voor veel duizend mannenen vrouwen van Groot-Brittanje, Ierland, en de kolonien, wenschen wij onze bewondering en onze sympathie voor u uit te spreken: onze bewondering van den prachtigen en heldhaftigen strijd voor uwe onafhankelijkheid tegen de macht van Groot-Brittanje, geholpen door al zijn kolonien; en onze sympathie in dit uur van uwe overgave, maar niet van vernedering, want gij hebt de vaderlandslievende helden der Historie geevenaard, zoo niet overtroffen. Wij wenschen oprecht te belijden dat gij door ons land noch rechtvaardig, noch vriendschappelijk zijt behandeld, maar dat, integendeel, een heerschen zelfzuchtige aard, aangestookt door een slecht onderrichten geest, ons heft geleid tot het began van een groot kwadd, (sommigen onzer zouden zeegen: een groote misdaad) bestaande in het samenzweren tegen, en het overvallen van uew twee republieken. Voor het tegenwoordige zegeviert het kwaad en de misdaad, en zig, die daarvoor aansprakelijk zijn, beweren luidruchtig dat, wat zig gedaan hebben, is geschied voor "alle tijden". Maar de geschiedenis der wereld toont overvloedig aan, dat niets op aarde "voor altijid kan worden gedaan, dat het hier inderdaad een voortdurende verandering is, en het is voor een jeder volkomen uit dit kwaad en dat de kreet "Africa voor de Afrikaanders" den laatsten uitslag zal mogen bekronen. Gelijk in Australie en Canada, zoo kan in Zuid-Afrika, de samenstelling van een overheer- 233 schend parlement, slechts een kwestie zijn van tijd. Wanneer dit zoo is, dan zult gil, of uw kinderen, een Vereeniging van Vrijstaten zien, die uw meest romantische aspiraties zal verwezenlijken. Wij hopen het, en gelooven dat de geschiedenis zich zal herhalen in de schlepping van een nieuwen Vereenigden Staat: de Vereenigde Staten van Zuid Afrika. Niet op het slagveld zal dit gewonnen worden, maar door het gestadig groeien eener groote Democratie, door vrije instellingen, en door een resolute vaderlandsliefde die door geen grijpende handed van buiten zal kennun beroofd worden van haar idealen. Neemt onze sympathie aan en onze broeder-lijke en zusterlijke wenschen, en wilt steeds bedenken dat een menigte geetesvrienden in dit rijk, uw socialen vooruitgang met belangstelling en vol hoop uw politieke eenheid gadeslaan. Zuid Afrika vooraan! Vold den glans, die u naar uw belooning zal voorlichten! _____ The above is the Dutch version of the Message to South Africa, the English of which appeared last month. It has been signed by nearly one thousand persons, including the following;- Mr. J. Page Hopps, Teacher of Religion, Croydon Mr. Walter Crane, A.R.W.S., London Dr. Alfred Russel Wallace, F.R.S., Parkstone Mrs. Wallace, Parkstone Alderman E. W. Longman, Secretary of the Labour league, Battersea Mr. Henry Holiday, Hampstead Mrs. Holiday, Hampstead Miss Holiday, Hampstead Mr. J. Bryn Roberts, M.P., House of Commons Lady E. C. Coomaraswamy, Worplesdon, Guildford Dr. R. J. Colenso, M.A., M.R.C.S., London Dr. C. F. Aked, Liverpool Mr. R. D. Darbishire, B.A., F.S.A., Solicitor, Manchester Mr. Arnold de Lisle, Hon. Sec. 'League of Peace,' Dudley Rev. W. Tuckwell, Rector of Waltham Mr. C. C. Massey, Barrister-at-Law, London Councillor J. H. Brown, president of the Battersea Trades and Labour Council, Battersea Mr. George Jacob Holyoake, Brighton Councillor S. Stranks, Croydon Mr. Olive Lodge, Junr., Architect, Clare, Suffolk Mr. Hodgson Pratt, National Liberal Club Mr. T. W. Watt, M.A., M.R.C.S. 234 Miss Kate Riley (on behalf of the P.S.A. of Bromer Road, Birkdale) Southport Rev. J. S. Jones, Rector of Colby, Norfolk Mr. W. H. Bradford, Junior United Service, Bournemouth Mr. H. J. Ogden, Manchester Rev. J. C. Street, Shrewsbury Mr. Edward Carpenter, Millthorpe, Sheffield Mr. J. S. Greenwood, Manager of Board Schools, Greenwich Mr. J. B. B. Robertson, Assistant Overseer to the Parish of Leicester, Leicester Mrs. Ellen Grout, Poor Law Guardian (Shoreditch), London Mr. Granville Sharpe, Master of Marlborough College, Ambleside Mr. Hermann Winkler, Poor Law Guardian (Shoreditch) and Borough Councillor (Shoreditch), London CAMPAIGN NOTES CONCERNING THE MESSAGE. I. I HAVE been favoured with a cataract of letters concerning The Message to South Africa : the large majority of them true 'love letters,' but many of them letters of awed prudence tempered by gentle egotism. These run something like this ;—' You are quite right, but that should not be said openly. It is true we have done these Republicans a cruel injustice, but they seem to enjoy it ; and at any rate, we ought to smother under a holy feather bed every expression of feeling that would make the 'loyalists' angry, that would help the British government to falsify its pledges, and that would give the defeated hope. The 'Boers' are now in the British Empire : let us keep them there. We did not approve of the burglary, but for heaven's sake do not open the window and rouse feeling, now that we are in.' I do not understand this curious smiling and whispering all round. It is not healthy, and it bodes no good. As for the Message, I cannot feel any penitence. On the contrary, this rather unhealthy attempt to close every window seems to call for special gratification that, at an early stage, one window was nailed open. The object of the Message was to anticipate, by a little, the verdict of history concerning the 235 heroism of these gallant Republics, to confess a wrong, and to light a star by venturing a prophecy. If this excites 'loyalists' and makes 'patriots' angry, I think it is desirable that they should get accustomed to it ; and that affords an additional reason for gratification that someone led the way in bluntly telling the truth. Some of my correspondents think that the policy of 'Hush!' is specially necessary just now. On the contrary, I think that this is the very hour for keeping our flag out and for shewing strength, until the people we have wronged are safely housed and well in possession of their self-government. We may then leave them to themselves, to work out their patriotic ideals, constitutionally, and in their own way. If we were all to shrink into silence now, the forces of evil might easily be emboldened to undermine the settlement, and let the old selfishness and resentment work its will after all. No : but we must stand on the watchtower, and be strong. A few of my correspondents seem to have strange ideas of patriotism. One, a good ex Pro-Boer, actually underscores the words, 'The Boers have accepted our gift of three millions of money.' and seems to argue from that that they are now in the empire, on a money basis, and there's an end of it. It is a bargain :—the surrender of so much patriotism for so many millions, plus the honour of belonging to the British Empire! Some of my correspondents tell me I am a traitor,—Mr. Voysey and Mr. St. Clair, for instance, —Mr. Voysey, abusively ; Mr. St. Clair, curtly, with the suggestion that I ought to be indicted for treason. No such luck! If Mr. St. Clair can do anything to bring me such infinite good fortune he will deserve and receive my boundless thanks. All this glib, incontinent and un-English prating about 'treason' wants reprimanding. But I fear this talk of 'treason' will go no farther than the breaking of windows and the writing of brutal postcards. It would indeed be an enlightening object lesson if the Government would prosecute honest and peaceable people who only desire to broaden the basis and extend the bounds of freedom, while 236 it continued to do honour to the memory of a rascal who broke his oath to his country, who was false to his colleagues, and who conspired to levy war like a freebooter against a neighbouring and friendly State. Such a prosecution would most effectively drive our protests home. I have a good deal of respect for most of my correspondents, though I have not been able to answer their letters; but the upshot of their efforts is the deepening of my convictions, the confirmation of my policy, and the making it still clearer that there is nothing like flinging out one's flag and sticking to it. In this matter, this is specially needed; for the confession that we have done wrong is the only sound foundation for our future relations with these people. Nothing can ever make that wrong right. It is true that they may accept the situation, bow the head and say 'God wills it, and we submit to the Lord's will': but we shall utterly mistake the whole thing if we imagine that means, 'There is an end of it.' They are fatalists, as all logical and sturdy Calvinists are. When the United States of South Africa arrive, they, or people of the same mould and mind, will still say, 'God wills it. Blessed be the name of the Lord!' So also, if that should come in our day, we of the Message will have no need to 'seek salvation,' or be 'born again.' We have 'saved our souls alive.' II. England has been trying to persuade itself that the ending of the war is a kind of joyous wedding, and that both sides, as in novels, will be 'happy ever after.' What melancholy nonsense! What want of imagination, and what ignorance of human nature in general, and of 'Boer' nature in particular it betrays! Certain terms have been accepted under compulsion, -confessedly under compulsion, - and the honest men will abide by them. But the old ideals simply must live in the Republican heart, and the cherisher of the ideals simply must 'follow the gleam.' That being so, it is as prudent as it is right to act upon this fact, and to have the ideals in the open and not under a ban. Our Message brings the ideals into the open, and makes it possible to 237 let sunshine and fresh air into what might easily become a dark corner for restless brooding. We ought to be sensible enough to know that behind the surrender and the terms there will be emotions and aspirations. These cannot be repressed, as emotions under a ban; but they can be sympathised with and guided, as natural feelings approved and shared by every true Briton: and this should be said, from the first, willingly and spontaneously, by us; for in that its value lies. In other words, - and this sums up the whole: - We must face facts as well as scrutinize terms, and make friends with a tendency that is sure to come and that ought to come. Ought? Yes. It was right that America should go alone; and not a shot ought to have been fired to prevent it. It was right that Australia should become a Commonwealth. And it will be right when Home Rule and Federation in South Africa lead on, as they must, to the only possible result of freedom. Ought we to encourage this? Certainly. It is English. It is inevitable. It is the ideal. To pretend that it cannot be, or to threaten that it shall not be, is dangerous folly: to bring it out to the light and treat it as an ideal at once, is to get brotherhood, kindliness, confidence, peace. III. One of the surprises of the correspondence bag has been that intelligent men have actually brought forward the old allegation that the Republicans began the war without provocation, whereas it has been shewn over and over again, and all the world knows, that we had plainly been picking quarrels and getting accustomed for years to the idea of armed interference; and that, before the ultimatum of the Republicans, asking for arbitration, we had called out the reserves, advanced our troops, summoned Parliament to grant supplies, and, in fact, done all we could to shew what we intended, without actually declaring war. In fact everything points to the conclusion that we artfully schemed to provoke the Republican s to make the first move, - which they did in self-defence. Another statement frequently made is that our people generously sheltered and housed the 238 women and children who otherwise would have starved. This is perhaps the wickedest instance of our hypocrisy. If we had left the women and children alone, they would have been comparatively happy and comfortable on their farms. We destroyed their farms and homes, and then huddled them up in wretched camps where the children died like flies. Kitchener did make war on women and children, and our talk of 'magnanimity' and 'generosity' is cowardly cant. IV. Some have said that our confession of wrong and our message of hope may incite the 'patriots' and the government to keep back the prisoners and to delay self-government. I think the contrary. We cannot answer for the 'patriots,' (they want keepers, not sponsors), but we may be sure that the government is nervously anxious to get matters arranged at the earliest possible moment: and I believe it will help if, instead of telling lies about the silly, sudden loyalty of 'the Boers,' we keep the sinners on the run. No: these sinners have had their day: it is our turn now. V. Some of my correspondents see 'disruption' in the prediction of a 'United States of South Africa,' and they do not want that: others see it and want it, but think it will do harm to predict it, or to confess that we desire it. But the curious thing is that Lord Milner hastened to say that he looked forward to a great South African nation; that the premier of Natal said he was so anxious for Federation that he would make Federation a condition of self-government in the Transvaal and Orange River Colonies; and that now the Premier of Cape Colony, Sir J. G. Sprigg, has strongly declared for South African Federation, and protested that it must come from within. What is that but the counterpart of the Australian Commonwealth; and what is that but the half way house to our ideal? 239 VI. It matters stood as the ususally lying telegrams and newspapers indicate, there would be something in the contention that if crushed Republicans are satisfied and even jubilant we might well let them alone. But matters do not so stand. It is unnatural: it is impossible. Thousands of men and women will sorely need the steadying and consoling influence of our sympathy and encouragement. President Kruger better represents the real men and women we have to deal with than the feather-headed weathercocks the news-agencies are trying to palm off on us: and he, in a message lately received by me, says, 'He has read your message with great interest, and has been much touched by the spirit of justice and the kindly feeling that guided you in writing it.' The awakening of that response throughout South Africa will do more than anything else to give us true peace, and a happy and prosperous future there. But it is a response which can only follow a confession of wrong-doing and a message of hope. VII. Some ask; 'If the Republicans are satisfied, why should not we be?' Is it possible that any really moral person can miss seeing that this means;= If the sinned against gives in, why should not the sinner be content? People talk as though we 'Pro-Boers' had nothing to do with it: and we are made to appear like intruders. That is absurd. As a part of the nation, we are partners in its policy, and are, in a sense, sharers of its sins. We have, in fact, most right to be heard as partners who feel smirched by the dishonesty of the firm. VIII. The following puts plainly what many offer us in various disguises, and with various tin-foil wrappings. I prefer to have it out with the government. We are strong enough. My Dear Sir,--I appreciate your courage and have been in such hearty sympathy with most of the things you have said about this recent war that I should like to fall i with your judgment about the address. Your kind note notwithstanding, 240 I still doubt the wisdom of opening addressing the Boers. They have been wronged, and I go as far as you in the desire to take the bitterness out of their souls by openly assuring them of our admiration. But I think we may injure them with the Government. I agree with you that the Government has been frightened. I am no fatalist, but for the present I think Providence is chastising them so sorely that we had better leave the thing in the irresistible hand. Your first argument, sympathy with our ill-used adversaries, appeals to me more strongly than the second, although I will be behind no man in my contempt for our present rulers. With kind regards and warm admiration for your heroic stand, - I am, yours very sincerely, * * * IX. The Daily Mail printed two infamous articles on the subject of the Message. 