SUPPRESSION OF SYPHILIS.

By J. TYLER KENT, A.M., M.D., St. Louis.

The subject assigned me for essay by our Honorable President, may seem to some of you, who perhaps have only given it a cursory consideration, to be a reductio ad absurdum; but upon a more mature deliberation, I can but hope you will join me in wondering why the subject has not had a Murphy, or a Moody, or an Ingersoll, or a Parnell, or some other great champion to sound a battle-cry against this great destroyer— venereal contagion. Physicians have lent their influence in legislative affairs, and have added to their pockets fat and frequent fees by appointments in social evil hospitals, and as physicians in charge of assignation prostitutes. The pretense of doing good was quite sufficient to mask their aim at getting cash from the female portion of the social-evil constituents, and it was not desirable to restrict the masculine division, or the highly profitable business might be markedly diminished, and men in high standing, who are now covered by legal gauze, would be exposed and dishonored. "If ignorance is bliss, etc."

The zealous divine in his honest toil at doing good, and the industrious Murphy in his most excellent labors at weaning the drunkard from his grog, are working in no more deserving and honorable a cause than is he, who would battle against and mark out a barrier to syphilitic contagion.

The extent that restraint, or the degree of suppression that may be brought about by measures based upon mature reflection, is yet to appear; but that there is need of restraint, and that measures looking to such an end are possible, is in my mind the farthest from doubt. When laws become possible, that deal with male and females upon the basis of equality, then may we hope. But so long as it is only talked and practiced that females shall be submitted to a registrative maculation, it need not be considered possible for humanity to escape the social monster. Enactments of unusual stringency must necessarily be made before our people shall be safe, even in the most pious realms of our society. The people of our

country through their religious principles, are now, in their supposed efforts at doing good, militating against the interests of their own posterity. They hold their hands uplifted in horror at the thought of legalizing prostitution or passing any laws pertaining to registration and inspection. They must be taught by the physician, that such a law is not intended to favor vice and crime, but to rob them of their lasting results. As prostitution has existed since the days of Rahab, it will probably exist in spite of laws and priests; but good people should join to deprive it of its dire sequelæ and lasting curse, venereal contagion. In this conflict, for such it is, we meet two classes of active opponents; first, the conscientious people who are acquainted only with the cause and, therefore, cannot consider the effect; second, the participants of the social evil itself. As it must be admitted that prostitution cannot be wiped out, we must accept the situation, and if possible, induce a legislative restraint over its evil consequences. I can see no better plan of extending the law around this class of human beings, than by licensing and thereby restricting all participants, male and female, who desire to use illicitly the means by which syphilis is propagated. The first action looking to such legislative measures must be directed toward convincing Christian people that any method of checking the results of vice is not so dire a sin as the silent submission to the vice itself. I am sorry to admit that it is an open question as to how we can best restrain vice and its evils by statute laws. But the results of this vice should be submitted in a forcible style to the people, advocated by medical men, and teachers of science. I am not so selfish that I would have my personal views, which are expressed in this paper, placed in advance, unless such views should appear to be the all-sufficient skeleton for the future needs of whatever may be required.

Syphilis is a disease that comes principally to the notice of the physician. If it should be his fixed duty to report every case to a public registrar, or board of health, as is the case in all large cities with other contagious diseases, the records would show the degree of contamination, or purity of our

people, after a period of a few generations. It will be said, I am aware, this would be disclosing our secrets! It is our custom to protect the secrets of our patients. But I must ask, if it should be the physician's solemn duty to secrete the shame of one man and permit his posterity to suffer from contagious disease? or, for the great public good, should the physician be compelled to make common this knowledge, offering the greatest good to the greatest number? I shall not attempt to solve these questions, but have simply propounded them that you may consider them at your leisure. Again, if we possessed such public records, and these records were open for inspection by every interested person-everyone contemplating marriage-much deception and misery might be avoided. The fear of being placed on record would make both male and female, careful beyond the probability of taking chances; and might we not hope to diminish contagion and protect so-called decent society?

