syphilis and prostitution

in taking up the consideration of the relation of syphilis to illicit sexual relations, we must again remind ourselves that we are approaching this subject, not as moralists, important though their point of view may be, but for the time being as sanitarians, considering it from the standpoint of a method of transmission of a contagious disease.

genital and non-genital syphilis in lax individuals.—the prevalence of syphilis among women who receive promiscuous attentions is enormous. it is practically an axiom that no woman who is lax in her relations with men is safe from the danger of the disease, or can long remain free from it. the type of man who is a light o' love does not go far before he meets the partner who has been infected by some one else. becoming infected himself, he passes on his infection to his next partner. syphilis is not so often transmitted in prostitution, open or secret, as gonorrhea, but it is sufficiently so to make the odds overwhelmingly against even the knowing ones who hope to indulge and yet escape. the acquiring of syphilis from loose men or women is[pg 134] usually thought of as entirely an affair of genital contacts. yet it is notable that extra-genital chancres are the not uncommon result of liberties taken with light women which do not go to the extent of sexual relation. women who accept intimacies of men who, while unwilling to commit an outright breach of decency, will take liberties with a woman who will accept them have only themselves to blame if it suddenly develops that the infection has been transmitted from one to the other by kisses or other supposedly mild offenses against the proprieties.

syphilis among prostitutes.—as to the prevalence of syphilis among both public and clandestine or secret prostitutes, several notable surveys of more or less typical conditions have been made. with the aid of the wassermann test much heretofore undiscovered syphilis has been revealed. eighty to 85 per cent of prostitutes at some time in their careers acquire the disease.[13] about half this number are likely to have active evidence of the disease. thirty per cent of the prostitutes investigated by papee in lemberg were in the most dangerous period—the first to the third year of the disease. three-fourths of these dangerous cases were in women under twenty-five years of age—in the most attractive period of their lives. averaging a number of large european cities, it was found that not more than[pg 135] 40 per cent of prostitutes were even free of the outward signs of syphilis, to say nothing of what laboratory tests might have revealed. it is more than evident that prostitution is admirably fitted to play the leading r?le in the dissemination of this disease. the young and attractive prostitute, whether in a house of ill-fame, on the street, or in the more secret and private highways and by-ways of illicit sexual life, is the one who attracts the largest number with the most certain prospect of infecting them.

[13] the figures here given are based on those of papee, wwednesky, raff, sederholm, and others. the recently published investigations of the baltimore vice commission showed that 63.7 per cent of 289 prostitutes examined by the wassermann test had syphilis. of 266 examined for gonorrhea, 92.1 per cent showed its presence. nearly half the girls examined had both diseases and only 3.39 per cent had neither. (survey, march 25, 1916, vol. 35, p. 749.)

concealed syphilis and medical examinations of prostitutes.—a number of delusions center around the relation of open and secret prostitution to disease. from the description of syphilis given in the foregoing pages, it must be apparent how little reliance can be placed, for example, on the ordinary medical examination of prostitutes as practised in segregated districts. the difficulties of efficient examination are enormous, especially in women. even with the best facilities and a high degree of personal skill, with plenty of time and laboratory help in addition, extremely contagious syphilis can escape observation entirely, and even the negative result of one day's examination may be reversed by the appearance of a contagious sore on the next. women can transmit syphilis passively by the presence of infected secretions in the genital canal even when they themselves are not in a contagious state. in the same way a woman may find herself infected by a man without any idea that he was in an infectious state. she may in turn develop active syphilis without ever realizing the fact. medical[pg 136] examination of prostitutes as ordinarily carried out does actual harm by deluding both the women and their partners into a false sense of security. the life which such women lead, with the combination of local irritation, disease, and fast living, makes them especially likely to develop the contagious mucous patches, warts, and other recurrences, and to relapse so often that there can be little assurance that they are not contagious all the time.

under such circumstances one might almost expect every contact with a prostitute on the part of a non-syphilitic individual to result in a new infection. the factors which interfere to prevent such wholesale disaster are the same which govern infectiousness throughout the disease. local conditions may be unfavorable, even though the germs are present, or there may be no break in the skin for the germs to enter. if the syphilitic individual is beyond the infectious period, there may be no dangerous lesions. here, as all through the history of infections with syphilis, there is an element of the unexpected, a favoring combination of circumstances. sometimes when infection is most to be expected it is escaped, and conversely it seems at times that in the "sure thing," the "safe chance," and the place where infection seems most improbable, it is most certain to occur.

personal hygiene in syphilis

syphilis is a constitutional disease, affecting in one way or another the whole body. for that reason, measures directed to improving the general[pg 137] health and maintaining the resistance of the patient at the highest point have an important place in the management of the disease. by his habits and mode of life a person with syphilis does much to help or hinder his cure, and to protect or endanger those around him. for that reason a statement of general principles may well be drawn up to indicate what is desirable in these regards.