'Infamous' but, so far as we know, the following represents the result: Prince Park, Liverpool. DEAR MR. HOPPS, - I have just read an article in the lying Daily Mail denouncing an 'incendiary document' which you are circulating for signatures against the South African Crime. I shall be glad if you will send me a copy of this so that I may sign it myself and obtain the signatures of friends. - Yours truly, * * * X. One troubled soul says that he regards the annexation of the Republics as a cruel wrong, and yet he shrinks from saying so now, and from doing anything in the matter; and he asks whether we can help him. Not in the slightest! XI. Many letters like this:- It is difficult to foresee to what this country is drifting, with its desire to suppress the truth. But go on with the work to which God has called you, ever remembering His word; 'Only be thou strong and of a good courage, and I will never leave thee nor forsake thee.' I hope to go on with my work, but also hope that my duty in relation to this subject is at an end. J. PAGE HOPPS. ========================== MR. VOYSEY'S PAILFUL OF PEACE. ----------------- Perhaps the maddest sermon on 'The Peace' was preached by the Rev. Charles Voysey, who, when he allows it, can beat even Joseph Parker in being 241 naked and not ashamed. We do not intend to dissect this sermon, or even to at any length criticise it. It will suffice if we describe it and quote it. Nearly three years ago, he tells us, he preached on the war, which, in his eyes, was a war to overthrow evil and cruelty, and on behalf of the weak and oppressed. Then, he says, 'I went on to shew how in war there was little or no room for the evil passions of men,' and that the 'fighting soldiers in the very act of inevitable bloodshed were only obeying the higher laws of God. War, in fact, furnished opportunities which few other episodes in human life could furnish for the calling forth of the noblest virtues.' And now, 'the terms of surrender on which we insisted more than a year ago have been unconditionally accepted, and nothing now remains but to thank God for our great victory and to betake ourselves to those vast schemes of justice and charity which alone we have been fighting to secure. The old republics have been swept away only that God's law of righteousness and love may be better kept than was possible under the sway of covetous and tyrannical men, who ran away laden with the public money.' We really must pause here for breath and retrospection. Mr. Voysey is evidently not chastened. The old arrogant and unteachable Adam is still strong in him. He has learnt nothing and forgotten nothing. He is blind to the demonstrated conspiracy of lie got up and paid for by Rhodes and his gang, and still thinks that Johannesburg was oppressed. He seems to know nothing about the letters from soldiers and officers which showed disgusting delight in destroying 'Boers.' He has apparently heard nothing about the wholesale destruction of orchards, crops, wells and farms, and the sweeping off of thousands of children into untimely graves. He sees only his 'God of Battles'. laying down His ghastly 'higher law,' and is as much an Old Testament Jehovist as Mr. Kruger, with this difference, that Mr. Kruger is not also a New Testament Pharisee. Mr. Voysey thanks his God for victory, dismisses the Republics with spiteful scorn, and insults officials who did their duty in protecting public money and safeguarding it from thieves. But all 242 this only lays bare the real animus of this type of 'patriot.' But let us go on. The nations of the world, we are told, are envious and jealous, but he hopes that 'our unsullied justice and generous rule shall soften their hearts and turn their animosity into friendship.' Only think of it; - our 'unsullied justice,' and our 'generosity,' - in India, in Ireland, - everywhere! But most wonderful was the effect of the war on the people at home. 'No sooner did we learn that we were in some kind and degree of peril, and that the difficulties of the war were enormously aggravated by the extent and nature of the territory where it was being carried on, than the people seemed to rise as one man out of the torpor and selfish worldliness and animalism in which they were sunk. They began to be serious.' That is perhaps the champion lie of the past three years. The people seemed to rise as one man out of animalism, says Mr. Voysey; but our experience is that they sank very deeply into it. 'They began to be serious,' says Mr. Voysey. Bosh! They began to act like drunken blackguards in almost every town and village in England, and to outrage men and women saner than themselves. 'So soon as the main object and purpose of the war was clearly seen,' says Mr. Voysey, 'justice, righteousness and generosity between man and man became more important, if indeed it did not for the first time lay hold of the attention and the heart.' 'Generosity'! There was never in all our experience such a debauch of implacable animosity and wicked rage against the better spirit of the lovers of honesty and peace. England seemed to be a different place during the reign of terror caused by the vicious spirit of the war. Mr. Voysey then turns upon the gallant band who resisted the war. We did it, he says, to our 'lasting and indelible disgrace'; we were and are 'an ignominious few.' Ours were 'perfidious exertions'; our speeches were 'disloyal'; and only in this 'exceptionally generous and tolerant land could such treason venture to express itself.' In other countries we 'should have been stamped out by prompt and capital penalties' - that is to say we 243 should have been hung; and Mr. Voysey seems to more than half wish it. Then follows a coarse attack on Mr. Gladstone, to whose example and influence, Mr. Voysey tells us, all our infamies may be traced. He it was who bred 'Pro-Boerism,' and 'transmitted the disease to the present generation.' But we cannot go on. We look upon this shocking exhibition of folly and falsehood with extreme pain, and would fain say nothing about it if we could. We are content, we are even anxious, to say no more about his odious affair; but then our old opponents must somehow stop these out-pourings, which only too painfully remind us of the lie factory and the Daily Mail in their wildest days. Until that stable is clean, we must turn on the hose. JUDGMENT DAYS? The mills of God grind slowly, But they grind exceeding small. WE did not follow our Christian pagans when they appealed to their 'Gods of Battles.' Still less did we go with them when they thanked this God for giving them the victory. Least of all did we agree with them when they attributed the King's abscess to God's reproof instead of to the King's indiscretions. But, at the same time, there is something arresting in what has happened. The Queen, who seemed to love nothing better than 'my soldiers,' broke her heart against the late war. The maker of that war, Cecil Rhodes, died before it was finished. The King, Rhodes' companion and shield, was hit hard, and nigh to breaking, over his coronation. Milner, in spite of the Government's desire to champion him, is obviously pushed aside and discredited: and Chamberlain, who used Milner for the glorification of his Colonial Office, is smashed against his Colonial advertising arch, a few days before what was to have been his coronation at the Guildhall. Salisbury, the hater of even 'a shred of independence,' has gone. Hicks-Beach, who found the money for tearing away that 'shred,' has also gone. One is 244 almost compelled to ask; 'Who next?' Is it just possible that some thousands of murdered men and women on the other side are doing what God is said to do? It looks very queer. --- LONDON'S WELCOME TO KITCHENER. SURELY London's welcome to Kitchener was one of which every high-minded Englishman must be or ought to be ashamed. It is true that there was in it, or that we tried to put into it, a little admiration for the man who sat on Milner and gave the Republicans decent terms: but the real welcome was to our dog who, in the fight, had won. But what a victory! The English bull dog, the Scotch terrier, the Irish hound, and the Australian mongrel had been worrying and gnawing two small puppies for nearly three years, and, more than once or twice, the puppies pushed the big pack hard: and, in the end, the puppies pushed the big pack hard: and, in the end, the puppies, after all, remain in possession! And yet Kitchener is welcomed as though he had saved England from the combined forces of the great continental powers! O, pull down the blinds, and go to bed! --- FLEET STREET GUSHING 'BOER.' GENERAL BOTHA is angry, it is said. The Fleet Street gushers went too far in saying the Botha declared the day of the surrender was the happiest day of his life. Plenty of other 'Boers; would be angry if they knew we had pictured them as giddy fools. Unquestionably, they were glad to make an end of the war, and many causes would conspire to make them so. They would see wife and child again - perhaps. They would go back to the old home, - or at all events to the old spot. They might, at al events, see the old fields and streams. Always blundering, always without imagination, the Fleet Street man mistakes this joy for joy in us! and even thinks - poor sillikin! - that 'the Boer,' after all, will be proud to belong to The Empire! 245 Ah no! even if 'the Boers' wished it, it could not be. There are scorched ideals and bitter memories, wounded hopes and the hundreds of unspeakable wrongs that lie between us; and he who jauntily looks over all that blasted region as an Eden, resounding with 'God save the King,' is living in 'A Fool's Paradise,' indeed. --- THE COLLEGE GRADUATE. THE CHIEF Justice of Kansas is a trifle hard on the college graduate, but he tells some wholesome truth in the following onslaught upon him. The Chief Justice writes from an American standpoint, but, in this country, we know something of the cub he described; - in Cambridge, Oxford, Glasgow and Edinburgh, for instance. I would reform the college student or kill him off. I know we pretend to dote on him and affect to believe that he is the hope and first care of the State, but it's a lie. We don't. Nobody but his mother does. From the time he first starts out to render 'Gallia est omnis divisa in partes tres' becomes an insufferable nuisance. If at that stage of his career his own gall could be divided into 3,000 parts instead of 3 and he left with only one of them, the relief to mankind and to himself would be inestimable, because an infinitesimal fraction of the whole of what he has would suffice the needs of any ordinary mortal. Why do I say these hard things about him? I say it because he is self important, noisy, conceited, ignorant of all practical wisdom, parts his hair in the middle, flaunts his fraternity badge and school colors in an offensive, challenging sort of way in everybody's face, and prances up street yawping his ear-splitting college yell to the fright and disgust of all timid, sensitive folk within sound. I saw him at the Twentieth Kansas reception, a bigger man than Funston - bigger even than Gen. Hughes - making more noise and taking up more room than the whole procession, elbowing everybody out of the way, and drowning the voices of the orators and the music of the bands with his idiotic 'Rock Chalk, Jay Hawk; Rah! Rah! Rah! Washburn, rah! Baker, hurrah! or whatever the infernal Siwash gibberish is. I have seen somewhat of this world and I think I have correctly sized up a good many people in it, and I give it as my mature and solemn judgment, based upon a careful, unprejudiced comparison of the many classes of people who cultivate the habit of making a holy show of themselves, that, with the exception to be hereafter noticed, the average college student is the most obtrusive and elephantine ass that fronts the grieved and frowning face of heaven. I was a college student once myself.246 Now, I am not objecting to what this creature learns at school. It's what he does not learn that I am talking about. Nobody ever heard of a college student who was fitting himself for anything but one of the professions, so called - that is, one of the professions of learning how to live off the balance of mankind. He's going to be lawyer, a preacher, a doctor, an editor, an author, an orator, a statesman, and no doubting thought ever ruffles his serenely egotistic soul that when once he vaults into the arena of affairs the things of this world will be speedily set to rights. But when he finally does land out, the much-abused, long-suffering world gets its revenge. The world just trips him up and rolls its big self over him and mashes the wind out of him and the picks him up and chunks him into a little 8 by 10 office, with cobwebs on the ceiling and fly specks on the windows and two broken leg chairs on the floor and a dozen second-hand books in a wobbly old case with the glass broken out; and, refusing to pay his board bill any longer, goes off and leaves him to learn wisdom from the ant. Nor have I any spite against the college student. I only think he takes up too much room and makes too much noise and costs too much money and is too smart in the budding days of his career. If he could only be induced to subside somewhat, to practice a little the modest habit of self-effacement, go out and soak his head, turn an X-ray upon his inwards and see himself as others see him, we could possibly endure him instead of filling up with wicked wishes for his assassination. But he won't. FREEDOM IN CAPE COLONY. HAS the letter of the Hon. G. Wilmot, a member of the Legislative Council of Cape Colony been sufficiently noticed? Writing in favour of the suspension of the constitution (i.e., of despotic Government), he says; Our object is to establish liberty in lieu of the otherwise inevitable rule of the Afrikander party, whose declared object is to rule the country for the benefit only of one section of the people - themselves. Magnanimity was extended to the Afrikanders when we gave them responsible government in 1872. How have they repaid us? By nine-tenths of this people becoming either passive or active rebels. And now will we be such fools as to believe that this most obstinate and tenacious people, who have proved that they can wait, will abandon a dearly loved policy, handed down from father to son, and engraved on their hearts? This writer takes credit for giving 'responsible government,' but he would not take it away, and govern despotically. Why? Because the majority are against him (that is the meaning of 'passive or active rebels.') 247 But the conclusion forebodes civil war. He asserts that 'this obstinate and tenacious people' will not abandon their cherished ideals; and the inference is that they must be denied self-government and simply gripped and held down. How do we like the prospect? How do the other Colonies like it? And are we stirrers up of strife who insist on putting a stop to this dangerous foolery? Free England ought to stop calling that 'rebellion' which is only a desire for government in harmony with the wishes of the people. Government of a community by compulsion is tyranny: and the inevitable reply to that is, - Your Imperial rule is despotism. WAS CECIL RHODES INSANE? UNDER this heading a scholarly American journal gathers together a number of contemporary opinions; and, on the whole, the opinion seems to be that Cecil Rhodes was a bit cracked; but at least one paper took the original view that he was only something of a fool. It says: Cecil Rhodes was certainly no fool where money was to be made, but in the domain of world statesmanship he was very much of a fool. Which proves that the captain of industry, who thinks that methods eminently efficacious for cornering mines can be applied to cornering minds and hearts and souls and bodies of millions of men, is no wiser than was many a hardy and rum-expanded pirate captain who, as he paced the moonlit quarter-deck of his little booty-laden brig, dreamed of what a wonder he might have been had fate only been kind enough to make him the commander of a great navy. The world's sense of humour and not its fears will be touched by Cecil Rhodes's secret and oath-bound Society of Millionaires for the Suppression of Human Folly and the Proper Government of Mankind. The same journal says: Rhodes seems actually to have dreamed of a secret society of millionaires whose business it should be to corner the money of the globe and then run things. That is, Rhodes conceived that the world's greatest need was the multiplication of himself. But as that could not be, the next best thing that occurred to him was for men of his own financial class to get together and organize a governing trust - to form a board of directors and manage the political concerns of the English-speaking race on a Rhodes basis. The news of the formation of such a trust would affect the English speaking race emotionally must as sheep, if endowed with human intelligence, would be affected by a 248 report that the wolves were holding a convention for the advancement of the wool and mutton interests. At best Rhodes's ideal was benevolent despotism. If possible of realization, his millionaires' governing trust would be the most intolerable tyranny of which the mind can conceive - the tyranny of a plutocracy. CONCERNING PITCH. A GOOD friend, thoroughly with us, nevertheless write; 'I trust, now that the war is over, your paper will soon be restored to that sweetness and simple kindness that used to make itself felt in all the articles. In touching the "unclean thing" we have not escaped defilement.' We thank him for his testimonial to character and for his counsel; and, all the more, because there is just a touch of truth concerning the contact with pitch. That close contact has been, from first to last, a grief, and often felt like a degradation; but, knowing what we knew, what could we do? Plenty of people kept their gloves on and their hands clean. We do not envy them. We trust, however, that the defilement is only skin deep; and we are not without hope that this descent into hell has vastly added to the experience which alone means - LIFE. IS MAN A CREATURE OF CIRCUMSTANCES? THE following letter has 'food for thought' in it:- I have read THE COMING DAY with much interest particularly the article on 'Is man a creature of circumstance?' It seems to me very clear that, whatever be the force of circumstances, man has a will which constitutes his spiritual individuality, and that by the exercise of this will, in directing his own actions, and those of others, he has the power to alter circumstances. This is not clearly seen in the individual man, but is very evidently true of man as a whole. The fact is that we do not live by ourselves, but all together; and, even if a man were cast alone on a desert island, the wisdom and the folly of his ancestors and of the people with whom he had once lived would be with him. If a man continued to live alone, however, he would fall out of touch with human life, and would deteriorate. But this would be, not only because he was removed from the influence of his kind, but also because his own mind and will had ceased to influence others. 