The ordinances of St. Louis, during the social-evil days, were of more than ordinary importance. When females were in a diseased condition they were taken to the social-evil hospital or submitted to the care of the house physician. The ordinance was in many respects a good one; but the so-called "good people" of our city regarded it as a greater evil than prostitution with all its consequences. They employed their united influence to procure its repeal and were successful. Some statistics in regard to the reported results of social-evil laws cannot be out of place. The St. Louis records are of little value from the short period of time the measure was in force and I shall not use them. Again, as it is my place of residence, my deductions might appear somewhat biased. The recorded facts obtained from the "Blue Book" of the Royal Commission may be taken, as far as data are recorded, as exhibiting the results generally observed under the legislation act of other places.

It must be remembered, however, that all figures are based upon a restriction of only one-half of the participants in the social evil. Women only were registered and inspected. Men were simply inspected where they applied for treatment

after contagion had taken place; but they were not prevented from returning to places of prostitution and spreading it among healthy women. I see no more reason for permitting a man affected with syphilis to have his liberty and immunity from restriction than a woman. The restriction of males would be quite easily enforced in large garrisons. Morgan writes that the proportion of the male population that suffer from venereal disease cannot be less than fifty to sixty per cent. Again, he writes: "It is not too strong a statement to make, that amongst the lower order, and the artisan male population, sixty-five to eighty per cent. suffer from the contagious diseases in some form; and that in proportion as we ascend in the social scale, while the percentages of soft, irritative sores diminish, gonorrhoea and infecting Syphilis increase; but I doubt if the percentage, even then of those who suffer, can be less than fifty to sixty per cent." This statement is in perfect harmony with the great Bomstead and writers of experience throughout this country.

"In three months there were treated in Dublin (Morgan) 480 cases of Syphilis and 400 of gonorrhoea,, a total of 880 cases out of a garrison averaging 4,307 men: so that in a year, at the same ratio, a number representing the entire garrison would have been under treatment-a monstrous state of things, if preventable, when it is considered in how many of these instances the seeds of ultimate deterioration would fructify almost indefinitely; and taking the soldier at the estimate cost of £100, the State has in Dublin £430,700 worth of its soldiers diseased in twelve months."

This is not different from the state of affairs in our late war. "In Devonport and Plymouth, where from the first the system has been most carefully and vigorously administered, the state of syphilitic disease in 1864, before legislation, showed 274 cases out of 2,481 strength; in 1865, before the Act of 1864 had made any impression, the numbers rose to 342 cases; in 1866, when only women informed against, or strongly suspected of being affected with contagious disease, were brought up for examination, the number fell to 200. In 1867, where the same system prevailed, a further reduction from 209 to 185 was reached. In 1868, under the monthly examination for the latter half of the year, the figures were reduced from 185 to 159. In 1869, when the fortnightly examination was

first instituted, the figures rose from 159 to 162, and in the following year were reduced to 85 or nearly one-half. The strength of the garrison was nearly the same throughout these years."-(Morgan.)

Taking the aggregate of twenty-eight stations of troops in the United Kingdom, the ratio per one thousand of primary venereal sores, in 1865, was 120; it continued to diminish until 1870, when a ratio of 54 cases only, was marked by the register.

If space had permitted, I would have prepared a table including the figures of results under the statutes in Paris, New Orleans, St. Louis and other cities; but I shall simply remark that such figures are only corroborative of the figures presented above, in a common showing of the good accomplished in all cities where the Act has existed. It is not pretended that a great showing could be made in a year or a decade, but in a century a great restraining influence would most certainly be manifested were the restrictions based upon the rules of justice to honest people and general equality with both sexes. But I must leave the statistical part of the subject and direct attention to some of the remote changes of Syphilis. We may the more readily see the necessity of some extraordinary effort to procure the much-needed legislation. It is against these that we most need to exercise our whole energies. These remote changes are so much more direful than those of the primary and secondary disease, because they are generally deep-seated and masked.

It is not the gangrenous genitals that I would picture to you; neither is it the common manifestations that show themselves in the forms of secondary outbreaks; such as ulceration of the throat, syphilitic exanthemata, alopecia, etc. You know these too well. Of the more masked forms that do not show themselves until a tertiary period, when our patient is supposed to be "cured;" and to the hereditary features, I wish to give you a fair and truthful picture. Syphilis as a cause of many nervous diseases will furnish you area for contemplation of no small dimensions. Study Syphilis, if you will, as an etiological factor, as a cause of paralysis, of myelitis and scler