a well-balanced life.—first, for his own sake, a syphilitic should live a well-balanced and simple life so far as possible. in this disease the organs and structures of the body which are subject to greatest strain are the ones most likely to suffer the serious effects of the disease. worry and anxiety, excessive mental work, long hours without proper rest, strain the nervous system and predispose it to attack. excessive physical work, fatigue, exhaustion, poor food, bad air, exposure, injure the bodily resistance. excesses of any kind are as injurious as deprivation. in fact, it is the dissipated, the high livers, who go to the ground with the disease even quicker than those who have to pinch.

alcohol.—alcohol in any form, in particular, has been shown by extensive experience, especially since the study of the nervous system in syphilis has been carried to a fine point, to have an especially dangerous effect on the syphilitic. alcohol damages not only the nervous system, but also the blood vessels, and makes an unrivaled combination in favor of early syphilitic apoplexy, general paresis, and locomotor ataxia. a syphilitic who drinks at all is a bad risk, busily engaged in throwing away his chances[pg 138] of cure. even mild alcoholic beverages are undesirable and the patient should lose no time in dropping them entirely.

tobacco.—tobacco has a special place reserved for it as an unfavorable influence on the course of syphilis. it is dangerous to others for a syphilitic to smoke or chew because, more than any other one thing, it causes the recurrence of contagious patches in the mouth. it is remarkable how selfish many syphilitic men are on this point. in spite of the most positive representations, they will keep on smoking. not a few of them pay for their selfishness with their lives. these mucous patches in the mouth, often called "smoker's patches," predispose the person who develops them to one of the most dangerous forms of cancer, which is especially likely to develop on tissues, like those of the mouth and tongue, which have been the seat of these sores.

sexual relations, kissing, etc.—contagious sores.—sexual indulgence, kissing, and other intimate contacts during the active stage of syphilis, as has been indicated, directly expose others to the risk of getting the disease. for that reason they should not be indulged in during the first two years of the average well-treated case receiving salvarsan and mercury by the most modern methods. exceptions to this rule should be granted only by the physician, and should be preceded by careful and repeated examination in connection with the treatment. under no circumstances should a patient kiss or have intercourse if there is even the slightest sore or chafe on the parts, regardless of whether or not it is thought to be syphilitic.

articles of personal use.—persons with a tendency[pg 139] to recurrences in the mouth or elsewhere should report to the physician any sore they may discover and should watch for them. persons with syphilitic sores in the mouth or elsewhere should have their own dishes, towels, toilet articles, shaving tools, pipes, silverware, and personal articles, and should not exchange or permit others to use them.

secrecy.—professional secrecy is something to which the syphilitic is most certainly entitled when it can be had without danger to the public health. so long as a syphilitic in the contagious period carefully observes the principles which ought to govern him in his relations to others, his condition is his own concern. but there is one person within the family who should, as a rule, know of his infection if it is still in the contagious period, since it is almost impossible to secure co?peration otherwise. no matter how painful it may be, a person with syphilis, if advised to do so by his physician, should tell husband or wife the true state of affairs. there is no harder duty, often, and none which, if manfully performed, should inspire more respect. for those who will not follow his advice in this matter the physician cannot assume any responsibility, and is fully justified, and in fact wise, if he decline to undertake the case.

re-infection.—since it is a common misconception, it cannot be said too forcibly that no person with syphilis should forget that his having had the disease does not confer any immunity, and that as soon as he is cured he may acquire it again. it is possible, by a single exposure to infection, to undo the[pg 140] whole effect of what has been done, just after a cure is accomplished. there can be only one safe rule for infected as well as uninfected persons—to keep away from the risk of syphilis.

quacks and self-treatment.—hot springs.—the temptation to take up quack forms of treatment or to treat himself without the advice of a physician besets the path of the syphilitic throughout the course of the disease; an enormous number of fraudulent enterprises thrive on the credulity of its victims. most of them are of the patent medicine specific type. others, however, have a tinge of respectability and are dangerous simply because they are insufficient and not carried out under proper direction. many popular superstitions as to the value of baths in syphilis and of the usefulness of a short course of rubs with bathing, or a "trip to the springs," are of this kind. enough has been said in the foregoing chapters to make it plain to any one who is open to conviction that syphilis is no affair for the patient himself to attempt to treat. the best judgment of the most skilled physicians is the least that the victim owes himself in his effort to get well.

patient and physician.—for the same reasons every person who has or has had syphilis, cured or not, or has been exposed to it, should make it an absolute rule to inform his physician of the fact. the recognition of many obscure conditions in medicine depends on this knowledge. for a patient to falsify the facts or to ignore or conceal them is simply to work against his own interests and to hinder his physician in his efforts to benefit him.