249 It is clear to me that while the exercise of the individual will is sometimes powerless, in direct opposition to a powerful temptation, yet that will can will to accept a general scheme, which will be of sufficient power to overcome the temptation. The laws, the manners, the customs of man are the product of the workings of the individual will in concert with the social will, and with or against the Divine will. Man is a creator as well as the creation of circumstances. This, I think, is the whole point, and it is one of those principles the truth of which becomes apparent to us the more we act upon them. NOTE BY THE WAY. CHURCH WINDOWS FOR FIGHTERS. - A celebrated stained-glass-window maker sends us designs of windows for deceased soldiers. They make on shudder. Here is one headed, 'Be thou faithful unto death, and I will give thee a crown of life.' What a horrid misappropriation of a sacred promise made to a testifying Christian! At the base we read, 'To the glory of God, &c.' One of the panels represents three gracious women caring for a child! Another window has the text, 'I have fought a good fight. I have finished my course': - a vile abuse of an apostle's summing up of his life of loving helpfulness. Still another contain a picture of Christ blessing little children, - a reminiscence of the infernal concentration camps, we suppose: also a picture of Mary sitting at the feet of Christ, having 'chosen the good part'! These hypnotised fighters and their backers seem to have little sense of decency and no sense of humour. A SULTAN'S ASTRONOMY. - At a great Coronation dinner, the Sultan of Perak was put up to praise British rule. Here is his peroration:- 'It is my prayer - and I believe that I speak for the other rajas of the Malay peninsula - that as long as the sun and moon continue to revolve around the earth so long might my country remain under the protection of the British Government.' (Cheers.) 'QUITE A LITTLE.' - We have now got down to the ultimate absurdity in the absurd use of the word 'quite.' We have had 'quite a number,' 'quite a quantity,' 'quite a time,' 'quite an audience,' 'quite a good few,' &c., and now we have 'quite a little.' Here is the beginning of an Article in a Psychological Magazine, 'Quite a little attention this last month has been attracted to that branch of Theosophists under the leadership of Mrs. Tingley, which calls itself "The Universal Brotherhood."' What would 'not quite a little' be? A TRUE GLADSTONE. - At the service in Hawarden Church on 'Peace Sunday,' the Rev. Stephen Gladstone, at the conclusion of his sermon, said: 'You may not all follow 250 me in my heartfelt desire that the day may come when, to our honour and interest to theirs, it may be possible to give them back, if they should wish it, that gift of freedom which is our own greatest pride and blessing, and for which they have so nobly striven. I should be false to my deepest convictions if I abandoned the faith that freedom is a blessing without which no noble nation can lice, and that nothing on earth but the very direst necessity could justify one Christian nation taking blessing from another.' Mr. Gladstone might well have signed our Message. - LYING OR MERELY SILLY? - We take the following from one of the London foolishnesses: 'Everything that has happened since the signing of the terms of the surrender,' says the Times correspondent in a letter from Bloemfontein, 'certainly leads to the belief that, for the present at any rate, the Boers are thoroughly sincere in their desire to come in and maintain a loyal and obedient attitude towards the new Government. 'The commandoes are everywhere surrendering freely, and unreservedly bringing in their arms. 'Quite typical is a remark made by the De Wet a few days ago, when asked if there would be any who might refuse to come in-"Not come in! I'll take my sjambok and let them know that I am now a subject of the King!"' And the feather-headed folk who read such servant-girl nonsense believe it! - A RHODES' MEMORIAL.- The Globe is a comic print which sometimes thinks it is serious. One day lately, when it thought itself serious, it printed this in its most prominent place; 'It is safe to say that the memory of Cecil Rhodes will never die; so long as the British people are a nation his name will live. He raised an imperishable monument to himself by his life, and in his death he reached across the grave to set up a memorial of untarnishable splendour. It is a duty to ourselves and a debt that we owe to posterity, to ensure that the likeness of such a man is preserved for all time.' The Globe need not be afraid. Rhodes will be remembered sure enough. But we should take Carlyle's suggestion and, instead of raising a statue, sink a pit to him. In another column it suggested that the crude and rowdy song known as 'The National Anthem' should be printed in all our hymn books. That measures this little 'Globe.' - THOROUGH AND STRAIGHT. - Once again The New Age stands firm when firmness is needed. In a late number, referring to our conquests in South Africa, it said; 'We ought to look facts in the face. It is idle to protest against a war of aggression, and then to acquiesce in its results. If a given war is unjust, then its consequences ought not to be accepted. If it is wrong to commit a burglary it is equally wrong to divide the spoil. The receiver is always a bad as the thief. The South African war has been denounced 251 roundly as "avoidable," "unjust," "criminal," and what not. And yet many who talked in this way are now saying that the result must be accepted. We fail to see the logic of this, and we are fully persuaded of its impolicy.' - A SOUTH AFRICAN COMMONWEALTH COMMITTEE.- We think the 'Stop the war' people have done well in creating a new committee, to hold up boldly the standard of a South African Commonwealth. Timid people will hesitate. Others will agree that 'What is done is done.' Some will find salvation in the robber's camp, and in the Briton's natural love of power when he gets it. But 'let him that hath a dream tell a dream.' There is no hurry. The commonwealth may not arrive in our day; but Federation is at the door: and Federation is half way. There will be no standing still. - - NOTES ON BOOKS - A BOOK BY J. HORTON ON 'MY SEARCH FOR TRUTH, AND WHAT I FOUND' (London: William & Norgate), is at any rate a real book that had to be written, and not a bit of book-craft done to order. The writer (we think, a woman) shews her hand at the start--and her heart also. She takes us into her confidence in a very touching way, but, in doing so, gives us the truth history of her book, as a record of soul stirring experiences and hard thinking. We do not entirely like her treatment of Darwin and evolution, but it is necessary to read between the lines on that subject, concerning which it is evident that she is wrestling with a profound thought possibly not yet adequately grasped by evolutionists. Anyone caring to watch the emerging of a strong and resolute thinker out of orthodoxy and its limitations into,-well, we hardly know what to say, but let us say into- an intensely spiritual rationalism, would be interested in an possibly profited by this unconventional and passionately earnest book. - We strongly commend to our readers a small and cheap book, by Mr. J. Clarke, M.A., on 'British India, and England's Responsibilities' (London: Swan Sonnenschein & Co.). It is not a happy book; very much the reverse, as it tells the story of British robbery, murder, and hypocrisy in India. But it contains matter that every British man and woman ought to know, and it is written in a masterly manner. As compressed history it is extremely useful; as an ethical study it ought to make us ashamed. - A SERVICABLE little book is 'America Abroad: The Annual Handbook for American Travellers," edited by J.W. Cundall (London: Greening & Co.). In less than 100 pages, including many full page advertisements, it tells nearly all that one needs to know about the ways and sights of London and Paris. It contains many illustrations; some rather attractive. 252 LIFE AND LIVES ------ I must do as you do? Your way I own Is a very good way. But still There are sometimes two straight roads to a town, -- One over, one under the hill. You are treading the safe and the well-worn way That the prudent choose each time; And you think me reckless and rash to-day, Because I prefer to climb. Your path is the right one, and so is mine, We are not like peas in a pod, Compelled to lie in a certain line, Or else be scattered abroad. 'Twere a dull old world, methinks, my friend, If we all went just one way; Yet our paths will meet, no doubt, at the end, Though they lead apart to-day. You like the shade, and I like the sun; You like and even pace; I like to mix with the crowd and run, And then rest after the race. I like danger, and storm, and strife, You like a peaceful time; I like the passion and surge of life, You like its gentle rhyme. You like buttercups, dewy sweet, And crocuses, framed in snow; I like roses born of the heat, and the red carnation's glow. I must live my life, not yours, my friend, For so it was written down; We must follow our given paths to the end, But I trust we shall meet--in town. --ELLA WHEELER WILCOX.BIBLE READINGS FOR PUBLIC WORSHIP OR THE HOME, COLLECTED, ADAPTED AND ARRANGED BY JOHN PAGE HOPPS. Contains 106 Bible Readings on the following subjects: - GOD. | JESUS. WORSHIP. | GREAT TEACHINGS. THE DEVOUT AND LOVING LIFE. | FOR THE YOUNG. THE INSPIRING SPIRIT. | THE FINAL NIGHT AND DAY. ONE SHILLING AND SIXPENCE. The Church Gazette, under the heading of 'A useful set of Bible Extracts,' says: 'Mr. John Page Hopps, in his introduction to "Bible Readings: (Williams & Norgate, pp. 113, 8vo, 1/6), asks "why should a man who wants to read such verses as "I have called upon Thee for Thou wilt hear me, O God. Incline Thine ear unto me and hear my speech. As for me I will behold Thy face in righteousness. I shall be satisfied when I awake with Thy likeness," be also compelled to say to the congregation, of some people, that "they are enclosed in their own fat"? But he would have to do that if he read straight on. Hundreds of such cases could be cited.' 'It is to avoid such incongruities that Mr. Hopps has compiled the book under notice, which consists of one hundred and six Bible readings, each of which is devoted to a special subject which firms its heading. Some of these consist of passages exactly as they stand in the Bible itself, while some others are made up of a series of extracts selected from various sources throughout the Old and New Testaments . . . The system succeeds in bringing together great thoughts on great subjects, whose mutual support might otherwise escape the reader's attention. For preachers, we think, the work will be especially useful and suggestive.' --- Published by WILLIAMS AND NORGATE, 14, Henrietta Street, Covent Garden, London, or direct from the Author (South Croydon) on receipt of the price named. --- Light. WEEKLY JOURNAL OF PSYHICAL AND OCCULT RESEARCH. 'Light' proclaims a belief in the existence and of the spirit apart from, and independent of, the material organism, and in he reality and value of intelligent intercourse between spirits embodied and spirits disembodied. Beyond this it has no creed, and its columns are open to a full and free discussion - conducted in a spirit of honest, courteous and reverent inquiry. Price 2d.; or 10s. 10d. per annum, Post Free. Office: 110, St. Martin's Lance, W.C. 'Light' is sold by all Booksellers. The trade supplied by E.W. Allen, 4, Ave Maria Lane, E.C. The Inquirer. Established 1842. Published Weekly. Price One Penny. 'The Inquirer' represents Reverent Freethought. It maintains that piety to be vigorous must be intelligent. Its writers belong to different shades of religious opinion, and it reports the doings and sayings of various sections of Church life; but its unity is found in the effort to 'seek truth,' by which as Marcus Antoninus said, 'no man was ever yet injured.' Published at Essex Hall, Essex Street, Strand, W.C.; and by John Hevwood, Amen Corner, E.C. The New Age: A DEMOCRATIC REVIEW OF POLITICS, RELIGION AND LITERATURE. Every Thursday. Price One Penny May be ordered of any Newsagent. London Office: Toole's Court E.C.By JOHN PAGE HOPPS. Published by Williams & Norgate, Covent Garden, London. PILGRIM SONGS, with other poems. Written during orty years. One Shilling. Or beautifully bound, with Two Portraits (1855 and 1890), Three Shillings. SERMONS OF SYMPATHY. With Portrait. Half-a-Crown. TWENTY SERMONS FOR OUR DAY. Two Shillings. BIBLE READINGS. 106 Bible Readings. Passages that are harmonious in atmosphere, thought and feeling, are here brought together, for continuous reading, as Lessons on given subjects. One Shilling and Sixpence. DEATH A DELUSION. Personal experiences. One Shilling. FIRST PRINCIPLES OF RELIGION AND MORALITY. Twenty Lessons. One Shilling. THE ALLEGED PROPHECIES CONCERNING JESUS CHRIST IN THE OLD TESTAMENT. New edition. Sixpence. A SCIENTIFIC BASIS OF BELIEF IN A FUTURE LIFE. Six Lectures. Fourth edition. Sixpence. THE PLAIN TRUTH ABOUT THE BIBLE. Fifth edition. Sixpence. THUS SAITH THE LORD. An unconventional inquiry into the origin, structure, contents and authority of the Old Testament. Seven lectures. Third edition. Sixpence. THE MESSAGE OF THE CHURCH TO THE WORLD. Six Discourses. Spoken at Croydon. Sixpence. MY CONFESSION OF FAITH concerning God, Jesus, Salvation, the Bible and The Future Life. Threepence. A CHAIN OF SEVEN. Progressive Lessons on God, Creation, Evolution, Man, Revelation, Duty, Salvation. Threepence. THE ULTIMATE AUTHORITY IN MATTERS PERTAINING TO RELIGION. Twopence. THE SEERS OR PROPHETS OF THE OLD TESTAMENT. Twopence. SUGGESTIVE DATES, LANDMARKS IN THE HISTORY OF THE WORLD. There are about 300 Dates; divided into 18 Epochs. On strong Card. Twopence. FORCED INTO DISSENT. The plain truth about the Book of Common Prayer. New edition. Twopence. WHAT IS RELIGION? WHAT IS IT TO BE A CHRISTIAN? WHAT DO I BELIEVE? Three Letters to a Child. In stiff coloured covers. One Penny each. --- On receipt of the price named, any of the above works will be sent (post free) by J. PAGE HOPPS, Sanderstead Hill, South Croydon. Cincinnati Social Hygiene Society BRANCH AMERICAN SOCIAL HYGIENE ASSOCIATION BUREAU OF ADVICE AND INFORMATION Telephone, Canal 1153 311 Bell Block Affiliated with Cincinnati Council of Social Agencies Co-operating with United States Public Health Service United States Bureau of Education Ohio State Department of Health Hamilton County Department of Health Cincinnati Department of Health Cincinnati General Hospital Cincinnati Police Department Cincinnati Educational Forces Perpetuating The Work Of Venereal Disease Control Inaugurated By The War Department DEPARTMENT OF EDUCATION PROGRAM 1. Co-ordination of Education Facilities- A. HIGH SCHOOL:- 1. Connecting up work done in separate high schools by bringing together the teachers doing this work through our education committee. 2. Conferring with teachers on the opportunities for introducing sex-education into their regular course of study, i.e. history, English, biology, etc. 3. Furnishing literature, etc. wherever desired. 4. Special speakers for schools not already provided with teachers. B. CLUBS- 1. Definite course of lectures to Mother's Clubs, Cincinnati Woman's Club, Woman's City Club, Community Service League groups, Church Clubs, etc. 2. Single talks to these groups or any small private clubs or social gatherings. C. PUBLIC LECTURES- 1. Arranging for meetings on Social Hygiene 2. Lectures to public gatherings when requested. D. LESSONS TO WOMEN IN QUARANTINE- [*not meu.*] 1. Regular talks and conferences with selected groups in the hospitals on the medical and physiology aspects of the subject. 2. Normal Course A. Course to speakers on Social Hygiene. This class to be limited to those with such qualifications as are specified by the committee. B. Course to case workers on medical phases of the work. 3. Library A. Development of a loan library in the offices of the society of books to be endorsed and classified by the Education Committee. B. Introduction of books into the public libraries and semi-public libraries, of books on the above list with definite recommendations in regard to the age of age of child for whom the book was intended. C. Starting reading centers, by appointing individuals in different parts of the city to take charge of a small number of books, who will act as supervisors and advisors for all the people in the neighborhood who wish to use them. 4. Propaganda A. Publishing pamphlets and literature, etc. B. Making or renting slides and moving pictures, etc., for use in connection with lectures. 5. Cooperation with Government and Other Organizations doing this type of work -- by using their publications and helping to carry out their programs wherever possible. A. United States Public Health Service. B. United States Bureau of Education. C. Ohio State Department of Health. D. Hamilton County Department of Health. E. Cincinnati Department of Health. F. Cincinnati Educational Forces. G. American Social Hygiene Association. H. Other Hygiene Societies, etc. PROTECTIVE WORK FOR WOMEN AND GIRLS CORA ANDERSON PEDDICORD, Director PROGRAM 1. Preventive Measures 1. Supervising commercial places of amusement such as public dance halls, parks, movies, theatres, etc. 2. Patrolling streets, military neighborhoods, hotel lobbies, restaurants, etc. 3. Warning girls who need protection from improper amusement, dangerous employment, etc. 4. Supplying financial help to stranded girls and furnishing transportation to their homes, if advisable. 5. Consulting parents who are troubled about their daughters. 6. Locating and returning runaway girls to parents. 7. Co-operating with established agencies to find employment, shelter, boarding places, proper recreational and educational advantages for girls in need of protection. 2. Reformative Measures 1. Co-operating with the police in interviewing girls and making investigations of cases that need attention but are not liable to arrest. 2. Aiding the court in investigating home conditions, former records, and securing other data that will assist the court in determining fit disposition for individual cases. 3. Co-operating with probation officers in keeping in touch with girls after release from court or penal institutions. 3. Health Measures 1. Supplementing the work of the venereal disease clinics in inducing suspected persons to report for examination and in the following up of patients at large, who, without supervision would not report regularly for treatment. 2. Securing quarantine of infectious carriers of disease who can not be trusted at large. [*not meu*] [*?*] 3. Improving conditions of quarantine to provide work and recreation for women and girls during the quarantine period. 4. Providing intelligent after-care for women and girls on release from quarantine with a constructive plan in view for restoring them to society as useful members. 5. Psychological and psychiatric examination of all prostitutes entering the police court and quarantine ward.[*C D A in Cincinnati*] BOARD OF DIRECTORS Dr. William S. Keller, President. Dr. E. W. Mitchell, Vice-President. Dr. Ruth Bernheim, Vice-President. Dr. Elizabeth Campbell, Secretary. Mr. Alfred S. Brown, Treasurer. Dr. A. C. Bachmeyer Miss Lillian Bowie Dr. C. J. Broeman Mr. Eugene R. Buss Mr. Charles R. Hebble Dr. Frances J. Iliff Dr. Frank W. Johnson Miss Annie Laws Miss Anna E. Logan Dr. C. P. McCord Rev. Jos. Reiner, S. J. Mr. Edwards Ritchie Mr. Ralph F. Rogan Mr. Jerome M. Sturm Mrs. Helen T. WoolleyUNITED STATES PUBLIC HEALTH SERVICE RUPERT BLUE, SURGEON GENERAL A STATE-WIDE PLAN FOR THE PREVENTION OF VENEREAL DISEASE BY ALLAN J. McLAUGHLIN Surgeon United States Public Health Service Commissioner of Health of Massachusetts REPRINT No. 455 FROM THE PUBLIC HEALTH REPORTS FEBRUARY 22, 1918 (Pages 223-237) WASHINGTON GOVERNMENT PRINTING OFFICE 1918A STATE0WIDE PLAN FOR THE PREVENTION OF VENEREAL DISEASE.1 BY ALLAN J. McLAUGHLIN, Surgeon, United States Public Health Service, Commissioner of Health of Massachusetts. In order to secure the greatest number of effectives in the selective draft, the prevalence of venereal disease in the civil population must be reduced. It is not necessary to discuss the reasons for a vigorous campaign for the control of venereal disease at this time. The reasons are too obvious and well recognized. The tremendous social and economic losses resulting from these diseases in times of peace are multiplied by the extraordinary conditions arising out of the world war. Furthermore, the winning of the war demands that these diseases be controlled in the entire civil population to insure the protection of the industrial army as well as that of the soldiers and sailors. To accomplish this it is not sufficient to inaugurate the campaign in the camps and a limited zone about the camps, but the control measures should include the larger cities and all parts of every State in the Union. The successful campaign against these diseases necessitates a complex program. 1. Moral, social, and economic phases in which the health officer can assist but which are best directed by other agencies. 2. That portion of the suppressive program which is directly under the control and within the powers an duties of the health officer. There is no part of this program in which the health officer is not interested. He has an obligation to devote his best efforts to securing results, but special activity is desired at this time in that portion of the program directly under his control. In putting any comprehensive plan into effect it is wise to do those things which may be done at once without special law or ordinance. Time is required to secure legislative authority, and this time should be employed in establishing certain fundamentals upon which the entire campaign is based. MEASURES WHICH REQUIRE MONEY BUT NO ADDITIONAL LEGISLATURE. (1) Establishment of free diagnostic facilities. (2) Establishment of free treatment facilities. If free diagnostic and treatment facilities are available thousands of carriers can be treated and made noninfective without compulsion 1 Reprint from the Public Health Reports, vol. 22, No. 8, Feb. 22, 1918, pp. 223-237. 47063° - 18 2 PLAN FOR PREVENTING VENEREAL DISEASE 3 of any kind. The first step necessary is to secure sufficient money to enable the State to furnish free diagnostic facilities and to secure the establishment of a chain of venereal dispensaries. This includes the manufacture or purchase of arsphenamine for free distribution. As a war measure it is possible in practically all States to secure money for a venereal disease campaign as a part of a nation-wide patriotic effort to increase the efficiency of the fighting forces. Diagnostic Facilities. There should be a State Wassermann laboratory, and in large cities branch laboratories may be utilized. A central Wassermann laboratory secures, by the greatly increased number of specimens examined, a much lower cost per test and much greater accuracy. The diagnostic facilities should include the simple laboratory equipment to be mentioned later in connection with the venereal dispensaries. Venereal Dispensaries. A chain of venereal dispensaries should be established, placed in such a manner as to furnish treatment facilities for the entire State. Sufficient money must be secured to enable the State to assist in the maintenance of these dispensaries, by furnishing free arsphenamine, and about $1,000 for each clinic for clerical or other expenses. On this basis it should be possible to establish these dispensaries preferably in connection with existing institutions, in order to "camouflage" the venereal clinic itself. These dispensaries should serve as centers to safeguard the distribution of arsphenamine, and State arsphenamine should be issued only through such dispensaries. Massachusetts recently adopted minimum standards for clinics for venereal disease control. These standards were prepared by the writer and are presented here in detail as an illustration of the dispensary method in the program for such control. MINIMUM REQUIREMENTS FOR ADMISSION OF VENEREAL DISEASE CLINICS OR DISPENSARIES TO LIST OF CLINICS SERVING AS DISTRIBUTORS OF ARSPHENAMINE FOR STATE DEPARTMENT OF HEALTH. (STATE APPROVED VENEREAL DISEASE CLINICS.) 1. Maintenance. - It shall be maintained directly by Government or municipality or receive written indorsement of municipal health authorities and the mayor. 2. Serve as distributing center for "arsphenamine." - It shall be a center for the distribution of State department of health "arsphenamine" (under such conditions as are outlined in memorandum on distribution of arsphenamine). 3. Management.- (a) If combined clinic for gonorrhea and syphilis, executive management of the clinic shall be vested in the "medical chief of the clinic" who shall be designated as the agent of the State department of health for the distribution of arsphenamine. (b) If separate departments treating gonorrhea and syphilis are maintained, under the executive management of an institution, some medical executive officer of the institution must be designated as agent of the State department of health for the distribution of arsphenamine.4 PLAN FOR PREVENTING VENEREAL DISEASE. 4. Clinic hours. - Clinics must be open at least three times a week and must provide at least one evening clinic period per week. 5. Chief of clinic. - The chief of the clinic shall be a qualified physician familiar with all modern laboratory and clinical diagnostic methods, experienced in the treatment of venereal diseases, and possessing the professional confidence of the medical profession of his vicinity. He shall agree in writing to carry out the duties required of him as agent of the State department of health for distribution of arsphenamine, and he shall be otherwise acceptable to the State department of health. 6. Staff. - The staff other than the "chief of the clinic," shall be adequate in number and training to furnish medical, surgical, nursing, laboratory, follow-up, and clerical service commensurate with the attendance of each clinic. 7. Laboratory service. - Dispensary laboratory service shall comprise at least facilities for microscopic examination for the organisms of syphilis and gonorrhea and for usual microscopic and chemical examination of urine. Wassermann tests shall be made at an approved Wassermann laboratory. 8. Equipment. - The location, rooms, instruments, apparatus, etc., shall be satisfactory to the State department of health. 9. Records. - Adequate records shall be kept of all cases applying for diagnosis or treatment as well as laboratory and follow-up records of the use or distribution of arsphenamine. 10. Hospital affiliations. - Each State-approved venereal-disease clinic shall have at its disposal, in the same or a near-by institution, beds for isolation or treatment of cases needing the same. 11. Educational or preventive measures. - The clinical staff shall devote sufficient time to adequately inform all patients as to the seriousness of venereal infection and the measures necessary to prevent infection of others, and shall supplement verbal instruction by furnishing approved literature. 12. Financing of clinics. - Approved venereal clinics may be either free clinics or "pay clinics," but if pay clinics they shall not refuse or discriminate against any patients referred or offering themselves who are unable to pay a fee. No charge shall be made for arsphenamine. These dispensaries should be established only in large cities, located strategically, in order to serve a wide area. The question of whether they shall be "free" or "pay" clinics should be decided locally. The self-sustained or partially self-sustaining pay clinic with a low fee and free treatment given to those unable to pay is preferable. The following instructions for the guidance of district health officers were issued in regard to distribution of State arsphenamine: ON THE SUPPLYING, DISTRIBUTION, AND UTILIZATION OF ARSPHENAMINE AND METHODS OF ACCOUNTING FOR SAME. 1. Emphasize (a) That the supply of arsphenamine is primarily to render cases of syphilis noninfectious. (b) That the State is furnishing the equivalent of many thousand dollars assistance in supplying arsphenamine. 2. The "approved clinics" shall serve as centers of distribution of arsphenamine for the "area" assigned by the State department of health to the clinic. Exception. - Arsphenamine for State institutions shall be furnished directly, when supply s available, from the control office of the State department of health. 3. The "chief of the clinic" shall be the agent of the State department of health for the distribution of arsphenamine. PLAN FOR PREVENTING VENEREAL DISEASE 5 4. Ledger accounts shall be kept with each "clinic" and the "chief of the clinic" shall be charged with each dose, identified by serial number furnished to his clinic. 5. So far as the supply of arsphenamine is available, the "chief of the clinic" shall utilize arsphenamine in the following order of priority: (a) For patients attendant upon the clinic in infective stage. (b) For patients in infective stage in "approved" hospitals, asylums, or institutions other than in in State institutions, located within the clinic area. (c) For patients in infective stage under care of practitioners within the clinic area. (d) For patients in noninfective stages, whether "clinic" patients, institutional patients, or patients under the care of private practitioners, in whatever order or sequence may appear best in the discretion of the "chief of the clinic." 6. All arsphenamine utilized, whether within or without the clinic, shall be identified by serial number, and reports of use made thereupon on a form furnished for that purpose. 7. The question of need for arsphenamine shall be determined as far as possible by confirmatory Wassermann test. In noninfective stage, Wassermann positive tests are to be obtained before the arsphenamine is used. 8. Hospitals and other institutions within each clinic "area" shall become "approved" institutions for utilization of arsphenamine after satisfying the "chief of the clinic" as to professional qualifications and familiarity with the special technique for the administration of arsphenamine of the medical staff of such institutions assigned to administer the same, determined by consultation with the "chief of the clinic," and agreeing to furnish reports of treatment of syphilis. 9. Private practitioners must satisfy the "chief of the clinic" as to their practical experience and familiarity with the technique of its administration before receiving arsphenamine for administration in private practice. 10. No fee for arsphenamine shall be charged under any circumstances. The "chief of the clinic" may, at his discretion, at any time discontinue the privilege of receiving arsphenamine itself, for failure to submit reports of treatment or Wassermann tests, or otherwise abusing the privilege of receiving arsphenamine. 11. Monthly the "chief of the clinic" shall forward to the State department of health a report on the doses of arsphenamine given at the clinic and furnished to institutions and physicians within the "clinic area." The following instructions were given to Massachusetts district health officers to aid them in securing the establishment of approved clinics: ON METHODS OF ESTABLISHING "APPROVED CLINICS." 1. No general method can be laid down. The district health officer is expected to exhibit initiative and energy in stimulating the early establishment of such clinics in the cities selected. He must study local conditions and make such concessions or modifications of the procedure outlined in these memoranda as in his judgment are necessary in individual instances, as long as he can be assured that the spirit of the minimum requirements is complied with. 2. The following groups should be interested and their support enlisted: (1) Local board of health. (2) Local medical profession. (3) City officials, especially the mayor. (4) Local committee on public safety. (5) Large manufacturers. (6) All organizations interested in public health. (7) Religious bodies. (8) Chambers of commerce, boards of trade, etc. (officially).6 PLAN FOR PREVENTING VENEREAL DISEASE. (9) Hospital management and boards. (10)Local district nursing organizations (11)All individuals and organizations whose homes have been furnished by the council of National Defense. (12)Local druggists' organizations. (13)The press (at least sufficient to insure that no antagonistic publicity is started through misunderstanding). (14) Educators. (15) Labor organizations (reasons same as the press). This part of the program also calls for energetic measures on the part of the district health officer. 3. In case an energetic local campaign of education seems necessary as a preliminary to successfully launching an "approved clinic," the district health officer should not hesitate to inaugurate such a campaign. Remember, you can get for the asking direct telegraphic indorsement from the War Department and the Council of National Defense, and can readily obtain by preliminary arrangement forceful speakers from the War Department, the Massachusetts Association for the study of Venereal Dis- eases, and from other bodies as women's section, Council of National Defense, Massachusetts Commission on Insane, Massachusetts Mental Hygiene Society, and other organizations. 4. If difficulty occurs in obtaining a man qualified to serve as "chief of clinic," performing both executive and clinical duties, or as chief clinician under a "chief of clinic," performing only executive duties, the Boston Dispensary will furnish facilities for intensive training for physicians wishing to qualify in specialty. 5. In general urge establishment of clinics as a national duty and as a war measure; insist that they be started on a high ethical plane, not as a traditional "clap clinic"; feature their function as educational and preventive centers; strive to affiliate with hospitals where possible to better "camouflage" cause of attendance. 6. If moral issue is raised in opposition to scheme, emphasize the well-established fact, determined by the finding of British authorities that the innocent sufferers from venereal infection form an actual majority. 7. If objection is raised from medical sources on the ground of loss or revenue, emphasize that the qualified medical profession, both of ethical and "advertising" character, is estimated at the outside to treat only 30 to 50 per cent of the total venereal infection-the remainder fall into the untreated, self-treated, and drug-store treated classes. 8 If objection is raised to the scheme locally- (a) From the standpoint of general skepticism of the urgency of the problem and the need for action, quote such facts as the statistics of the Council of National Defense as to the comparative frequency of venereal infection in freshly drafted men and regulars. (b) On the grind of expense involved in view of the extraordinary war-time public expenses, quote much conclusion as that of the British Royal Commission on Venereal Diseases, arrived at after a most exhaustive study in a country war-burdened to a degree this country can not yet comprehend, which says: "That the conditions now existing and those which must follow on the conclusion of the war imperatively require that action should be taken without delay. We realize the claims of economy at the present moments, but we believe that all necessary expenditure will be recouped by the results which can be obtained. "No short-sighted parsimony should be permitted to stand in the way of all the means that science can suggest and that organization can supply for guarding present and future generations upon whom the restoration of national prosperity must depend..." PLAN FOR PREVENTING VENEREAL DISEASE 7 Further instructions were given to district health officers on the following points: (1) Minimum equipment for dispensaries. (2) Cost of equipment and maintenance (3) Supervision.^ 1 Certain instructions given to district health officers in regard to policy may be helpful: ON CERTAIN POLICIES TO BE EMPHASIZED AND THOROUGHLY EXPLAINED. To a considerable degree these have been touched upon in various memoranda, but it is desired here to call to the attention of the district health officer the need for a reasonably uniform departmental policy to be followed by them in establishing clinics. It is intended that the district health officer will only modify these policies if he is certain that such modifications are necessary or desirable to insure the success of a given clinic. 1. Emphasize preventive functions of clinics, and in doing so point out that clinics can be made powerful preventive agencies in two distinct ways: (a) By the direct benefit of lessening foci of infection, and (b) By the correlation of repressive, correctional, and educational methods with the routine activities of the clinic. 2. Explain clearly the relationship of the "clinic" to the "clinic area." Under this head particular attention should be paid to explaining the purposes of the clinic and the methods of arsphenamine distribution, to the local boards of health, management of institutions and medical profession located outside of the municipality but within the "area" 3. Relationship of clinics to hospitals. Whether the clinic is maintained as an integral part of a general hospital or not, the district health officer should devote special attention to the problem of obtaining bed facilities for patients coming under the care of the clinic who need temporary hospital care. Another feature that will require careful explanation from the beginning will be to make the hospital and other institutional managements understand that they are not entitled to arsphenamine and libitum by virtue of being hospitals, that they are under the same relationship to the "chief of clinic" as private practitioners and must satisfy him as to the ability to handle the product safely, and are to use it primarily for infectious cases and are to receive it for administration of other cases only in event of the supply being more than sufficient for all infective cases within the "area." 4. Relationship of clinics to medical profession. The success of the "clinics" will depend more upon the sympathetic cordial support of the medical profession of the city and "area" than upon any other factor outside of the immediate management of the clinic. It is, therefore, highly essential that the support of the medical profession be obtained. This means practically an educational campaign among physicians. Each district health officer should inaugurate this at once, and push it at every opportunity. After the clinic is inaugurated, practitioners should be urged to utilize it and should be made to feel that it is their clinic. They should be told frankly from the outset that the full success of the clinic may means a certain loss of revenue to them, but it should also be emphasized what a small percentage of venereal cases are now being handled by the qualified practitioners of medicine, and they should be urged to support the clinic as a measure designed; first of all, to reach the untreated or maltreated venereal case. 1 Details of these instructions are omitted, but if desired may be secured by addressing the State commissioner of health, State House, Boston, Mass.8 PLAN FOR PREVENTED GENERAL DISEASE. Every practitioner in the "area" should have clearly explained by the district health officer, after the clinic is once begun, the relationship of the clinic management to the distribution of arsphenamine, and that special facilities for diagnosis, consultation, and treatment are open to him. A system whereby the practitioner can refer patients, whom he does not wish to turn over permanently to the clinic for treatment, for limited or special treatment, administration of arsphenamine for example, and have them referred back to him at the end of such special treatment, should be worked out jointly by the district health officer, representative of the local medical society, and each "chief of clinic." Practitioners should be encouraged to seek consultation either at the clinic or in the office of the practitioners respecting any case of suspect venereal disease under their care. Every practitioner within the "area" should clearly understand that he can obtain laboratory assistance for any case of his, gratuitously, through the clinic. Each clinic should be an active Wassermann station and should make it easy for physicians to utilize the serviced of State or other "approved" Wassermann laboratory. Attendance of physicians other than the regular staff at the clinic should be encouraged after the clinics are well established, but care will always have to be exercised, especially in small cities and at pay clinics, to see that attendance of physicians other than the regular staff does not tend to decrease the attendance of the clinic. One great advantage of having several consultation rooms and an entrance to consultation rooms other than directly through the patients' waiting room is that thereby it is possible for any physician to attend and see patients he has referred to the clinic without seeing other patients, It is very desirable that as far as circumstances will permit the patients' privacy should be respected. 5. Minimum assistance.-In making efforts to get clinics launched, sacrifices any nonessentials, but make up your own mind as to the minimum staff neccessay to insure proper handling as patients at any given clinic and then insist that the minimum staff be provided. The following would seem to be a minimum staff for the smallest area: One "chief of clinic," One medical assistant, [one or both covering laboratory service.] One qualified nurse, who is nurse, follow-up worker, and clerk. Janitory service. 6. The relationship of the chief of clinic to the district health officer must be particularly close and harmonious one to realize the full possibilities of the clinic scheme. He should have a free hand and not be hampered as to details, On the other hand, he should be given clearly to understand from the beginning that when he wishes to bring anything up to the State department of health, he does not need to go any further than the district health officer to obtain all the assistance, advice, and direction that the department can give. Conversely, the district health officer should at all times being promptly to the attention of the "chief of clinic" any and every suggestion, whether critical or commendatory, that comes to his attention. The district health officer should make it one of the prime objects of his work not only to continually keep the purposes and possibilities of the clinics before the medical profession o the"area," but also should call the same clearly to the attention of officials and others whom work is of such a character that they could utilize the services of the venerael clinics. Included in this group should be police authorities, almoners and oversees of the poor, prison physicians and chaplains, Y. M. C. A. officials, officials of the draft law, officials of rescue societies, and the like. Personnel of dispensary.-The possibility and qualifications of the chief of clinic are the most important factors in the success of the entire veneral clinic scheme. PLAN FOR PREVENTING VENEREAL DISEASE. 9 The ideal arrangement is to have hum combine general executive function-i. e., management of personnel, supervision of finances, duties as distributer of arsphenamine, etc.-with the functions of the clinical specialist. In most cases, this arrangement will be possible and is in all ways to be desired and urged from the standpoint of avoiding friction, divided responsibility, delays, and questions of divided authority over clinical staff and clerical staff. In all instances the chief of clinic must enjoy the confidence of the medical profession of his vicinity. The solution of all-important question of obtaining hearty cooperation and support from the medical profession of the city and "area: will depend upon him and the district health officer more than upon all other interested persons combined. As official referee and distributor of arsphenamine, he must be a man of discretion, judicial temperament, and without prejudices or favorites, and not capable of being intimidated by any influences, Often he must refuse arsphenamine, and it is all essential that he make each refusal as far as possible so unmistakably based on sound grounds of best public policy that the refused party will see the reasonableness of his stand. If he is also the chief clinician, he must be thoroughly grounded in the technique of best modern methods of diagnosis and treatment. Above all he must be a man who is interested in the preventive and educational possibilities of his clinic, and in heart sympathy with the State department of health's policy of developing the clinics to the point where the chief clinician will actually and efficiently lessen the total incidence of venereal disease in his area, If the object is not constantly keep in mind and every effort put forth to make its accomplishment a reality, all work is in vain. Furthermore, he must be a man who can appreciate the vital importance of keeping records and of enforcing business like methods of administration in all manners pertaining to the routine work of the clinic. Medical and surgical staff.-The number of persons on the medical and surgical staff will vary with the size of the clinic, but the all important point is that at least one, either the "chief of clinic" himself or, if he does not perform clinical duties, the chief assistant (or assistants, if the distinct department for gonorrhea and syphilis are maintained(, shall possess special experiences with venereal diseases, and a thorough knowledge of modern methods of diagnosis and treatment sufficient to I've him without question an authoritative position in such matters. Physicians of the vicinity should be encouraged to make application as temporary assistants with or without pay for the purpose of familiarizing themselves with modern methods of diagnosis treatment; but the regular medical and surgical staff should in all instance receive compensation sufficient to represent a fair monetary return, judged by local standards, for the time devoted to the clinic, and to effect the potential loss of emergency revenue from private practice due to attendance at fixed hours at the clinic. The duties of the medical and surgical staff should include educational work with patients, making of necessary clinical records and reports, taking and transmitting material for laboratory examination and demonstrating the best method of diagnosis and systematic treatment to physicians. Consultatons.-Consultation work by the "chief of clinic" or his clinical assistants with practitioners of the "area" should be encouraged, but clearly defined policies should be laid down dor each area and generally understood and agreed to by the local profession as to the circumstance under which consultation outside of the clinic should be gratuitous or "pay" consultations. It is advisable to have a fee scale definitely fixed in advance. Nursing staff.-The nursing staff of the clinic may often be satisfactorily filled by one female nurse reporting only at certain hours for female clinics. The nurse may 10 PLAN FOR PREVENTING VENEREAL DISEASE. be utilized for the taking of female histories advantage. The advisability of obtaining a male nurse or "orderly" as assistant will depend on local conditions. Laboratory staff.-The laboratory staff will depend largely upon the size of the clinic. Outside the largest clinics, a separate laboratory staff probably will not be needed/ The clinical staff in the similar clinics should do ordinary direct microscopic and urinalysis laboratory work. Wassermann, in most instances, will be outside the clinic in the State or other approved Wassermann laboratories. "Follow-up staff."-The development of a scientist yet "human" follow-up system is perhaps the most characteristic feature of the "modera" venereal dispensary, and marks it off most sharply from the policies, procedure, and results of the traditional "clap clinic." The principal functions will be: (a) Supervision of the prostitute patient, including enlistment of the sympathies and support of social betterment agencies for the deserving case. (b) Establishment of good "team work" with the police and reformatory agencies for the purpose of the suppression of the incorrigible type, or at least their temporary isolation for at least a period sufficient to insure their treatment to the point where they cease to the spreaders of infection. (c) Looking up validity of reports from patients as to sources of infection. (d) Enlisting cooperation of employers of labor to encourage utilization of the services of the clinic. (e) Checking up the mentality of prostitute patients and enlisting the assistance of proper authorities in cases of those deserving special handling as mental deficient. (f) Keeping track of "parole'" patients of both sexes. (g) Looking up patients still in need of treatment who fail to report at the clinic. In some clinics the services of a full-time specially trained "follow-up" worker will be needed. In others, various part-time adjustments will be necessary. Clerical staff.-One full-time clerical assistant will be needed in most clinics to keep up records properly, and to be available to receive requests and requisitions for arsphenamine, laboratory containers, to make appointments for the "chief of clinic," answer the telephone, etc. It is advisable to arrange if possible that State department of health money be directly utilized to provide for clerical service. Clerical service need not be full eight hours per day nor every day in the week, but should have definite hours, well known to local medical profession, 8o that arsphenamine can be furnished according to the direction of the "chief of clinic " at reasonably convenient and frequent periods. A possible combination of functions, that might prove very satisfactory in smaller clinics would be the full-time employment of one graduate nurse with social service or public health nursing experience, and have her attend female clinics, act as clerk of clinic, keeping regular office hours for that purpose, and devote the remainder of her time to follow-up work. Control of Prostitutes for Treatment. Prostitutes are recognized as the most prolific source of general disease. It is possible to do much in the suppression of prostitution by enforcement of existing laws and ordinances, It may be possible in some cities and States to secure more drastic laws for control of and elimination of this source of infection. It is certain that in many cities by enforcement of existing laws and especially by an arrangement securing the cooperation of health officers, police authorities, and city magistrates, control of thousand of prostitutes. PLAN FOR PREVENTING VENEREAL DISEASE. 11 for purpose of treatment and their elimination as carriers can be effected, Preliminary to this arrangement a proper venereal dispensary and a sufficient number of beds for hospitalization must be available, It is certain that in may States the carrier material in the person of prostitutes available for treatment under existing laws far exceeds the facilities for treatment, This lack is especially marked in hospital facilities. Educational. Lectures should be given by male lecturers before men's and boys' clubs and organizations, industrial groups and labor unions, fraternal and professional groups; and by female lecturers before women's clubs, groups, and organizations, employing lantern slides, moving pictures, and other devices or exhibits. Placards should be placed in public lavatories, barber shops, railroad stations, and other places where men congregate, and pamphlets should be distributed, especially to the groups mentioned in the preceding paragraph. MEASURES WHICH REQUIRE LEGISLATION In addition to the measures which probably do not require legislative authority beyond the granting o appropriations, there are certain necessary measures for which legislation should be secured. (1) Reporting of venereal diseases. (2) Elimination of quacks and charlatans. (3) Prevention of treatment by drug clerks. (4) Examination and treatment of prisoners. None of these measures are here discussed in detail. Reporting of Venereal Diseases. In Massachusetts no additional legislation was necessary, the State department of health having general authority to add to the list of reportable diseases. The following letter was sent to all physicians: GENTLEMEN: Inclosed herewith are advance copies of the regulations adding gonorrhea and syphillis to the list of reportable diseases. This department has studied the question of reporting gonorrhea and syphillis for the last two years ad sought all information possible on the subject. The method adopted by these regulations is in substance that known as the "West Australian" method of handling venereal diseases-so called because first adopted by the State of West Australia. Because of their peculiar character any scheme for the reporting of gonorrhea and syphilis encounters difficulties which are not shared by other communicable diseases. Requiring reporting by name would be inoperative to a great degree, The alternative course is reporting by number, initials, etc. Up to a certain point the "West Austrailian" method has this anonymous feature, but with the proviso that when an actively infected patient fails to continue treatment, it becomes the duty of the physician to report the name and address of the patient.12 Plan For Preventing Veneral Disease. When the name is reported the State department of health will report it to the local board of health having jurisdiction. There it is incumbent upon the local boards of health to adopt some amendments to their rules and regulations as may seem advisable to them for the control of such cases. It is easy to criticize features of this system, but it seems to be working in many parts of the world than only other scheme that has yet been bought forward for the reporting of venereal diseases. The State department of health will be glad to send on requisition to the board of health of any city or town at weekly or monthly intervals the statistical information obtained through the original anonymous reports from that city or town. This department relies confidently on the hearty cooperations of the local boards of health in making a success of this most important war measure. The following forms are self-explanatory and illustrate the method of reporting: Special Regulations Governing The Reporting Of Venereal Diseases Promulgated By The Massachusettes State Department Of Health. WAR MEASURE Commonwealth of Massachusetts State Department of Health. Gonorrhea and Syphilis Added to List of Reportable Diseases. Effective February 1, 1918. Reports to be in conformity with special regulations direct to State department of health. Special regulations governing the reporting of these diseases are given herewith. Note carefully that all reports of gonorrhea and syphilis are to be made direct to the State department of health, statehouse, Bostom, and not to local boards of health, as in the case of all other diseases dangerous to the public health. The State department of health, at a meeting held December 18, 1917, voted, that the list of diseases declared dangerous to the public health be further amended by adding gonorrhea and syphilis so that the said list now reads as follows: Aetinom yeosis German measles Pneumonia (lobar only). Anterior poliomyelitis Glanders Rabies Anthrax Hookworm disease Scarlet fever Asiatic cholera Infectious disease of the eye: Septic sore throat Chicken pox (a) Ophthalmia neo Smallpox Diphtheria (b) Sup. conjunctivitis Tetanus Dog bite (requiring antribic (c) Trachoma Trichinosis treatment) Lepresey Tuberculosis (all forms) Dysentery: Malaria Typhoid fever (a) Amebie Measles Typhus fever (b) Bacillary Mumps Whooping cough Epidemic cerbrospinal menin- Pellagra Yellow Fever gitis Plague Reportable to local boards of health in accordance with the provisions of sections 49 and 50, chapter 75. revised laws, And Gonorrhea, Syphilis, reportable to State department of health direct, under authority of chapter 670. Laws of 1913, in accordance with the special regulations herewith promulgated. Regulations Governing The Reporting of Gonorrhea and Syphilis 1. Gonorrhea and syphilis are declared diseases dangerous to the public health, and shall be reported in the manner provided by these regulations promulgated under the authority of chapter 670, Laws of 1913. 2. Gonorrhea and syphilis are to be reported (in the manner provided by these regulations) on and after February 1, 1918 3. At the time of the first visit or consultation the physician shall furnish to each person examined or treated by him a number circular of information and advice concerning the disease in question, furnished by the State department of health for that purpose 4. The physician shall at the same time fill out the numbered report blank attached to the circular of advice, and forthwith mail the same to the State department of health. On this blank be shall report the following facts: Name of disease.................................| Martial condition and occupation of the patient.... Age........................................................| Previous duration of disease and degree of infec- Sex.........................................................| tiousness...................................... Color......................................................| 12 Plan For Preventing Veneral Disease. The Report Shall Not Contain Name or Adress of Patient. 5. Whenever a person suffering from gonorrhea or syphilis in an infective stage applies to a physician for advice or treatment, the physician shall ascertain from the person in question whether or not such person has previously consulted with or been treated by another physician within the Commonwealth and has received a numbered circular advice. If not, the physician shall give and explain to the patient a numbered circular advice and shall report the case to the State department of health, as provided in the previous regulation. If the patient has consulted with or been treated by another physician within the Commonwealth and has received the numbered circular of advice, the physician last consulted shall not report the case to the State department of health, but shall ask the patient to give him the name and address of the physician last previously treating said patient. 6. In case the person seeking treatment for gonorrhea or syphilis gives the name and address of the physician last previously consulted, the physician then being consulted shall notify immediately by mail the physician last previously consulted of the patient's change of medical adviser. 7. Whenever any person suffering from gonorrhea or syphilis in an infective stage shall fail to return to the physician treating such person for a period of six weeks later than the time last appointed by the physician for such consultation or treatment, and the physician also fails to receive a notification of change of medical advisers as provided in the previous section, the physician shall then notify the State department of health, giving name, address of patient, name of disease and serial number, date of report and name of physician originally reporting the case by said serial number, if known. 8. Upon receipt of a report giving name and address of a person suffering from gonorrhea or syphilis in an infective stage, as provided in the previous section, the State department of health will report name and address of the person as a person suffering from a disease dangerous to the public health and presumably not under proper medical advice and care sufficient to protect others from infection to the board of health of the city or town or patient's residence or last known address. The State department of health shall not divulge the name of the physician making said report. Notification Blank From Physician to Another Physician Who Formerly Treated The Patient. ...............................................................................Mass., ......................................................................191... Dr.................................................................................... Street address (if known)............................................ .......................................................Mass. Dear Doctor: In accordance with section 6, Regulations Governing Reporting of Veneral Disease, I herewith notify you that..........................................................................................., (Name of patient) of...........................................................having serial number...................................................., (Address.) circular of instructions for prevention of.............................................., formerly treated by you, has now placed himself under my care and treatment. Respectfully, yours, ....................................................................M.D., .................................................................................... (Address) Notification Blank From Physician Reporting Name of Patient Who Failed to Continue Treatment ...............................................................................Mass., ......................................................................191... State Department of Health, Division of Communicable Disease, State House, Boston, Mass. Gentlemen; This is to notify you that...................................................................................., (Name of patient) of..............................................................................................................originally reported by (Address of patient.) ..........................................................................as serial number........................................191., (Name of physician) (Give, if known) who has been under my care for treatment for.................................in the infective stage (Specify gonorrhea or syphilis) has not reported to me for six weeks following date of his last appointment with me, nor have I received any notification from another physician that he has placed himself under his professional care. I am therefore reporting his name and last known address in accordance with section 7 of the Special Regulations of the State Department of Health Governing the Reporting of Gonorrhea and Syphilis. Sincerely, yours, ................................................M.D., ...............................................Street, ...............................................Mass. 14 PLAN FOR PREVENTING VENEREAL DISEASE. CIRCULAR OF INSTRUCTIONS WHICH PHYSICIAN MUST FURNISH TO EACH PATIENT WITH VENEREAL DISEASE. COMMONWEALTH OF MASSACHUSSETS A FEW FACTS ABOUT SYPHILIS ISSUED BY THE MASSACHUSSETS STATE DEPARTMENT OF HEALTH, STATEHOUSE, BOSTON. Keep - Read carefully and often - Remember your number. 1. Syphilis, also known as "pox," "blood disease," etc., is a serious contagious disease, slowly acting, which may affect all parts of the body. 2. Syphilis is caused by a minute germ, which can only be seen with a powerful microscope, which circulates through the blood and attacks every organ in the body if unchecked by proper treatment. 3. Syphilis is usually but not always transmitted by sexual intercourse. 4. Syphilis always begins by the germs entering the body through a break or abrasion of the skin or of the lining of the mouth or sexual organs. This abrasion may be so small that it cannot be seen. 5. Syphilis always begins with the local sore which develops at the spot where the germs penetrate. The germs grow slowly at first and from two to eight weeks may elapse before the sore appears. This initial sore, pimple, or ulcer is usually painless and is called a "hard chancre" or the first stage. 6. Syphilis gradually develops after the chancre has apparently been cured. Skin rashes, sores in mouth, swelling of glands, fever, deep pains in bones, sore throat, falling out of hair, are some of the most frequent symptoms of this stage. Any one or more of these symptoms may occur. This is known as the second stage. 7. Syphilis, when untreated, may appear to be cured spontaneously after the second stage, but it is not. It remains in the blood and the deep parts of the body. . The germs will lie quiet sometimes for years and then suddenly produce the terrible effects known as the third stage. They will slowly destroy the brain, nerves, bones, blood vessels, etc. Locomotor ataxia, paralysis, paresis, or softening of the brain, and some forms of apoplexy, are a few of the later effects of untreated syphilis. They may come on as late as 29 years after the original "chancre," but are all part of the same disease and caused by the same germs. 8. Syphilis, when uncured, may also be transmitted to unborn children through either father or mother. It is one of the greatest causes of miscarriages, children being born dead, and of weak, sickly children. When born alive, these babies often spread the disease, as their syphilis is very contagious. 9. Syphilis is extremely contagious in the first and second stages. 10. Syphilis is most easily cured in the first or "chancre" stage, is readily curable in the second stage, and may be greatly improved in the third stage. 11. Syphilis in all stages requires long thorough treatment by special remedies to insure a cure. Certain laboratory tests, especially the one known as the "Wassermann test," are of great assistance in determining when the disease is cured. 12. Syphilis can be accidentally transmitted during the first and second stages and from babies with congenital syphilis in a great variety of ways, by kissing, by articles accidentally contaminated with secretions from the sores, as towels, pipes, drinking glasses, eating utensils, etc. 13. Syphilis affects most public and clandestine or secret prostitutes. It can be best prevented by avoiding all chance of infection. 14. Syphilis can be cured, but not in a week or a month at any stage. A person with syphilis must be sure he is getting competent treatment and then stick to it a long time, until the "blood tests" and his physician say he is cured. PERSONAL ADVICE TO PATIENT. 1. Do not forget your disease may be communicated to others by contact other than sexual intercourse. 2. It may be transmitted by any of the secretions of the body, but more especially by blood or blood serum coming from raw mucous surfaces, such as cracked or sore lips, mucous patches in the mouth and throat, discharges from syphilitic ulcers and sores. 3. Never permit the slightest opportunity for other persons to come in contact with any of these secretions. 4. To avoid this, follow these rules: (a) Until the acutely infectious stage is passed and permission is given by the physician, you should have individual drinking cups and eating utensils. These should be sterilized by boiling after each use. Never use public drinking cups. (b) Tooth-brushes and containers of pastes, powders, or mouth washes used in caring for the teeth should be kept in separate containers or compartments where no opportunity for contact with others is possible. Brush teeth night and morning (or better, after each meal) and keep mouth clean. If you have bad teeth have them attended to by a dentist. Be fair to him and his next patient by telling him you have syphilis, so he may take precautions and not infect others. (c) Use no razor or other articles used in shaving except your own, and permit no other person to use your shaving outfit. Shaving in a public barber shop is prohibited for one year after beginning of infection. (d) Basins, lavatories, and bathtubs should be washed out thoroughly with soap and hot water after each use by you. Separate basins are to be used whenever possible. The use of public bathtubs is prohibited. (e) You should use individual towels. (f) Handkerchiefs and clothing, especially underclothing, which may by soiled by secretions, should be laundered separately, or if impracticable, they must be immersed in boiling water or an approved antiseptic solution, as advised by the physician, before being added to other laundry. (g) All dressings of sores or ulcers must be burned or otherwise destroyed. Never leave them where they are accessible to flies. (h) Never kiss others or permit them to kiss you. (i) Sleep alone and practice continence. Your physician will tell you good habits to improve your physical tone and hasten recovery. (j) Follow your physician's advice, and do not cease treatment until by every known laboratory method he has satisfied himself of your recovery, and assures you there is no longer danger of your transmitting the disease. (k) Do not be led astray by promises of hasty or permanent cure by falsely advertised remedies. Cheap cures make miserable lives and expensive funerals. You gain nothing but bitter experience by deceiving yourself, and you risk the injury of those nearest and dearest to you. Play fair with yourself and with others. 5. Consult your doctor at least once a month for two years. 15 PLAN FOR PREVENTING VENEREAL DISEASE IMPORTANT - READ CAREFULLY - FOLLOW INSTRUCTIONS IF YOU WISH YOUR NAME KEPT SECRET. You are given this circular of instructions with this serial number by your doctor because the law requires him to do so and to report your case to the State department of health by this number without revealing your name. If you change doctors for any reason and wish to keep your name concealed you must see to it that the doctor you last consult notifies the doctor previously having charge of your case within six weeks. If you fail to come for treatment at the time ordered by your doctor within the period in which your disease is infective and your doctor does not receive notice within six weeks from another doctor stating that you have placed yourself under his professional care, the doctor giving you this circular is obliged by law to report your name and address to the health authorities as a person suffering from a disease dangerous to the public health and presumably not under proper medical advice and care sufficient to protect others from infection. You will then be liable to quarantine or such other procedure as the board of health may determine. If you want your name kept secret follow these instructions carefully. Your doctor will tell you when your case is no longer infective. No.............. BLANK FOR FIRST REPORT OF CASE BY SERIAL NUMBER ONLY. No.... WAR MEASURE. Report of a case of syphilis COMMONWEALTH OF MASSACHUSETTS, STATE DEPARTMENT OF HEALTH. (Date)........ 191.... (City or Town)..........., Mass. Patient's age.......; sex.............; color............. Marital state - Married. Single. Widowed. Divorced.* Occupation (give specific character of occupation)........... Is occupation or sanitary surroundings at place of employment such that patient will be a menace to the health of others? ......... If so, what measures of precaution have you advised? .......................................................... Has your diagnosis been confirmed by laboratory tests? ............ If so, which? ................... Date of onset of disease...................... 191.... Signature of reporting physician................... M.D. Address of reporting physician........................... ........................ Mass. *Strike out works that do not apply, or draw circle about word indicated. INSTRUCTIONS TO PHYSICIAN. Tear off this slip. Fill out and mail to State Department of Health, State House, Boston, using enclosed addressed envelope. Instructions are to be given and explained to patient. The name of patient is not required. If patient can not read English and can read Armenian, Greek, Finnish, French, Italian, Lithuanian, Polish, Portuguese, Swedish or Yiddish, give patient serial numbered circular in English and request the State department of health to send you by return mail one or more copies of unnumbered translations of circular, specifying languages and number of copies of each desired. (See back of slip for ordering.) Elimination of Quacks. If State laws are insufficient, proper legislation should be secured to prevent the treatment of persons suffering from venereal disease by quacks. There is sufficient law in many States to effect this, and the laws should be vigorously enforced just as soon as the treatment facilities are made available by the establishment of venereal clinics. Prevention of Treatment by Drug Clerks. In preparing a comprehensive program for the prevention of venereal diseases in Massachusetts it was deemed necessary to ask the legislature to pass an act prohibiting druggists from dispensing any medicines for venereal diseases except upon the prescription of a physician. Since syphilis and gonorrhea have been declared diseases dangerous to the public health and made reportable, a druggist16 PLAN FOR PREVENTING VENEREAL DISEASE. has no more right to treat them than he has to treat smallpox, diphtheria, or scarlet fever. The fearful results of bad treatment, especially in gonorrhea, are attributable quite as much to the treatment of cases by drug clerks over the counter as to the activity of quacks and charlatans, and it is essential that the practice of treatment of venereal diseases by drug clerks be stopped at the earliest possible moment. Examination and Treatment of prisoners One other legislative measure should be passed, viz, requirement of medical examination and treatment of prisoners. Whatever excuse we may have for not securing the treatment and elimination of the carrier in the general population, we have not the slightest excuse for discharging from our jails and reformatories thousands of prisoners with venereal disease untreated and in many instances not even diagnosed or recorded. ADDITIONAL COPIES of this publication may be procured from the superintendent of documents government printing office Washington, D.C. at 5 CENTS PER COPY DO NOT DESTROY-- When you have no further use for this pamphlet give it to someone else.Reprinted from "The Shield." December 1919-January 1920. PROPHYLAXIS AND VENEREAL DISEASE BY DR. MARY GORDON (LONDON) A paper read before the International Conference of Medical Women, New York, October, 1919. Ladies and gentlemen, I must begin by making an apology to you. One the old programme I was put down or another subject, which I found, when I got here, was practically what we in England call notification of venereal disease. We have no such thing in our country, but I find that you have it. Therefore, I could only have engaged in an academic debate against people who could set me right. and I felt my position would be a poor one, and you would be so uninterested in anything I had to say that I asked the Committee to be kind enough to allow me to change the subject. They saw my point and allowed me to take the question of prophylaxis instead. Prophylaxis is a question that concerns us all, both in America and England. People are just proposing to us now, that we should adopt it for our general population. It is an extremely practical question about which everyone of us, both as citizens and as doctors, have to make up our minds, and I am really very much pleased that I had no time to get in my paper the other day. For one thing, I should not like to have followed so closely after Dr. Hooker's very brilliant paper on the same subject, and for another thing I am so glad to be speaking here to a number of people who are not doctors, but who are citizens, and who, I am sure, will appreciate equally with my doctor friends what I have got to say. (Applause.) Measures directed against the spread of venereal disease may be of many varieties. They may be scientific and up to date, that is, in harmony with the best and most modern theories - or the reverse. They may contribute to the establishment of public health - or they may not. They may advance the good of the world or retard it. I am only going to speak to-day of two well-known prophylactic measures which are really of the same order. Both measures have been tried in the various armies during the war. Both were, I believe, recommended by scientific men who had found them of value in their personal experience in preventing disease. The war is now over, and the reason I am drawing attention to them here is, that suggestions have been made that at any rate one of them should be introduced as a public measure for the protection of the civil population from disease. I do not think that, with this audience, I need go into detail as to the methods that were employed, and that are not recommended again; they are probably familiar to all of you. I will, however, remind you that the Prophylactic Packet (called in at least one army "The Blue Light Outfit") consisted of various medicaments and appliances which were provided for soldiers to use before exposure to infection, and also, in some cases, after exposure to infection. "Early Preventative Treatment" was given after exposure to infection2 PROPHYLAXIS AND VENEREAL DISEASE by skilled assistants wherever this was possible. It consisted in thorough cleansing and disinfecting with various antiseptics. In neither case was there a question of disease being actually present. Both treatments were directed to removing the possible consequences of a dangerous act of sexual intercourse by preventing the development of disease. Neither of these forms of treatment could lay claim to being new. Many forms of disinfection and attempts at protection have been known to prostitutes and their clients ever since disinfectants were invented. Many prostitutes use them, chiefly at the request of their clients, but they do not think much of them, and they know that they themselves are not really protected by them. They are afraid of them, especially of preparations of mercury, which are sometimes poisonous to them. I have heard that in America the idea if the "Prophylactic Packet" was not popular. It was not popular in England either. In England, some of the people who had most to say about it were the soldiers themselves, many of whom felt much insulted by its distribution in the army, and told their womenkind about it when they came home on leave. Many also testified to the harm that had come to men and boys in the army through the suggestions supplied to them by various kinds of prophylaxis. An official inquiry was held in England, and a report was presented to the Ministry of Health last August, shortly before I left home. Memoranda (incorporated in the Report) were furnished to the Committee of Inquiry by the Armies of Great Britain, Australia, Canada, New Zealand and America. Put very briefly indeed, the following were the main findings of the Departmental Committee. That the issue of prophylactic packets tend to give rise to a false sense of security, and thus to encourage the taking of risks which would not otherwise be incurred. That, in certain circumstances, the spread of disease might be increased. That, in spite of the most careful instruction, the packets were not used as intended. They were used by the individual of self treatment, and delayed diagnosis and the application of proper treatment at the time when it was of the first importance. That the most carefully organised packet system (such as exists now in the Army) (a system which would be unattainable in the civil community) had not produced such a general reduction in the incidence of venereal disease as to counteract the disadvantages mentioned. The Committee further expressed the view of all the representatives of the different Departments who assisted them "that the true safeguard against these diseases is individual continence and a high standard of moral life." (Applause.) The Committee also stated that the volume of evidence in favour of the system was too small and too exceptional, and the instances of failure even under exceptional circumstances too numerous, and the difficulties of administration too great, to justify an official application of the system to civil life. Therefore, we see that they officially relegated the prophylactic packet to the Hades whence it came, although they had no antidote to offer for the trail of moral poison it had left behind. PROPHYLAXIS AND VENEREAL DISEASE 3 Of Early Preventative Treatment the Committee say they "are satisfied that, while certain drugs and medical preparations may be relied on to remove or destroy the infection of venereal disease if applied by skilled attendants very shortly after exposure, such results cannot be secured if these drugs and preparations are used unskilfully or too long a time after exposure." They say no more, but leave this matter still in the air. You will remark, however, that in at least one army (the Australian), the two treatments were both thoroughly given, so that even if the "prophylactic packet" failed "Early Preventative Treatment" might have succeeded, and the same figures, of course, applied to both. It was well tried. At a "Blue light depot" in London, in 29 months, 222,882 attendances were made for skilled disinfection, and at 18 other centres 4,623 weekly average attendances were made. Yet the rate of admissions to the hospitals hardly fell at all, and one out of every six or seven men were admitted each year during that time.* Now this is the treatment that is being advocated for our civil population in various countries. It has been suggested that centres for disinfection after exposure should be established and should be kept open day and night. I have been shown a plan of one of these to be attached to a public lavatory. They are also to be attached to clinics or hospitals where bona fide sick and diseased people come for treatment. Who would come for this early preventative treatment? Naturally, the people who have been indulging in sexual intercourse, which they know or suspect to be dangerous. The suggestion is that public funds are to be spent on them, practically to make their pleasures safe for them. More continent, and socially more valuable men are to be taxed to secure their immunity from the results of their unhygienic conduct. "Early Preventative Treatment" is the concomitant of incontinence. (Applause.) You are all citizens and taxpayers. Do you really want to pay for that? You are doctors. Are you willing to assist in promoting or working this scheme - as an experiment - for that is what it still is? *See p. 5 Report of the Inter-Departmental Committee on Infectious Diseases in connection with Demobilization, 1919 on "Prophylaxis against Venereal Disease." "The system organised by the Australian Forces was most thorough. Men were almost individually instructed, and packets were handed with full directions to men going on leave. Theoretically it should have reduced the venereal rate to negligible proportions." TABLE C. (A). Australian Forces in United Kingdom | Admissions to Hospital. Ratios per 1,000 per annum. | Approximate number of men infected. 30th September, 1917 | 167 | 1 in nearly 6 31st December, 1917 | 150 | 1 in 6 1/2-7 31st March, 1918 | 176 | 1 in 5 1/2-6 30th June, 1918 | 133 | 1 in 7 1/2 30th September, 1918 | 132 | 1 in 7 1/2 31st December, 1918 | 147 | 1 in 6 1/2-7 In the 18 months 12,844 men were admitted to hospital. 4 PROPHYLAXIS AND VENEREAL DISEASE I suppose that no one here has had a bigger opportunity than I have had of doing something to promote this form of prophylaxis. Every year I converse with hundreds of girl and women prisoners who are given to the most casual and promiscuous sexual intercourse. I am not one of their gaolers, but I look after their interests, and as a rule, they trust and listen to me. Among them are many who are not wholly reckless and degraded, or who, if they are, are not averse to taking up new "stunts" as they call them. Men of all classes resort to these girls and women. I have every chance of preaching the gospel of "Early Preventative Treatment" to them, with the practical certainty that my words will reach some of their male associates, and will not be without some effect. I have also the power to teach and influence the small army of prison officers and charitable people, who, all over the country, try to help and rescue these women. And I do not use my power. I might possibly prevent these girls from contracting syphilis and I don't try? I don't, because I think I might be doing more harm than syphilis does. (Applause.) See how I am situated. I have had to put to myself these proposition and find the answers for myself. First of all, venereal disease is a set of symptoms which result from mis-directed sexual action. The cause of its spread is rarely accident. It is usually due to bad sexual habits, or the want of such control as may reasonably be expected from men and women. My duty as a doctor, in preventing ill-health, is to keep this before them. I have been urged to regard the fact that the world is full of elementary, ignorant, reckless people, and that, since other people suffer from their conduct, we cannot wait until they acquire moral sense and self control, but must take any steps we can to mitigate the dreadful state of things we are up against. This is a counsel of pure panic, and it is of no use to anyone from any point of view. (Applause.) I am not prepared to take any steps out of panic. I want to know exactly what I am doing. Again, I have been urged to tell poor humanity that venereal disease is "just like any other disease" (whatever that may mean) and at any rate that it should be treated openly as though no shame were attached to it. I cannot tell my patient that no shame attaches to it. Shame is a most ancient and complex product of evolution, experience and the grace of God. It is also under another aspect the "feeling of inferiority" which other speakers have referred to, which is the direct result of the dislocation in the individual life. We did not put it there, and it only goes, when the dislocation goes. We cannot otherwise take it away. I cannot, therefore, tell these people that I do not blame them, and that there are no moral issues connected with their loss of control. Otherwise, why should they not do as they like? I am bound to tell them that they must not contract bad sexual habits, and must not indulge them. I cannot admit that people who habits are inherently unhygienic (and all casual intercourse is this) and able to command public or private assistance in order to avoid the consequences of their acts. PROPHYLAXIS AND VENEREAL DISEASE 5 I cannot admit that they need or deserve consideration, and , practically, special provision for the lusts of the flesh (because): - (A) If I assist in making such provision, I assist in confounding the moral sense of the community, and keeping men in the bondage from which I desire they should be free. (B) I should also lead ignorant people, and those whose lives are already full of sexual difficulty, to believe that unhygienic conduct could be made safe. (C) If I tried to make it safe for them, how could I tell them it was wrong? They would not believe me. (D) If I were to give them the impression that it is safe, or even less risky, I should almost certanly increase the practices which cause disease, and thereby increase the incidence of disease itself. (E) I cannot pretend to protect the innocent victims of disease if I help to increase its general incidence. (F) If the State which governs me, disregards its own ideals, and encouraged the protection of unhygienic and anti-social acts, and becomes the official stake-holder between virtue and vice, it denies its functions and ceases to have a coherence on which I can reply, or in which I can believe. As a doctor I must not advise or encourage the governing body to act in this way. (Applause.) Let me use a handy illustration. Supposing a governing body were to say to a man tempted to drink too much, "We have given you every moral, and religious, and social, and hygienic reason why you should be sober. In addition to all the misery which you will make it you are not, your country wants your work. To be efficient you must turn up in the morning at your work. Therefore, if, in spite of all, we say, you will persist in getting drunk; when you leave your drink-shop go to the "Blue Light" shop at the end of the street; where you will get an emetic, or a wash out, or a pick-me-up and be put straight again." Now you don't like that idea well enough to carry it out. I don't notice that it was the way you went to work over your drink problem in America. You would have called it not only disgusting but futile. But after all, it would only have been "Early Preventative Treatment." No poison absorbed. No man going home to beat his children, no rows, nor scandal, nor arrests. All round saving of public money. All-around increase if efficiency. Recommended and practiced since the days of the Roman Empire. Still has the approval of men about town! Why not do it? We can only reply that we repudiate the idea that it could succeed in any way worthy of calling success. Still it was the method we chose, both here and in England, for dealing with men whom we could not influence in any other way in the matter of their sexual want of control. And mind you, people are still toying with the idea of "Early Preventive Treatment" and have not yet sent it to its own place. They are going to ask us all for a decision. Whoever else can remain neutral, we cannot. (Applause.) (G) Again, as a doctor I am bound to consider the well-known effects of suggestion upon people in a condition of imperfect equilibrium. We have 6 PROPHYLAXIS AND VENEREAL DISEASE had abundant evidence of the effect of this on the young solder. The young solder, during the war, certainly lived in a heated atmosphere of suggestion. He had lectures, he had posters, books, leaflets, he had moving pictures, all on the topic of sex. Wherever he went he was talk to - exhorted. Before he went on leave he was specially paraded and warned, and told to be a man and resist. At the same time he was reminded of the "Blue Light Depot," and the prophylactic packet was thrust upon him. Behind him was the weariness and hardship of his life in the open. Before him, anywhere behind the lines, were regulated houses of prostitution, which offered him wine, supper, a soft bed, women and possibly disease. A man is not always sexually inclined when he is tired, or when he is drunk, but alcohol makes him highly suggestible. He had the alcohol to take his last defences. Will any one of us who has ever known any temptation in its hungry, suggestion, insistent form, say that it was commonsense treatment? If we had desired a crop of venereal disease were we not asking for it, in this hothouse cultivation of all that was likely to lead to it? And when the soldier had passed his "Blue Light Depot" and had put the lasy touch of degradation on himself by so doing, what mush have been his "feeling of inferiority" when, as he often did, he found himself diseased. Therefore, it is not my business to suggest or to tempt. (Applause.) (H) Again, I am personally concerned as a doctor and a citizen in not encouraging low and false standards - in not debasing the moral currency. I am out after the whole man and woman. The findings of the newer psychology, I think, are with me there. The man who comes to me for "Early Preventative Treatment" is in some measure a sick man. He is one of the short-circuited" individuals, whom Dr. Amsden has so graphically described. By his conduct he is depriving himself of interest in life itself. And I would like to remind you that an individual who has shut himself off from the true needs; who is living, not his natural life, but a life that is largely faute de mieux, with a sexuality that is merely an evacuant of nervous reserves - such an individual lives a life which is in part an atmosphere of phantasy. Even in the brothel there is the pretence of love. And a life of inner phantasy is a life of outer acting. Acting is a picture of a part of life, but it is not life. Your unadapted short-circuited man who is indeed switched off from his own fundamental realities, or who, being aware of them, will not face them; is always an actor. An ator who cannot leave his stage is a sick man. He is sick with something much worse than venereal disease. "Early Preventative Treatment" is not his road to cure. If you doubt me look for a moment at th eman as he could be but for this sexual hitch. For, as we have all been saying, men and women cannot be satisfied by indulging the mere cravings for physical gratification. They need that fuller and completer satisfaction which includes all their desires, for friendship, companionship, parenthood, citizenship, pride in a clean and respected daily and civic life. Casual and temporary unions, where the absorption is purely sexual, dissipate energy, disintegrate and lose natural instincts, and force men and women either to a secret double life; or to declassify and separate themselves from their natural social environment. A man's potential success and honourable career may be PROPHYLAXIS AND VENEREAL DISEASE 7 irretrievably stultified and hampered, by habits of irregular sexual relations with women. Just as he has outgrow the tricks of his puppy-hood so he has to outgrow this kind of sexuality. The "Early Preventative Treatment Centre" holds him to it. If, instead of becoming at a proper age, a happy wife and mother, a girl, or woman lives the irresponsible life of paramour, mistress or prostitute, her life is mutilated and her finest energies are inhibited or destroyed. The damage done to a woman whose development and whole reproductive cycle is violently thrown out of gear, and whose energies are limited to the simple purposes of sexual congress, is very great. In addition, the cultivation of the sex-instincts, to the exclusion of all natural modifying factors and safeguards, leads to an increase of desire, to exhausting excess, to selfish want of consideration for others, and a woman is the result who could not be more seriously sick if she had venereal disease. These are some of the ills which the establishment of "Early Preventative Centres" will help to bring upon the women of your country. (I) Out of such material you cannot hope to obtain healthy mating. Many evils arise out of the attempt of people who have unfitted themselves for marriage to undertake it. You have jealousy, marital unhappiness, incompatibility (both physical and mental), infidelity, adultery, abortion - all these are the results of the failures of human beings to develop their lives along natural and social lines. (J) Then again, if you are going to establish "Early Preventative Treatment| you have to consider whether you will also confer on women as well as on men whatever degree of prophylaxis you hope to secure. If you decide to do so, you may as well write "Safe Vice and State Sterilisation Depot" over the new establishment, for it would be impossible to prevent the treatment from being used for the prevention of pregnancy. You would not like the young generation who are just growing up, and who, you are so bent on educating rightly, to read that title, or even to think in those terms of your "Early Preventive Treatment Centre." Yet, they assuredly would do so. And if they had nothing to say about being hypocrites, well - they would be very for-bearing. Here, ladies and gentlemen, you have the row of bars that stop me personally from desiring this prophylaxis. I do not want it at the price. I am old fashioned enough to believe that there is still room for us all in the Garden of Eden - and I put my trust for the boys and girls of the future in intelligent self-direction - every time - and, in the filthy disinfecting lavatory, never. (Applause.) This scheme is, therefore, for me, a counsel of evil, in which I can take no part. Now, I think you are entitled to ask me what I do propose as a remedy for the venereal scourge? (A) I believe in thorough sound, scientific treatment of disease freely provided, and freely sought, and privately given. (B) I think it important to let all grown people know that as soon as they observe symptoms they should go to a doctor. I believe in doing anything that we find after due consideration, to be of value, to educate the young so that they will bring grit and character, reason and conscience to bear on 8 PROPHYLAXIS AND VENEREAL DISEASE this, as well as on all other problems, for this is the way to liberate men to the enjoyment of that fuller life which is the way to the real conquest of venereal disease. If any young person comes to me in distress over some first sexual mishap, I will refuse him nothing, but will do all I can to save and restore him. But he is a rare avis, and I venture to say that if the Prophylactic Centre comes into being, he will become practically extinct. But I will not treat any other person who may come and demand my service, while there is no evidence of disease.* I am friend of all, but I am not a scavenger, nor a mere cleaner-up of careless or vicious persons. That is not what my fine profession is for. I will give no living person information as to any means of avoiding for his or her proper human responsibilities. But I will give every person asking for it such advice and information as may enable him to overcome his personal difficulties, and to find for himself a way of living free from harm to others, or reproach to himself. (Applause.) And last of all. If there is any valid basis for the principle which we seem to have established at this Conference that it is our duty to discover a way of life, rather than fresh nostrums and specifics, and other moribund devices for securing a healthy people, let us keep that before us. We have had enough of quack remedies. We have been told of all manner of means that were going to prove royal roads to the prevention of disease. The prostitute herself has been called a "high priestess of humanity" the inscribed prostitute and the regulated house, in their turn were a supposed benefit. Prophylaxis was another, punishment was another, and now that all these stand utterly discredited. "Early Preventive Treatment" is to head the bill. I ask you not to believe in any of them, but to believe only in such ways as do not premise the degradation of any man or woman. We have had many bad laws and regulations on this subject all over the world, and all especially hard on women. Do not let us be in a hurry to support more legislation until our way is much more clear. The attitude of "scare" leads us nowhere. Syphilis and gonorrhea have been here a long time. Do not let us be sidetracked by them, because they are still going to be here after we are all dead. There are worse things in the world. They are not the real disease, they are only symptoms of a real disease, which is in ourselves, and once we get down to the root causes, they will go. (Applause.) Let us be sure, also, that the way o life is not through the cult of barrenness, impotence, and race-suicide, which is the true connotation of "Early Preventive Treatment." These things belong to the blind alley, and the dark corner, where we may safely leave them to rot and fertilise a more profitable field of research. (Applause.) *What is bad for the public is bad for all individuals who make up that public, therefore, I am not at liberty to do privately for a fee, or in a Venereal Clinique - what I will not do in an Early Preventive Treatment Centre. VACHER & SONS, LTD., Westminster House, S.W.1.-77331 LOVE A Treatise on the Science of Sex-Attraction For the Use of Physicians and Students of Medical Jurisprudence BY BERNARD S. TALMEY, M.D., With forty-seven cuts, eight-four drawings, in the text Third Revised Edition Einstweilen, bis den Bau der Welt Philisophie zusammenhalt, Erhalt sie das Getriebe Durch Hunger und durch Liebe. -SCHILLER, "Die Weltweisen." The book is neatly bound in cloth; pp. viii, 433. Price $4.00 Orders will be promptly filled upon receipt of the price THE PRACTITIONERS' PUBLISHING COMPANY 171 WEST 126TH STREET, NEW YORK CITYTABLE OF CONTENTS PART 1: INTRODUCTION. Hunger and love, love and civilization, sex-worship, phallicism, yonism, mount of Venus, horseshoe, lingam, the cross, temple-courtesans, Christianity and sex, fashion and sex, female bosom, psychology of clothes, prudery, physician's ignorance, morbid fiction, change in sex discussions. PART 2: EVOLUTION OF SEX. Chapter 1 - Organic evolution. Mechanistic and vitalistic theories, theology, creative evlution, Lamarckism, Darwinism, variation, amphimixis, protozoa, morula, coelenterata, blastula, gastrula, primitive membranes, worms, chorda dorsalis, coelom, echinodermata, mollusca, arthropoda, vertebrates. Chaper 2 - Evolution of the genital system. Wolffian body, cloaca, ducts of Muller, ureter, kidney, genital ridge, sex-gland, allantois, bladder, urachus, sinus urogenitalis, urethra, perineum, anal membrane, male internal sex-organs, female internal sex-organs, genital swelling, genital tuberle, groove, male external genitals, female external genitals. PART III: ANATOMY OF SEX Chapter 3 - The male genitals. The male gentals, scrotum, testitals, descent of testicals, vas deferens, spermatic cord, seminal vesicles, ductus ejaculoatorii urethra, prostate, colliculus, sinus pocularis, penis. Chapter 4 - Female genitals. Mons of Venus, labia majora, vestibule, bulbs, clitoris, Bartholinian glands, hymen, vagina, uterus, broad and round ligaments, tubes, ovaries, Graafian follicle, ovum. Chapter 5 - Secondary sexual characteristics. Man's figure, skeleton, laryngeal projection, shoulders, pelvis, limbs, skin, steps, gaits, voice, Woman's figure, head, hair, face, neck, chest, abdomen, thighs, respiration. PART IV: PHYSIOLOGY OF SEX. Chapter 6 - General physiologic phenomena Cell-division, maturition, impregnation, mitosis, polar bodies, Mendel's law, unit-characters, segregation, zygote. Chapter 7 - Functions of the male generative organs. Function of testicles, spermatogenesis, maturition, function of seminal vesicles, prostate, Cowper's glands, urethral glands, semen, erection, ejaculation, nervous control orgasm. Chapter 8 - Functions of female sex-organs. Function of ovaris, ovum, Graddian follicle, tubes, menstruation, function of uterus, female ejaculation, function of vagina, Bartholinian glands of clitoris, course of the sexual act. Chaper 9 - Libido sexualis. Quality of pleasure, symptoms of pleasure, orgasm, symptom of after-lust, intensity of libido, the senses in its service, inhibition of libido, duration of copulation, postorgastic stage. PART V: PSYCHOLOGY OF SEX. Chapter 10 - Psychology of sex-attraction. Nature of the instincts, children's affections, puberty, sex instinct in animals, mechanism of sex activity, emotions of puberty. Chapter 11 - Development of reproductive impulse. Conjugation in univellular animals, in metazoa, binary fission, budding, sporulation, conjugation in chilodon, in monads, hermaphrodites, self-fertilization, erotic chemotropismus in fishes, birds, mammals, attraction of mates, permanent matings, protections of the young, monogamy. Chapter 12 - Sensual love. Egotism of sensual love, fondness, attachments, hatred . Chapter 13 - Sentimental love. Conscious altruism, mental characters, psychic qualities, true friendship, love and passion, development of individual love, characteristic of the ideal women's love, obstructions in the development of love, tension at puberty, reasons for the disturbances in love's development, disillusion of sensuality. Chapter 14 - Eros and libido. Emotions of Eros and libido, in men, and in women, jealousy, transcendental attraction, two desires of Eros, difference in the two sexes, emotion of jealousy, its cause, vanity, woman's former love-affairs. PART VI: PATHOLOGY OF SEXUALITY. Chapter 15 - Paradoxia. Sexual desires in the old, in infants, causes of early masturbation. Chapter 16 - Anaesthesia. Etiology of impotence in male, chain of sex-act, satyriasis, nymphomania, troubles in bladder, in menstruation, nervous debility, consensualism, break in chain, continence and impotence, woman's sexuality, impotence in women, clitoris sexuality, excesses in copulation, hysteria, practice of withdrawal, four impotencies in males, aspermia, azoospermia, four types of impotence of copulation, atonic impotence, partial impotence, premature ejaculation, symptoms of the impotent, pollutions, paralysis of bladder, urinary symptoms, female impotence, frigidity, sterility, impotence of libido, organsmus retardatus, nymphomania, orgasmus praecox, diminished frequency.Chapter 17—Hyperaesthesia. Mixoscopy, its emotions, obscene sights, erotomania, in men, in women, satyriasis, nymphomania, priapism, masturbation, in animals, in women, incest in men, in women. Chapter 18—Paraesthesia. Masochism, submission to pain, in men, in women, sadism, platonic sadism, four degrees in men, in women, fetichism, in men, in women, exhibitionism, homosexuality, in animals, in savages, in history, in men, in women, perversity, four kinds homosexual perversion, psychic hermaphrodism, in men, in women, effemination, viraginity, transvestism, in men, in women, zoöerastia in men, in women. PART VII: SEXUAL HYGIENE. Chapter 19—Hygiene of childhood. Necessity of early instruction, hygiene in infants, in children, in period of puberty, menstruation, pollutions, prevention of masturbation, syphilis, gonorrhoea, prostitution, alcohol, vanity, pleasure-seeking, prophylaxis against infection. Chapter 20—Eugenics. Aim of eugenics, methods of elimination of the undesirables, marriage of defectives, personal liberty in marriage, segregation, sterilization, castration. Chapter 21—Sex-hygiene for adults. Engagement-rules, selection of partner, wedding day, bed-room, positions of conjugation, frequency of conjugation, sequels of great frequency, in general health, in special organs, in the emotions, in sex pleasure, pain of defloration, conjugation during menstruation, conjugation during pregnancy, after confinement, conjugation during lactation, conjugation of nervous people, duration of conjugation, preparation of the woman's muliebria in partial frigidity, offspring and sexual life, interval between two confinements, sterile time for conjugation, time of day for conjugation, dispareunia, impeditio of conception, sequels of withdrawals, of preventatives, abortion, abstinence, means of sexual excitement. PART VIII: MORALITY. Chapter 22—Standard of morality. Moral standard of revealed religion, law, ethics, custom, Supreme Intelligence, chaos in morality, economic determinism, the superman, ethics and work, morality of love, philosophy of pleasure, moral standard in nature, rationality in nature, aim of nature, altruism and morality. Chapter 23—Sexual morality. History of marriage, promiscuity, consanguineous family, punaluan family, pairing family, patriarchal family, female chastity, adultery, law of obstacles, modesty, coyness, female morality and reason. Chapter 24—Male chastity. Two reasons for male chastity, syphilis and gonorrhoea, prevalence of gonorrhoea in men, infection of mothers and children, sterility, syphilis, its complications, alimentary canal, respiratory tract, circulatory system, genito-urinary system, skeleton, muscles, nervous system, prostitution, clandestine vice, injury of abstinence, ethics of evolution.